St Joseph's Care Home

St Joseph’s Care Home is a residential care home providing accommodation and personal care to up to 19 people. The service provides care and support to older people some of whom live with dementia. At the time of our inspection there were 10 people using the service.

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

We found areas of the premises had not been well maintained by the provider. There were plans in place to complete some repairs and maintenance works. Following the inspection action was taken to address some of these issues and we were provided with an action plan that showed the other works would be completed in the near future.

We received very positive feedback about the management of the care home and people’s care from people’s relatives.

People received an assessment of their needs and preferences before they started receiving care. Care plans developed from these assessments provided the information and guidance staff required to ensure people’s individual needs were met in a personalised way.

Policies and processes were in place to support safe management and administration of medicines.

Systems were in place to protect people from abuse. These included safeguarding adults’ policies and suitable training for staff. Personalised risk assessments helped keep the people safe and supported their independence.

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

Proper recruitment and selection policies and procedures helped to ensure that only suitable staff were employed to provide care and support to people. Staff were provided with the induction, training and support they needed to carry out their roles and responsibilities in providing people with good quality effective care.

The registered manager was responsive throughout the inspection and to our feedback.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 March 2021.) Two breaches of regulations were identified in relation to medicines and quality assurance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

Recommendation

We have made one recommendation about developing a more dementia friendly environment.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Joseph’s Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Joseph's Care Home is a care home registered to accommodate a maximum of 19 older people with dementia. On the day of this inspection there were 12 older people with dementia living in the home.

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

Medicines were administered safely, however there were shortfalls in tallying medicines remaining, guidelines about when to administer pain relief to a person and ensuring that medicines changes were clearly recorded on the appropriate records.

Assessments were carried out to ensure people's needs could be safely met, however we did find specific shortfalls for particular people in relation to risk assessment completion. Where risks were identified, there was guidance in place for staff to ensure that people were safe but not always detailed enough around behaviours that certain people may exhibit.

There were methods of monitoring the quality of the service, however, there were shortfalls to maintaining full and complete recording practices around medicines and risk assessment processes.

Rating at last inspection

The last rating for this service was requires improvement (Report published 26 October 2019).

Why we inspected

We carried out a short notice announced focused inspection of this service on 19 January 2021. The provider was not found in breach of regulations at the time of the previous comprehensive inspection, however the service was identified as requires improvement in safe and well-led and rated as requires improvement overall as the result of that inspection. We carried out this inspection to examine if improvement had been made. We also carried out a check of infection prevention and control.

This report only covers our findings in relation to the key questions safe and well-led which were rated as requires improvement in the previous comprehensive inspection report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains as requires improvement. This is based on the findings at this inspection as the service had improvements that needed to be made.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Joseph’s Care Home on our website at www.cqc.org.uk.

Follow up

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

St Joseph's Care Home is a care home registered to accommodate a maximum of 19 older people with dementia. On the day of this inspection there were 16 older people with dementia living in the home.

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

While improvements had been made to the environment and fire safety of the premises, we still found that fire safety needed further attention to ensure people who used the service were safe in the event of a fire. The service had systems to protect people from the risk of abuse and improper treatment. Staff managed people's medicines well and kept the home clean and tidy.

People were cared for by staff who were well supported and had the right skills and knowledge to meet their needs effectively, following good practice guidance. Staff supported people with their healthcare needs and worked well with external healthcare professionals. The service met people's nutritional needs and worked with them to make sure food provision also reflected their preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated well, with kindness and compassion by staff who respected their privacy and dignity and promoted inclusion. The service supported people to be independent and to regain life skills. We received positive feedback about the caring approach of staff.

People's care and support had been planned in partnership with them. Staff knew people well and

supported them in line with their current needs and wishes. Staff were knowledgeable about people's likes, dislikes and personal preferences.

The management team were dedicated to improving the ongoing care and support people received and spoke of plans to further improve the service. Quality audit processes were in place and were generally effective. They had identified that fire doors did not ensure people were safe in the event of a fire. However, the risk to people was still present during the day of our inspection and work to the fire doors had not commenced. Both people and staff had confidence in the management team and staff felt valued and well supported. This had resulted in a positive, encouraging and supportive culture within the home.

