This inspection took place on 18 and 24 April 2018 and was unannounced. Lady Sarah Cohen House is operated and run by Jewish Care, a voluntary organisation. Lady Sarah Cohen House is registered to provide accommodation for up to 120 people who require nursing or personal care and treatment of disease, disorder or injury.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were 94 people living at the service on the day of the inspection, the majority of whom were over 65 years of age with disabilities.

We last inspected the home on 4 and 9 January 2017 when we found the provider was in breach of three regulations, in relation to staffing levels, governance of the service and the safe management of medicines. At this inspection we found improvements had been made and the service was no longer in breach of any regulations.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the CQC 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 using the service told us they felt safe at the service. There were systems and procedures to safeguard people from abuse and staff had a good understanding of their role in protecting people from harm and abuse.

We saw staff were kind and caring and people told us this was the case.

Medicines were safely managed at the service; stocks tallied with records and were stored appropriately.

Recruitment checks and other related documentation required were in place prior to staff starting work, so staff were considered safe to work with vulnerable adults.

We found there were enough staff to meet peoples’ needs.

Care records were detailed and together with risk assessments provided guidance to staff in managing people’s needs.

There was a choice of menu and food was of a good quality, prepared in line with Kosher dietary laws.

There were quality audits in place which covered key areas including medicines, care plans, staff supervision and the service offered at night. There were effective management systems in place to ensure training took place, and there was compliance with health and safety issues.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We have made two recommendations in this report. We have made a recommendation about the provider obtaining the views of people regarding their personal experience of care, and that they review their medicines policy and practice.

This inspection took place on 4 and 9 January 2017 and was unannounced. We last inspected the home on 6 and 7 January 2016 when we found the provider was in breach of two regulations, in relation to staff supervision and monitoring of changes in care records. The provider sent us an action plan stating what improvements they were going to make. During this inspection we found that the provider had made adequate improvements in relation to providing regular supervision sessions to their staff team including conducting group supervision. However, the daily care records were not consistent in detailing information on people’s general wellbeing and how they spent their time.

Lady Sarah Cohen House is a nursing home registered to provide accommodation, nursing and personal care and support for up to 120 older people. Lady Sarah Cohen House is operated and run by Jewish Care, a voluntary organisation. At the time of our inspection, 104 people were living in the home.

The home is purpose built with dining and lounge areas on each floor. The home has 120 bedrooms with ensuite facilities split across three floors. All the floors are accessible via lifts and there is an accessible garden. The home shares kitchen and laundry facilities with another care home from the same provider. The home is part of the Betty and Asher Loftus centre, a community hub with access to a synagogue, shop and a café.

There was a manager in post, they were undergoing registration process with the Care Quality Commission. A registered manager is a person who has registered with the CQC 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 using the service told us they felt safe at the service. Staff had a good understanding of the safeguarding procedure and their role in protecting people from harm and abuse. The service had systems to identify and manage risks. The service maintained detailed risk assessments which were regularly reviewed, but we found a number of gaps. There was an improvement in daily care records since our last inspection however we found inconsistencies in them. People were generally happy with the support they received from staff administering their medicines. We found errors in medicines administration records (MAR) charts. The service was clean and had effective measures in place to prevent cross contamination.

The manager and service manager told us that there were sufficient numbers of staff employed to ensure that people's individual needs were met. However people, their relatives and staff told us there were not enough staff available at all times to meet people's individual needs.

People were provided with choice of food at meal times. Not all staff used appropriate methods to support people in making choices of what they wanted to eat. The service worked closely with various health and care professionals to support people with their needs and wishes.

The service followed safe recruitment practices. Staff received induction and regular training, and records confirmed this. Staff told us they found supervision useful and received regular one-to-one and group supervisions. The service was reviewing their appraisal system.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People told us staff asked their consent before supporting them. The manager and staff demonstrated a good understanding of the procedures under MCA and DoLS.

People using the service and their relatives told us they found staff friendly and caring. People told us staff listened to them and their individual health and care needs were met. However, they said agency staff were not always helpful and did not know people’s needs.

The care plans included people’s life

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Relatives told us “the family’s views were taken into account too.”

Care plans we looked at were wide-ranging and assessed people’s individual needs and risks. They were regularly reviewed and mainly up to date. People's religious and cultural needs were recorded and respected and relatives told us that staff “know each individual person and treat them as individuals.”

The home provided induction and a variety of other training for staff, who also received regular supervision. The manager was in the process, prior to the inspection, of addressing consistency of supervision and recording and ensuring that training impacted on practice.

