The inspection took place on 25 October 2018 and was unannounced.

At our last inspection on 11 October 2017, we found the registered provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included those for person-centred care, mental capacity, assessing and mitigating risk, governance, and staff training. In addition they were in breach of one regulation of the CQC Registration Regulations 2009, regarding notifications. At this inspection, we found that improvements had been made and the provider was no longer in breach of the regulations.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least good.

Joseph House provides accommodation, care and support for up to 40 people with learning disabilities. Joseph House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were some concerns around infection control and the safety of the environment in some areas. The communal bathrooms we looked at were not clean, and some of the fittings were in a poor state of repair.

Risk assessments to the environment were not in place for the home and each person, such as assessing whether people’s bedrooms had any risks identified, and whether these were mitigated appropriately.

Risk assessments associated with people’s health conditions had improved since our previous inspection and were detailed with risks to individuals in line with their own care and support requirements. Information within care plans was accurate and up to date. Staff had guidance to mitigate specific risks to people.

There were improvements in staffing in the home. There were staff available to support people when needed, and staff had training relevant to their roles and they knew what support people needed.

The service had improved and was compliant with the Mental Capacity Act 2005 (MCA). People had mental capacity assessments for specific decisions that were being made about their care. Staff sought consent before delivering care, and only restricted some people’s liberty in line with the legislation.

Quality assurance systems had improved, and those in place identified most areas where improvements were needed, with the exception of some environmental checks, such as the cleanliness of the bathrooms. There were improved quality assurance systems around gaining feedback from people and analysing the results. Action was taken where there were identified faults in any health and safety related equipment, such as fire doors.

People’s medicines were administered safely by staff who were trained to do so, and medicines were stored securely.

There were recruitment checks in place, however staff application forms had not always been filled out thoroughly.

Staff carried out personal care behind closed doors and respected people’s dignity and privacy. Staff adapted their communication to encourage people to make choices. People’s interests and hobbies were supported and there was a range of activities and entertainment within the home on offer, with some people going out regularly into the local community and nearby town. People and their families had been involved in planning care for people when they wanted.

People’s care plans had improved and were person-centred with details of individual preferences, and

Joseph House provides accommodation, care and support for up to 40 people with learning disabilities.

There was a registered manager in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

We had previously inspected this service in December 2014. We found that the provider was meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was rated ‘Good’. During this 2017 inspection, we found the registered provider was in breach of six regulations. These included those for person-centred care, mental capacity, assessing and mitigating risk, governance, CQC notifications and staff training.

The registered manager had not always reported concerns to safeguarding to ensure concerns were properly investigated by the responsible authorities.

There were not always staff available to support people when needed, and staff did not all have training relevant to their roles. The staff team had gaps in their knowledge of how they should support people, especially in relation to mental capacity and safeguarding procedures.

People did not have mental capacity assessments completed by the provider to establish whether they were able to make specific decisions or consent to aspects of the care they received. The provider could not be assured that people’s rights were upheld.

The registered manager had not always sent statutory notifications to CQC when they were required.

Risk assessments were not always detailed with risks to individuals in line with their own health requirements. Not all information concerning risks to people within their care plans was accurate and up to date. Staff did not always have enough guidance to mitigate specific risks to people.

People’s medicines were administered safely by staff who were trained to do so, and medicines were stored securely. Risks to the environment were assessed and mitigated appropriately.

There were recruitment checks in place, however staff application forms had not always been filled out thoroughly.

People’s privacy was not always fully upheld because there were not locks on doors of a bathroom and toilet. There was CCTV in operation which people had not been consulted about inside the home. Staff delivered personal care behind closed doors.

Staff did not always encourage choice and independence for people by providing opportunities for people to increase their independence and choose where to spend their time.

People’s care plans were not always person-centred with details of individual preferences, and they were not always updated accurately when they were reviewed.

People’s interests and hobbies were not always supported on an individual basis, but there was a range of activities and entertainment within the home on offer. People and their families had been involved in planning care for people when they wanted.

People received enough to eat and drink throughout the day and people were supported to access healthcare services.

Quality assurance systems in place had not identified areas where we found concerns, and therefore these needed improving. The registered manager had not always taken action where concerns had been raised to them.

This inspection took place on 16 December 2014 and was unannounced.