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

Rating at last inspection (and update) The last rating for this service was requires improvement (published 23 January 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

At our last comprehensive inspection on 26 February 2016 the service met the regulations we inspected and was rated Good. At this inspection we found the service to be deficient in some areas and have rated it as Requires Improvement.

People who used the service and their relatives informed us that people had been treated with respect and dignity. The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse.

There were suitable arrangements for the administration of medicines and medicines administration record charts (MAR) had been properly completed.

There was a record of inspections of equipment carried out by specialist contractors. However, the premises were not well maintained and some areas of the building were in need of repairs and redecoration. We found a breach of regulation in respect of this.

There were a lot of leaves at the front of the building. These may pose a slip hazard when wet. Some fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Individual personal emergency and evacuation plans (PEEPs) were prepared for people to ensure their safety in an emergency. We however, noted that the fire risk assessment of the premises had not been updated to include the arrangements for people who smoked. There was no fire evacuation plan for the premises with guidance on how evacuation should be conducted. This is needed to ensure that care workers are aware of the procedure to follow in the event of a fire. We found a breach of regulation in respect of this.

The home had a recruitment procedure in place to ensure that care workers recruited were suitable and had the appropriate checks prior to being employed. We however, noted that two care workers’ records did not include a second reference. These were provided by the registered manager during our second visit to the home. The staffing levels were adequate. Care workers had received a comprehensive induction and training programme. There were arrangements for staff support, supervision and appraisals.

The care needs of people had been carefully assessed and attended to. Appropriate care plans had been prepared which reflected the choices and preferences of people. The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The dietary needs of people had been assessed and arrangements were in place to ensure that people received adequate nutrition. Some people including two people with diabetes had made improvements in their health as a result of the care provided.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS. Mental capacity assessments had been carried out for people who used the service.

People were encouraged to be as independent as possible. The home had an activities organiser and people could engage in various social and therapeutic activities which were appropriate for them. The service had a policy on ensuring equality and valuing diversity. There were arrangements to ensure that people’s diverse needs including their religious and cultural needs were met. People were supported with their religious observances and provided with meals in accordance with their wishes and preferences.

Checks and audits of the service had been carried out by the registered manager and the operations manager to ensure that the service provided care of a good quality. We however, noted that there were deficiencies related to staff recruitment, health and safety and fire safety which had not been identified and promptly responded to. We found a breach of regulation in respect of this.

The recent satisfaction survey of the home indicated that people and their representatives were satisfied with the services provided.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

At our last inspection on 1 September 2014 the service met all the regulations we looked at.

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

People living in the home had varying degrees of dementia. Some of them could not provide us with comments regarding the care provided. Some were able to tell us about their experiences and views. They informed us that they were satisfied with the care and services provided. They said they had been treated with respect and felt safe living in the home. There was a safeguarding adults policy and suitable arrangements for safeguarding people.

Staff were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and recorded. Staff prepared appropriate care plans which involved people and their representatives. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records. People’s healthcare needs were monitored. Staff worked well with community healthcare professionals to ensure that people’s needs were met. This was confirmed by relatives we spoke with.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings and one to one sessions had been held for people and the minutes were available for inspection. The home had an activities programme to ensure that people were encouraged to participate in social and therapeutic activities.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and some people who spoke to us could confirmed that they had been given their medicines. This was also confirmed by relatives we spoke with.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their manager. There were enough staff to meet people's needs. Teamwork and communication within the home was good.

People and their representatives expressed confidence in the management of the service. The results of the last satisfaction survey and feedback from people and their representatives indicated that they were mostly satisfied with the care and services provided. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence.

The premises were clean and no offensive odours were detected. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. We however, noted that the gate to the attic room which had an unrestricted window was not locked. The registered manager agreed that a lock would be fitted. We were informed soon after the inspection that a lock had been fitted and a window restrictor fitted to the window.

The complaints procedure was on display in the home. Complaints made had been promptly responded to. Regular audits and checks had been carried out by the registered manager of the home and senior company staff. We however, noted that these audits did not identify and promptly rectified some deficiencies such as the names of staff not recorded for fire drills, safeguarding policy not updated and the medicines trolley not being chained to the wall. The deficiencies were promptly rectified after the inspection.

