This inspection took place on 12 and 19 November 2018 and was unannounced on the first day.St Joseph’s Care Home is registered to provide residential and personal care for up to 36 people. At the time of the inspection there were 36 people living at the service. The service is a purpose built single story building consisting of three units and provides care to adults with complex physical needs and learning disabilities. The service also operates a day care centre. Each of the three units has its own dining room, lounge and sensory room. There is a pleasant garden area with outdoor seating.
As the service provides care to people with learning disabilities, the care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
St Joseph’s is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of our inspection a registered manager was in post. A registered manager is a person who has registered with 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.
We last inspected the service on 5 February 2016 when we rated the service as being 'Good.'
At this inspection, we found the service to be in breach of ‘Safe, care and treatment’ and ‘Good governance’ which are breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because systems in place to manage topical medication, thickening agent, PRN medications (as and when required medication) and controlled drugs were not being properly managed and systems to manage the quality and safety of the service were not always effective.
We found that topical medicines were not managed safely. Topical medicines are medicines which are usually applied to the skin such as creams, gels and ointments.
We also found that the use of thickener in fluids was not recorded on people’s fluid input charts. Thickener is a prescribed product and is used to reduce the risk of choking for people with swallowing difficulties.
We looked at the management of PRN medication. We found that for some people who were on PRN medication (such as pain relief), staff had not recorded the time of administration meaning it was not possible to identify whether the correct amount of time had elapsed between doses.
Controlled drugs were not always managed safely. Controlled drugs are subject to the Misuse of Drugs Act and associated regulations and so require extra checks.
We found that for one person with a PEG feed, the care of the PEG had not been recorded on the MAR chart. We spoke to a senior member of staff about this who advised us the care had been carried out but had not been formerly documented.
The service was also in breach of Regulation 17 ‘Good governance’ of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because systems to manage the quality and safety of the service were not always effective. Although we saw evidence that the service carried out regular audits and had identified issues, it was not always recorded as to what action had been taken and by who. In some instances, action plans had not been implemented to say what actions would be completed.
Some of the medication audits we looked at highlighted medication errors, it was not clear from the audits as to whether action to address those issues had been undertaken. Although medication audits were being carried out, they were not always effective and had not highlighted the concerns we identified during our inspection. You can see what action we asked the provider to take at the back of the full version of this report.
All of the people we spoke with and their relatives told us they felt safe living at St Joseph’s. Staff understood their responsibilities in relation to safeguarding people from abuse and mistreatment and were able to explain how they would report any concerns. Any safeguarding concerns which had arisen in the service were acted on in a pro-active way. Provider meetings were held to discuss concerns which helped decrease the risk of any recurrence.
Arrangements were in place with external contractors to ensure the premises were kept safe.
We looked at how accidents and incidents were reported in the service and found they were managed appropriately.
We looked at recruitment processes. We reviewed personnel records for four members of staff. We saw that each staff member’s suitability to work at the service had been checked prior to employment to ensure that staff were suitable to work with vulnerable people.
We looked at care records belonging to four people. We saw that people’s care requirements were identified and people were appropriately referred to external health professionals when required. This helped to maintain people’s health and well-being.
People and their relatives were involved in the formulation of their care plans. We saw that people’s preferences were considered. Staff supported people in a person-centred and dignified way.
Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the rights of people to make their own decisions.
Many people were supported on a one-one basis and we found there were enough staff on duty to meet people’s needs. Interactions we observed between staff and people living at the service were warm and caring. Staff treated people with great respect and took care to maintain people’s privacy and independence. Relatives of people living at the service told us that staff were extremely compassionate and considerate.
There was an open visiting policy for friends and family. The service provided dedicated accommodation for relatives so they could stay overnight to support their loved one if required. This helped both people and their visitors feel supported. Friends and family told us the service actively involved them in the care of their relative and made them feel welcome. For people who did not have anyone to represent them, the service supported them in finding an independent advocacy service to ensure that their views and wishes were considered.
The service operated a day centre for people who did not reside at the service. People living at the service could also utilise the resources at the day centre. Activities included movies, arts and crafts and music.
All meals were home cooked on the premises using fresh ingredients. We spoke to the chef who was knowledgeable about people’s preferences and dietary requirements. Innovate methods of cooking and presenting pureed food were utilised which helped to make food more appetising and increased people’s independence when eating.
The service had a complaints procedure in place. Complaints were recorded and acted upon appropriately. Relatives told us they would feel comfortable in raising any concerns they had with the manager.
We found the environment to be clean and spacious, this made it easy for people to navigate around. People could decorate their own room so that each room was completely unique to them.
Feedback about the management of the service was positive. Staff told us managers were supportive and promoted an open and transparent culture.