Records relevant to people’s care and the management of the services were generally accurate and fit for purpose. Records were kept securely and could be located promptly when needed.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practicing professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People who use the service told us that staff were kind and respected their privacy. They confirmed that staff treated them with care, respect and dignity. They told us that they were offered a choice in relation to activities, care preferences, food and drink. People told us they could attend regular meetings with the management of the home to air their views about the service. One person said, “We can go to meetings every week”.

People said that they were satisfied with the food provided by the home. They described the food as, “Very good”. They confirmed they had a choice of menu and that their religious and cultural menu requirements were being met.

We observed that lunch time was sociable, relaxed and unhurried and that people using the service were being provided with food which was well presented and of sufficient quantity. Staff were sitting with people and supporting them to eat and drink their meal. Staff were not rushed and stayed with the person until they had finished their meal.

People who use the service told us that they felt safe at the home. They said they had no concerns or complaints about their care but would speak with their relatives, the manager or the staff if they needed to. They told us that the regular meetings were a good forum to express their views or concerns about the service.

People were positive about the staff who supported them.

A relative we spoke with told us, “They’re sometimes short staffed and rushed but always respectful.”

One person told us, “I’ve got a care plan and I’ve been told that I can look at it any time I want to”. Relatives we spoke with were also aware of the care planning process and most had signed these plans to indicate their agreement with how their relative should be looked after and supported.

The service was ensuring that records in relation to nutrition and health care needs were up to date, reviewed regularly and were kept securely.

This meant that any changes in a person’s nutritional requirements or possible associated health care problems were identified promptly so the manager could take the appropriate action.

People who use the service expressed satisfaction with the care provided and they indicated that their needs had been attended to. They spoke highly of staff and stated that staff had treated them with respect and dignity. Their views can be summarised by the following comments :

" They are wonderful. They take good care of me.”

“Staff are very caring and very respectful.”

We observed that people who use the service comfortable and well cared for. Staff were noted to be interacting regularly with people who use the service. They were responsive and when the call bell was activated in one of the bedrooms, they responded promptly.

People who use the service said they were happy with the accommodation and facilities. We noted that the home was clean, tidy and furnished to a high standard.

The required health and safety checks had been carried out.

We observed that there was a good variety of therapeutic and social activities being provided for people who use the service and one to one sessions were available for them. This ensures that people who use the service are stimulated.

We were able to speak to several relatives. The feedback received was positive and indicated that people who use the service were well cared for and they had been consulted regarding the care provided. The views of relatives can be summarised by the following comment:

“The all-round standard of care is superb, and in my opinion, unbeatable.”

This inspection took place on 6 and 7 January 2016 and was unannounced. Lady Sarah Cohen House is a nursing home that is registered to provide accommodation nursing and personal care for up to 120 people. The home is run by Jewish Care, a voluntary organisation, and has a dedicated unit for people with a diagnosis of dementia. The home is split into three units on separate floors, and at the time of the inspection there were 107 people living in the home.

The home’s registered manager was no longer working at the home. 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 an interim general manager in place who advised that they would be applying to be the registered manager of the home. The previous registered manager was due to be deregistered for this service.

Staff did not receive sufficiently regular supervision meetings to support them in their role, and agency staff were not provided with clear recorded induction and orientation information before working with people. Improvements were also needed in records kept to ensure that people’s changing needs were noted and addressed promptly.

The home was clean and well maintained with a refurbishment programme in place. People’s care and nursing needs were met, and they were provided with their medicines safely. Their consent was sought before care was provided, and staff had training in the Mental Capacity Act 2005 and understood their duties when people were unable to consent. Some people expressed concerns over staffing numbers, and particularly the use of significant numbers of different agency staff. The management team were aware of this issue and in the process of further recruitment to posts at the home.

Safe systems were in place for recruiting staff. Staff training needs were assessed, with systems in place to make sure they had training in relevant areas. Staff showed a good knowledge of people’s life histories and preferences regarding their care and support needs. They were clear about the procedures for reporting abuse and felt that management listened to their views.

People were provided with a wide choice of food, and were supported to eat when this was needed. They spoke highly of the food provision in the home. They were also very satisfied with the range of activities available to them, organised by the living-well team.

People’s health needs were met, and they were supported to consult with health and social care professionals as needed without delay. They had the opportunity to be involved in decisions about their care and how they spent their time at the home. They and their relatives attended meetings or spoke directly to a manager to raise any issues of concern.

The provider had systems for monitoring the quality of the service and engaged with people and their relatives to address any concerns. When people made complaints they were addressed appropriately.

At this inspection there were two breaches of regulations, in relation to staff supervision and monitoring of changes in care recorded. You can see what action we told the provider to take at the back of the full version of the report.