The Rubens

The Rubens is a care home without nursing care. The home accommodates a maximum of 26 people in one large building. At the time of our inspection 26 people lived in the home, some of whom were living with dementia. Care was provided over two floors. On the ground floor there were two lounges, a large dining room and a smaller dining area. Bedrooms were located on the ground and first floor; a lift was available to the first floor. There was an enclosed garden with seating areas for people and relatives to enjoy.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Some people had not had Deprivation of Liberty Safeguards applications made which put them at risk.

Risks to people were not always assessed, managed or monitored safely. Risk assessments were not always completed for people’s specific risks and falls were not always recognised as incidents and sufficiently monitored. Care plans were not always kept up to date with people’s changing needs and support. Infection prevention control policies were not always followed regarding the environmental cleanliness and furnishings.

Staff had not received training around people's specific health conditions, such as diabetes. Several training courses had lapsed over time, meaning staff were due refresher training and some staff were waiting to attend courses.

The registered managers carried out quality assurance processes, including internal audits. However, these were not always effective in identifying the concerns we identified. This meant areas of improvement were missed which could potentially cause harm.

The provider acted quickly to the recommendations identified and has taken action to improve each area. These will be reviewed on the next inspection.

Medicines were managed safely by suitably trained staff and people received the medicines in a private and dignified way.

Staff used personal protective equipment (PPE) effectively and received infection prevention control training.

There were enough staff on duty to support people’s needs and staff were recruited safely.

Staff understood what was meant by abuse and they were confident about how to report their concerns.

People, relatives and staff told us they felt involved in the service and able to express their opinions and make suggestions to improve the care provided.

Visiting professionals told us the culture was person centred and they confirmed how the provider works in partnership to achieve positive outcomes for people.

People and relatives were complementary about the meals provided. They told us people had choices over their meals and could have drinks and snacks when they wanted.

People, relatives and staff were confident to raise concerns or complaints and told us they felt these would be listen to and acted upon.

People had confidence in the registered manager’s ability to lead the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 08 February 2019)

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention control, incident monitoring and risk assessing concerns. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only. We inspected and found there was a concern with Mental Capacity Assessments and Deprivation of Liberty Safeguard (DoLS) referrals, so we widened the scope of the inspection to include the key questions of Effective.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

The provider acted during and after the inspection to mitigate the risks identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Rubens on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to gaining peoples consent, acting in people's best interests, and governance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

What life is like for people using this service:

Following the inspection of 18 and 19 September 2017 we identified one breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the ineffectiveness of the governance systems used to identify shortfalls in service provision.

At this inspection we found that improvements had been made and this regulation was now met.

People were safe living at The Rubens. We found there were systems and processes in place for people's needs to be safely met.

Staffing levels were adequate to meet people's individual care needs.

People received their medicines on time and staff understood each person's abilities and health needs.

People were supported to have control and choice over their lives and staff supported them in the least restrictive way possible.

Recruitment of staff was thorough. Appropriate checks had been undertaken before staff began working for the service.

Staff knew about and followed safeguarding procedures.

The provider’s policies and systems supported staff practice. Staff understood legislation around people's ability to make decisions.

Staff had a kind and caring approach towards people. They respected people’s privacy and dignity.

People enjoyed meaningful activities and there were appropriate opportunities to engage with the activities coordinator in groups or on a one to one basis.

Systems and processes for assessing and monitoring the quality of the provision were robust. Audits identified any issues with service provision. The provider had plans to remedy any issues found.

People, relatives and staff spoke highly of the management team and the way the service was run.

More information is in Detailed Findings below

Rating at last inspection: Requires improvement (report published 19 January 2018)

About the service: The Rubens is a care home that was providing personal care to 21 people at the time of the inspection, some of whom were living with dementia. It is registered for a total of 26 beds.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved and was rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Rubens provides accommodation and personal care for up to 26 older people, the majority of whom were living with dementia. On the days of our inspection the home was fully occupied.

The home had a registered manager. However, they were not present on the days of the inspection. The deputy and the area manager assisted with the facilitation of the inspection. 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.

Medicines were not stored appropriately and there was a potential risk of people obtaining medicines that had not been prescribed for them.

The provider had not maintained fire safety standards as identified by the fire safety officer in January 2017. This meant there remained a risk of people not being able to safely evacuate the home in the event of an emergency.

People were at risk of not receiving a service specific to their needs or preference because they were not involved in planning their care.

People's consent for care and treatment was not obtained, so they were at risk of not receiving a service the way they liked.

The provider offered a service for people living with dementia. However, the environment was unsuitable and added to people’s confusion and also had an impact on their independence.

The provider had systems in place to monitor the quality of the service provided to people. However, these were ineffective in highlighting some of the short falls we found.

Sufficient staffing levels were provided to meet people’s assessed needs and the provider’s recruitment procedure ensured safety checks were carried out before people started to work at the home.

People and their relatives felt confident to share their concerns with the registered manager or staff which would be listened to and acted on.

Staff were caring, kind and attentive to people’s needs and provided support in a way that promoted their privacy and dignity.

Systems were in place to enable people and their relatives to tell the provider about their experiences of using the service. Relatives and staff were aware of who was running the home and staff felt supported by the registered manager to carry out their role.

People were cared for by skilled staff who were supported in their role by the management team.

People were supported by staff to eat and drink sufficient amounts to promote their health. People were assisted by staff to access relevant healthcare services when needed.

You can see what action we told the provider to take at the back of the full version of the report.

Everyone we spoke with told us they were satisfied with their care. Care plans were well written, clear and contained detailed information about people's individual needs. This meant staff understood how people preferred their care to be delivered.

People who used the service and their representatives were able to contribute to their reviews. People told us that they enjoyed the food and drink provided within the home and they were able to choose what they wanted to eat from the menu and where they preferred to eat a meal.

We found that people who used the service were protected from the risk of abuse. This was because the provider had taken reasonable steps to identify potential abuse and acted appropriately.

The home was clean, tidy and well maintained. Regular safety and maintenance checks were being carried out to make sure that the premises were safe and suitable for people's needs.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received. The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We viewed records that showed people or their relatives had been involved in and consulted about the care and support. People received a care needs assessment prior to being admitted. We saw that staff supported people sensitively and politely. We observed how staff promoted their privacy and dignity whilst delivering care.

People were protected because staff were confident to recognise and report abuse.

People were supported by a knowledgeable and well trained staff team who knew their care and support needs.

We saw that staff asked people if they were alright and if they needed anything. If people had any concerns or worries they were seen to speak with staff or the manager. We saw records that showed the provider had systems in place to monitor and review people's complaints.