St Joseph's Home - Bristol

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

People living at the home were safe as there were systems and processes in place to safeguard them from abuse. The risks to people's safety were well managed and there were enough staff safely employed to meet people's needs. People's medicines were managed safely, and staff worked in a way that promoted the

prevention of infection.

The registered manager had processes in place to learn from adverse events at the service. 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. There was a programme of audits in place to assist the management team to identify and address shortfalls.

Rating at last inspection

The last rating for this service was good (published 5 April 2018).

Why we inspected

This inspection was carried out as the home had not been inspected since the 19 and 20 October 2017. We undertook this focused inspection to check the service was Safe and Well-Led.

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 remains Good. This is based on the findings at this inspection.

Follow up

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

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

St Joseph’s Home is a care home that provides personal and nursing care for up to 42 older people. The service is provided in accommodation over two floors. At the time of the inspection, 26 people were living at the home.

We found the following examples of good practice.

People’s families had been kept up to date by staff, and were supported to visit their loved ones where possible. When visits in person were not possible, people had been supported to keep in contact with friends and family using phone and video calls. Visits at the home were planned to reduce risk and the spread of infection. A large room had been designated specifically for visiting and was not used for any other purpose. The layout of the room encouraged people to maintain social distance, and it was thoroughly cleaned between each use. Visitors were made aware that they would be required to keep distant from their family member and wear a mask during visits.

The building was large and spacious with accessible outdoor space. It was exceptionally clean and well maintained. Additional cleaning tasks were introduced at the start of the pandemic, and surfaces such as door handles and rails were cleaned throughout the day. Staff cleaned equipment after each use and carried out regular decontamination processes. Processes were in place to manage laundry safely to control the risk of cross infection.

Care staff worked on one floor of the home, which reduced the risk of spreading infection. The team were committed and knew people well. Staff morale was good and staff spoke positively about the support they had received. The provider had been able to offer on site accommodation at times, and support staff to safely travel to work.

Staff had access to supplies of personal protective equipment (PPE), and they had received training to ensure they used this correctly. Ear savers and custom adaptations were used to ensure PPE fitted people securely. PPE was available on every floor and was disposed of safely.

Regular testing was in place for staff and people who lived at the service. People who lived at the service had started to receive vaccinations against Covid-19. This information was recorded to provide assurance and overview.

St Joseph's Home provides accommodation for people who require nursing or personal care for up to 42 people. At the time of our visit there were 36 people living at the service.

There was a registered manager in post. 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 of the Health and Social Care Act 2008.

People were protected from abuse because staff understood how to keep them safe, including understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

Appropriate numbers of staff had been deployed to meet people's needs and keep them safe. Staff had attended training relevant to people's needs and they had received effective supervision from the management team.

Effective recruitment procedures were in place to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Risk assessments were in place to mitigate the risk of harm to people and staff.

People received their medicines when they required them and in a safe manner. Staff received training and guidance to make sure they remained competent to handle people's medicines.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and the DoLS. Staff had the right skills and training to support people appropriately.

People told us they enjoyed the food at the service. They were offered a choice of meals which were appropriate for a balanced diet.

Staff knew the people they supported and offered care in kind and compassionate ways. People's dignity was maintained and staff gave people the time they needed when speaking with them. People were supported to maintain their independence.

People were encouraged and supported to engage with activities that met their needs. People accessed their local community independently and with the staff.

People were supported and helped to maintain their health and to access health services when they needed them.

Effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service.

The registered manager promoted an open and inclusive culture within the service. People and their relatives felt the service was well managed.

St Joseph’s Home – Bristol provides accommodation and nursing care for up to 42 older people. At the time of our inspection there were 39 people living at the home.

A registered manager was in post at the time of our 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 home is run.

The home was not consistently safe as robust recruitment procedures had not been followed. This meant that staff had begun work without the full range of checks being completed or documented. Medicines were not always administered or stored safely, as recording omissions were identified. Risk assessments identified potential risks to people. However, these were not consistently accurate or detailed enough to be able to inform staff of how to reduce the risks to people.

Staffing levels were safe. Staff were supported through an induction process, regular supervision, training and meetings. Training needs were identified for staff and planned accordingly. Care was not always effective as care plans did not always provide accurate or detailed enough information in regards to people’s nutrition and hydration needs.

