This inspection took place on the 7 and 12 September 2018. The first day of the inspection was unannounced and we informed the provider of our intention to return on the second day.

At our last planned comprehensive inspection on 28 June 2017 and 4 July 2017, we found the provider in breach of Regulation 18 of the Registration Regulations 2009. This was in relation to the reporting of notifiable incidents to the CQC, the provider failed to report two safeguarding incidents as required by law. We also made three recommendations relating to complaints, the updating of policies and procedures and updating of information contained in support plans. The service had an overall rating of Requires Improvement. We rated Safe, Responsive and Well-led as Requires Improvement and Effective and Caring as Good.

During this inspection we found the provider had made some improvements, policies and procedures had been updated and care plans reviewed. Although the provider had submitted notifiable significant incidents, we found that we had not been notified of three incidents involving the police and a person receiving respite care from the service. This meant that we did not have important information about the service to effectively monitor people's safety and wellbeing. We are considering what action we may need to take to address this.

Yad Voezer 2 is a ‘care home’ for members of the Orthodox Jewish faith. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Yad Voezer 2 accommodates up to a maximum of eight people with a learning disability or autistic spectrum disorder. At the time of our inspection there were six women living at the service. One of the bedrooms was used for respite care which was vacant at the time of our visit. The home accommodates women only and the provider has a neighbouring home for men, located nearby. Apart from the registered manager, all staff are female.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe with staff and comfortable approaching staff with any concerns. People were protected from the risk of abuse. Staff knew what constituted abuse and understood their responsibility to report abuse. Staff were aware of the whistleblowing procedure and reporting any concerns to external authorities.

Risk assessments identified risks and actions to mitigate these. Staff understood about risk management and how to manage behaviours that challenged the service. We found recruitment practices were not always followed to ensure staff were safe to work with people. We found gaps in references and criminal record checks.

Staffing numbers were based on level of need, but we made a recommendation about reviewing staffing.

Medicines were managed safely and systems in place for auditing and checking how medicines were being administered. Individual Pro Re Natan (PRN) medicine to be given when required protocols were not in place to guide staff on when to administer PRN.

People were protected from the risk of the spread of infection because staff followed infection control practices when providing care, including the use of personal protective equipment (PPE).

There were systems in place for reporting and recording incidents and accidents and learning from incidents took place. However, these incidents were not always reported to the CQC.

Safety checks were carried out to ensure the building was safe for people using the service, however, we found urgent repairs were not always carried out in a timel

This inspection was undertaken on 28 June and 4 July 2017. The first day of the inspection was unannounced and we informed the provider of our intention to return on the second day. At our previous planned comprehensive inspection on 4 July 2015 the service had an overall rating of Requires Improvement. We rated Safe and Well-led as Requires Improvement and Effective, Caring and Responsive as Good. We had made one recommendation for the provider to seek guidance from a reputable source to set up a cleaning schedule appropriate for a care home, in order to prevent and control infection.

We conducted an unannounced focussed inspection on 4 April 2017 to check that the provider had acted on the recommendation and we also looked at whether other improvements were made in relation to issues we had identified within safe and well-led. At the focussed inspection we found that the provider had improved the quality of the cleanliness in accordance with the recommendation, and the issues within safe and well-led had been satisfactorily addressed. Measures had been taken to improve how risk assessments were developed, new procedures had been implemented to ensure that medicines were stored at correct temperatures and obsolete documents had been removed from people’s folders so that relevant information was easily accessible. Following the focussed inspection we could not improve the ratings for safe and well-led from requires improvement, because to do so requires consistent good practice over time. The provider was advised that we would make these checks during our next planned comprehensive inspection.

The service is registered to provide care and accommodation for up to eight people with a learning disability or autistic spectrum disorder. At the time of this inspection, there were six women living at the service. We were informed that one bedroom is ordinarily used to provide short breaks or respite care which was vacant when we visited. The home is for women only and the provider has a separate care home for 10 men, which is located on the same street. All of the staff and volunteers are female, apart from the registered manager. People who reside in the home are members of the Orthodox Jewish faith.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was a registered manager in post, who also managed the nearby service for men. He was present during the inspection and was supported by a deputy manager, who was permanently based at Yad Voezer 2.

