27 August 2020
During an inspection looking at part of the service
St Joseph is a residential care home providing personal and nursing care to 12 people aged 65 and over at the time of the inspection. The service accommodates people in one adapted building and can support up to 15 people.
People’s experience of using this service and what we found
The provider remained in breach of the regulations due to poor risk management in relation to the safety of the premises, infection control concerning COVID-19, fire safety and failing to ensure risks related to people’s needs and incidents at the home were always effectively assessed. The provider did not adequately review incidents to look for potential themes and to ensure all necessary action was taken to keep people safe. People and relatives felt the service was safe and staff we spoke with knew how to respond to safeguarding concerns, although not all staff had received training in this area and other areas related to the safety of the service. Feedback indicated there were not always enough staff to support people safely. Processes for staffing levels and recruitment were not robust. Medicines audits had helped promote safe practice although we identified some further improvements needed. Improvements were underway to the safety of the premises yet we identified further hazards which we asked the provider to address.
The provider remained in breach of another regulation because systems and processes failed to ensure the quality and safety of the service. We needed to prompt the provider to address shortfalls in the safety of the service, some of which they had identified but not addressed. Systems had also failed to ensure risks were adequately assessed and that records in relation to risks were accurately maintained. We identified the provider was in breach of a third regulation because CQC had not been notified as required about specific incidents and events concerning three people living at 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 Inadequate (published 27 June 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating and to follow up on breaches identified at the last inspection in March 2020.
We carried out an unannounced comprehensive inspection of this service on 11 March 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance systems.
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 and Well-led which contain those requirements.
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 remains as Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Joseph on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified continued breaches in relation to safe care and treatment and good governance at this inspection. We also identified a third breach in relation to the provider’s requirement to notify CQC about specific incidents and events at the service.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
After our inspection we made a referral to West Midlands Fire Service and informed the local authority of our inspection findings. We will continue to work with partner agencies and 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.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.