People and relatives told us that staff were kind and caring. We observed positive interactions and relationships between staff and people living at the home. The home supported people to maintain their independence and respected their privacy. People’s needs were fully assessed to ensure the home was able to meet them.

The registered manager was aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to assess if the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm is required. The registered manager kept clear records of the steps taken in the DoLS process. Staff were aware how the Mental Capacity Act 2005 was relevant to their role and applied the guiding principles through choice and enablement. Staff were not always confident in their knowledge of DoLS. We have made a recommendation about staff knowledge and understanding of the Deprivation of Liberty Safeguards.

The home was not always well-led. There were quality assurance systems in place. However, these did not always highlight areas that may need improvement. Feedback was sought from people and relatives through surveys. However, further investigation or changes as a result were not always completed. People were given the opportunity to feedback and make suggestions through regular meetings and we saw changes made as a result. The home had established positive community links and held events which were inclusive to the wider community. Volunteers were encouraged at the home and supported the home in the activities it provided to people.

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

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People living in the home were treated with dignity and respect by the staff that supported them. We received a number of positive comments about care workers, such as "they're wonderful". Another person told us "it's great here". One person told us that they totally trusted the home to care for their relative.

Where there were risks associated with people's health, these were assessed and appropriate support plans put in place. For example, we saw that Waterlow assessments were used to assess whether people were at risk of pressure damage to the skin. Bed rail assessments were used to ensure that these were used safely. Risk assessments were reviewed on a regular basis.

Is the service effective?

People living in the home and their representatives were involved in the care planning and review process. This helped ensure that support was person centred and reflected the needs of each individual. One person that we spoke with told us that they had received a very prompt reply when they had emailed the home to discuss an aspect of their relative's health.

Staff told us that communication was good in the home, so that staff would be aware of any particular issues relating to individuals. This information was discussed at handovers.

Is the service caring?

People that we spoke with during our inspection gave positive feedback about the home and the staff. One person told us that they'd been very well looked after when they came back to the home from hospital. This person also told us that staff had gone out to buy their favourite drink for their birthday.

We made observations of people receiving the support they needed, in line with their care plan. For example, we saw one person being supported with their breakfast meal and the food they were given was identified as their preferred breakfast in their care plan.

One person told us about how staff took time to discuss an album of photographs with their relative. The photographs in the album showed important and significant events in the person's life.

Is the service responsive?

We saw that the service worked well with other healthcare professionals. For example, in the case of one person who was under the care of district nurses, we saw that staff communicated with the nurses when the dressing required changing. One family member told us that staff would always speak with the GP if they had any concerns about their relative's health.

When any areas for improvement were identified by other agencies, we saw that the service took action to address them. For example, a report by commissioners found that there needed to be more 'dementia specific' activities. We asked what had been done in response to this finding and we were told that 'rummage bags' had been put in place for two people in the home with dementia.

We also saw minutes of health and safety committee meetings where any accidents and incidents were discussed. This provided opportunity to identify any learning points and put any required action plans in to place.

Is the service well led?

We saw that there were systems in place to monitor the quality and safety of the service provided. This included gathering the views of people living in the home and their relatives. People had opportunity to attend a monthly service user meeting if they wished to do so, and were also asked for feedback through a survey every 15 months.

The home received regular visits from a 'development advisor' within the organisation and these visits focused on specific themes each visit. For example we saw reports on personal care/resident's rights and another on maintenance.

Any accidents and incidents that occurred in the home were recorded and analysed on a monthly basis.

We asked the provider to send us copies of mental capacity assessments and best interest decisions. We viewed a number of examples that demonstrated that improvements had been made and that decisions were being recorded appropriately. We also viewed examples of audits that showed how cleanliness and hygiene were being monitored in the home.

Following the action that the home had taken to improve aspects of their record keeping, we found that they were compliant with the associated regulation.

During our visit we saw that the home was kept clean and well maintained. People said that their rooms were cleaned daily. Although we found no concerns in relation to cleanliness and hygiene, we found that cleaning audits were not recorded and it was therefore unclear how cleaning was monitored.

We found that care plans were sufficiently detailed and gave staff good information about how to support people in the home. These were reviewed regularly. People enjoyed a range of activities and on the day of our visit, we saw that a party was being held for St George's day.

We saw that consent was sought where appropriate on day to day issues such as the taking of photographs. The manager of the home had an understanding of the Mental Capacity Act 2005 and this meant that decisions were taken in the best interests of people who lacked capacity. However decisions were not always appropriately recorded.