Social and healthcare professionals provided positive feedback regarding the management of the home. They indicated that the home was well organised and staff communicated well with them.

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.

Is the service safe?

The relatives of the people using the service told us that they were confident that people were safe. Staff were clear about their roles and responsibilities and felt well supported by management staff.

Staff understood their role in safeguarding the people whom they supported and reporting any concerns they had to the manager. We saw there was appropriate and concise advice available for staff to refer to if they had safeguarding concerns. The home had systems in place to identify, assess and manage risks relating to the health, welfare and safety of people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

Equipment used by the staff to care for people was appropriate, although in one case we found that whilst an item of equipment had been serviced there was no sticker displayed on it to inform staff that this had occurred and the equipment was safe to use.

Is the service effective?

Relatives of people using the service told us they were happy with the way their loved ones were treated and staff were 'a good team'.

Risk assessments had been carried out where necessary and these were used in the planning of effective care.

We saw minutes from staff meetings and saw staff communicated between each other. They were guided by an effective system of documentation, which ensured there was continuity in the care that was delivered. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Is the service caring?

We saw people were given the opportunity to participate in activities and staff supported people to take part in religious and cultural festivals. We observed the care people were receiving and how staff interacted with them. We saw people using the service were spoken to respectfully and staff used a caring approach . Relatives of those using the service commented on the caring nature of staff towards their relative.

Is the service responsive?

The home had a system in place for learning from incidents and complaints. We saw where care had been below the standard expected the registered manager had taken steps to ensure systems were changed to ensure this was not repeated.

We saw that the staff integrated the advice given by various health professionals into the care that was provided to people. Written notes about people's health and care were completed by staff . People received individualised care, which was responsive to their interests and preferences. A variety of activities were available for people to participate in as they chose. Activities were geared specifically to those who were affected by dementia. People's care and health was monitored closely and junior staff escalated quickly to their senior colleagues if they were concerned.

Is the service well-led?

The home was led by an experienced manager who understood their role and took steps to ensure care was of a standard people would expect. The home was supported by a senior team who undertook monitoring and checks of the quality of the service. Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

We spent a period of time observing four people who could not talk with us in the communal area of the home. Our observations showed that staff had time to speak with people and to give them individual attention. We noted several examples of staff speaking with people and treating them with respect. However we also observed a few examples of poor interactions with people, when staff spoke with a person but did not wait for a response from them.

We looked at the care plan files for six people who were receiving end of life care. The care plans were written in plain English and showed the person's wishes and preferences.

The infection control procedures included clear instructions for hand washing and we saw reminder posters for washing hands in all communal areas. The daily cleaning log covered all areas of the home and showed that each bedroom was deep cleaned periodically. However we observed some areas of cleaning that had not been attended to due to the absence of the domestic scheduled to work that day.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. All care plans had current assessments for the person's health needs, including the risk of falls, pressure care and mobility.

People who use the service were protected from the risk of abuse. The provider responded appropriately to any safeguarding concerns. We saw evidence of training for all staff in safeguarding of vulnerable people.

The provider had robust procedures for quality assurance and audits. We saw evidence of regular audits of procedures for maintaining health and safety in the home. The provider sent out quarterly satisfaction surveys to staff, people using the service and their relatives and acted on any comments that were made.

We observed that staff on most occasions talked to people and explained things to them before providing care and support to them. Whilst people or their relatives were kept informed of changes in the condition of people, we found limited evidence of their involvement when care plans were drawn up for people or when there were limitations to people's freedom such as when bed rails or sensor mats were used. During the inspection we observed people's choices were respected by staff. We saw people offered choices for meals and activities.

Our inspection has identified some areas that needed improvement for people to experience safe and appropriate care and support. We found that care planning did not always address all the individual needs of people such as when their needs challenged the service. Accidents and incidents although recorded, were not fully investigated to identify their causes, so that action could be taken to prevent these from happening again. In a few cases where there were suspicions that abuse could have occurred, these had not been referred to the local authority safeguarding adults team to ensure these incidents were appropriately investigated.

Mr Khan's name appears on this report as they were still registered as a manager but not in post during the visit.