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 timely manner.
Staff received an induction which including mandatory training relevant to their roles. Staff received supervision which included a review of their performance and training needs. Staff also took part in yearly appraisals to assess their performance and set goals for the coming year.
People’s nutrition and hydration needs were met and people were provided with a choice of meals that met their religious and cultural needs. People’s spiritual and cultural beliefs were respected and staff supported people to celebrate their Jewish faith.
Staff worked within the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were given choice and staff asked people for their consent before providing care.
People had access to healthcare professionals to ensure that their health needs were met and well-being maintained.
Staff treated people with dignity and respect and staff encouraged people’s independence. People’s confidentiality was respected and records relating to people using the service were kept in a lockable cabinet.
The atmosphere at the home was warm and welcoming which gave it a homely feel. We observed people were comfortable with staff who were caring and kind. The service operated an open-door policy which enabled people to approach staff whenever this was needed.
People had care plans which were personalised and detailed how care should be delivered. Care plan reviews took place, however, we found review dates differed which made it difficult to know which plan was the most up to date, also information was not always updated to reflect people’s current needs.
The service responded to complaints and staff supported people to make a complaint if they were unhappy with the service. A copy of the complaints procedure was displayed on the communal notice board in easy read pictorial format. This made it more accessible to people using the service.
Quality assurance systems were in place to monitor the quality of the service and audits took place. However, these audits were not always effective in identifying some of the issues found during our inspection. Care records were not always up to date or accurate and the provider failed to notify the CQC of significant incidents. Several changes in senior management at the service meant that governance and overall management of the service lacked consistency.
We found four breaches of Regulations. This was in regards to the provider informing us about significant incidents at the service, safe care and treatment and good governance. We have made two recommendations. These are in relation to managing behaviours that challenged the service and management of staffing hours.
You can see what action we told the provider to take at the back of the full version of the report.