Staff understood how to identify different types of abuse and report their concerns to their line manager. The provider’s whistleblowing policy advised staff of how to report any concerns about the conduct of an employee, manager or volunteer by using the organisation’s internal structures or through external reporting to other relevant authorities. However, we found that the registered manager had not appropriately notified the CQC about two safeguarding allegations, as required by law. This meant that we did not have important information about the service to effectively monitor people’s safety and wellbeing.

Individual assessments were in place to promote people’s independence and mitigate identified risks to their safety and welfare. Staff had been safely recruited which ensured, that as far as possible, they were suitable to work with people who use the service. Records showed that staff had completed medicines training and had the appropriate knowledge and skills to safely follow the provider’s medicines policy and procedure.

Checks were made to ensure that people were provided with a clean, hygienic and safely maintained home.

The provider’s training programme took into account the mandator

We conducted a comprehensive inspection of this service on 15 July 2015. We made one recommendation for the provider to seek guidance from a reputable source to set up a cleaning schedule appropriate for a care home in order to prevent and control infection. We carried out this inspection on 4 April 2017 to check that the provider had acted on the recommendation and also look at whether other improvements were made in relation to issues we identified within Safe and Well-led.

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Yad Voezer 2 on our website at www.cqc.org.uk.

Yad Voezer 2 is an eight bedded care home for people with a learning disability. The care home is for women only and all of the staff team and volunteers, apart from the registered manager, are female. At the time there were six women living at the service. People who reside at the service are members of the orthodox Jewish faith. Non-Jewish staff are supported to learn about the faith so that they can support people appropriately.

There was a registered manager at the service. A registered manager is a person who has registered with The Care Quality Commission to manage the service. Like registered providers, they are registered ‘persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that the provider had improved the quality of the cleanliness and provided people with a hygienic and comfortable environment. Measures had been taken to improve how risk assessments were developed, to ensure that there was clear information about the nature of the risks and the actions required to mitigate the risks. The provider had implemented new procedures to ensure that people’s medicines were stored at correct temperatures, in line with pharmaceutical guidelines.

We noted that the provider had removed obsolete documents from people’s folders, so that staff and external professionals could consistently access current and relevant information. People’s records had been updated to ensure that any changes were reflected on all necessary documents. We were not in a position to check whether additional information had been added to people's records to clearly demonstrate whether there was a Deprivation of Liberty Safeguard authorisation in place, as the necessary documentation was not available on the day of the inspection. We will check this at the next comprehensive inspection.

This inspection took place on 7 July 2015 and was unannounced. At our previous inspection in July 2014 we found the provider was in breach of three regulations relating to care planning, the Mental Capacity Act 2005 and safe recruitment. During this inspection we found that improvements had been made in these areas and the provider was no longer in breach of these regulations.

The service is registered to provide care home accommodation for up to eight people. Six people were in residence, although one was in hospital at the time of the inspection. One bedroom is used by people for short breaks or respite care.

The home is for women only and all the staff and volunteers, with the exception of the manager,

are female. People who live in the home are members of the orthodox Jewish faith. Non-Jewish staff are supported to learn about the faith so that they can support people appropriately.

The registered manager of the provider’s care home for men had applied to become the registered manager for this service too. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the service was recruiting skilled and knowledgeable staff using safer recruitment procedures. They were well-informed about the Mental Capacity Act 2005 and about the needs and preferences of all the people they cared for. The provider gave staff access to good quality training to help them to meet people’s individual needs. Staff had confidence in the management team and told us they were supportive and approachable.

There were sufficient staff to meet the needs of people and volunteers offered additional support, particularly in relation activities associated with people’s faith.

A Kosher kitchen was kept and people enjoyed the food. The evening meal was delivered by a Jewish restaurant.

There was a ‘family’ atmosphere within the home, we observed positive relationships between the people who used the service and the staff and volunteers. People had access to a range of social, leisure and religious activities and participated in domestic tasks within the home.

A system of audits and checks ensured the management team identified most quality issues. There was evidence that they acted to rectify them and any learning points were discussed in well attended staff meetings.

Some improvements were needed in relation to the cleaning schedule, the temperature at which medicines were stored and the way risk assessments were completed. There was also a need to reduce the number of duplications and overlaps in record keeping. The provider had started work revising policies and procedures, but this work was not yet complete. We have made a recommendation about setting up a more detailed cleaning schedule to improve infection prevention and control.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed, and the records we looked at. If you want to see evidence that supports our summary please read the full report.

We spoke with three people who used the service, the acting registered and deputy managers, three staff members and four family members. Whilst we were able to speak with people, our conversations were limited because of their complex health conditions. We reviewed the care plans of three people.

This is a summary of what we found:

Is the service safe?

Three of the 12 members of staff had received safeguarding and whistleblowing training in the last three years.

Systems were in place to ensure staff learnt from events such as accidents and incidents.

We saw all people had care folders containing information related to their care and all staff had individual staff files.

During our inspection we assessed how the Mental Capacity Act (MCA) 2005 was being implemented. This is a law which provides a system of assessment and decision making to protect people who do not have capacity to give consent. We also looked at Deprivation of Liberty Safeguards (DoLS). DoLS aim to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We saw that some people were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required. We saw no applications for DoLS had been made although in May 2014 a social worker had requested an application was made.

We have asked the provider to tell us how they will make improvements and meet the legal requirements in relation to safeguarding adults.

We looked at the recruitment of new staff. We found that some required checks were not always carried out before staff started work.

We have asked the provider to tell us how they will make improvements and meet the legal requirements in relation to staff recruitment.

Is the service effective?

We observed from speaking with staff and watching how they communicated with people that staff had an understanding of people’s care and support needs, and knew them well.

Staff assessed people’s health and care needs with the person and their family members. Staff told us care plans assisted them to meet people's needs. People's preferences, interests and diverse needs were recorded, and care and support was provided in accordance with the wishes of people using the service and their families.

Is the service caring?

All family members told us they felt their family member was safe in the care of staff.

Staff showed patience and gave encouragement when supporting people. One person said, “Staff are very good, they’re the best.” Another person said, “Staff look after me.” One family member said, "Staff are excellent, no reservations,” another family member said they were, “Very kind” and a third family said they were, “Fine.”

Is the service responsive?

We saw information in care plans included risk assessments; however, there were shortfalls in keeping accurate records. People's care plans and risk assessments were not always up-to date and accurate to meet their care needs.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessing people's needs accurately to reflect their risk assessments and care plans.

People took part in activities within the home and the wider community.

All family members told us they knew how to make a complaint. We saw there was a process in place to respond to any issues of concerns.

Is the service well-led?

This small service has quality assurance systems to identify and address issues. We saw people who used the service their representatives and staff were asked for their views about their care and treatment.

The service was providing care to six people with learning disabilities and preparing for the arrival of one person for respite care. We met three of the six people living at the home and spoke with one person during the inspection. Two people said they preferred not to speak with us.

The provider assessed people's individual needs and preferences to ensure their care was safe and people's rights were protected. Staff obtained people’s consent before providing care. The person we spoke with said they liked living at the home. They said, “I can choose what I have. My room is looking good.” We saw that people using the service freely approached and interacted with staff members and staff responded promptly to people's requests. There were a range of activities on offer at the home including daily support to meet people’s religious and cultural needs.

The staff encouraged people to feedback their views about the service including any concerns or complaints. The provider acted on people’s feedback.

The home was clean and well maintained. There were enough staff to support people living at the home. Staff members told us they were well trained and qualified for their roles and we also saw staff training certificates.

At our previous inspection, we found the provider's records about people did not provide up-to-date information for staff on how to support people safely. We reviewed three people's care plans. The plans were up-to-date. Each plan included clear risk assessments and important and relevant information from people's health and social services teams. We also checked the records the home kept in supporting people with their money. These records showed that people accessed their money when they wanted and financial transactions were recorded and checked.

We met five of the six people currently living at the home. We were able to speak with two people. People said they liked the home. One person said: "I do think it is good". Another person said: "[It is] very nice". People said they felt safe at Yad Voezer 2.

We saw people were able to enjoy a range of activities throughout the day, for example, going to a Jewish day centre and visiting a local garden centre. One person showed us photographs of a trip to the beach.

We saw that staff interactions with people were caring and promoted people's choices. The service enabled people to practice their religion in the way they wanted.