Joseph House provides care and accommodation for up to 40 people who are living with a learning disability. On the day of our inspection there were 31 people living at Joseph House.

The service is required to have a registered manager in day to day charge of the home and the registered manager had been in post since January 2011. 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.

People were very positive about what it was like to live at this service and they described an environment where they were fully engaged in deciding how they wanted to live and what was important to them. People felt safe living at this home. There were close and caring relationships between staff and people, with support being given discreetly to protect people’s privacy and dignity.

Staff received training to support them to give good care and enable people to be as independent as possible. The staff group was settled and there were robust recruitment and induction processes in place when required.

There were safe management arrangements in place in respect of medicines storage and administration. Audit processes were in place and only trained and competent staff handled medicines.

Staff knew about and understood the Mental Capacity Act and Deprivation of Liberty Safeguards. They understood how this legislation affected the way they supported people around how they make choices and acting in the best interests of the person.

People made choices about how they wanted to live and they were involved wherever possible in developing and reviewing their care support plans. Choices and options were offered and staff respected the decisions that people made around daily living. People could choose how their personal space was decorated and furnished to their taste.

People felt staff were very kind and caring. Staff spoke to people in a respectful and compassionate way and encouraged people to be as independent as possible.

There were plenty of varied activities taking place providing engagement for people in hobbies that interested them. People were supported to socialise both in the home and also out in the community.

The service has a complaints procedure available, including in easy read form. People were asked for their views about the quality of the service and regular resident meetings also took place where people could air their views and opinions. The views of friends, visitors and health professionals were also sought.

Audits were in place to ensure the environment and all care activities and processes within the home were safe and effective.

A single inspector carried out this inspection. The focus of the inspection was to answer one of the five key questions: Is the service caring? This was because we had received concerning information about the way that some staff spoke to people using the service.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service caring?

We spoke with 12 people living at Joseph House, looked at three care plans, observed the way staff interacted with people and spoke with the registered manager.

People living in this home were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. Staff spoke politely to people and we did not hear any raised voices. We found that people were relaxed in the company of staff. People we spoke with told us that most of the current staff spoke nicely to them and they were able to speak with carers if they needed support. They referred to a member of staff, no longer working at Joseph House, who used to, “…shout at us a lot.” They said it was much better now and they got on well with all the staff.

People we spoke with told us they liked living at this home. One person said, “It’s really good here”. Another person told us, “We have lots of things we can do. I’ve been knitting this morning”. Most people were enjoying laughter and conversation over lunch although one person said, “This place is too noisy. I prefer peace and quiet”.

People were consulted about their care and support where possible, or their representative acted on their behalf. We were told, “The staff are great, they always ask me”. Care plans were kept under review and were written so that they reflected each person’s needs and preferences. Care records contained information about when other health or social care professionals were involved with the person’s care. We were told by a visiting professional that the service co-operated well with them.

The home was clean and tidy and there were no unpleasant odours. Staff understood about infection control and the risks associated with poor hygiene. We saw that staff had received training about this.

Staff files were in good order and contained all the information we would expect to find. They showed us that staff received opportunities for professional development and that they were well supported through a regular supervision process.

All the records we looked at were clear, accurate and fit for purpose. They were securely stored and were accessible to authorised people only.

People told us they liked living at Joseph House. One person said, "It's really good here". Another person told us, "Staff help me when I need it, they are very kind". They said that staff respected them and we saw staff speaking to and supporting people in a respectful and dignified way.

People were involved in deciding their care and support packages and their choices and preferences were sought and recorded within their care support plans. The plans reflected their chosen lifestyle and we could see that people had been involved and had signed to say they agreed with their plan.

Medicines were kept safely and we saw administration practices that were safe and robust. Arrangements were in place to store medicines securely and the records were clear, accurate and up to date.

People spoke about the staff. One person said, "The staff are lovely". We saw that the service employed sufficient staff to be able to support people effectively. Staff training was in place and encouraged professional development.

People told us they knew how to complain or raise concerns. One person said, "The staff are nice, they respect me. I would tell Bev if I was unhappy". Another person told us they would speak with the provider and said, "Bev would sort it out". People had a copy of the complaints procedure and it was available in pictorial format to aid understanding where necessary.

We spoke with two people in private and at length who were extremely happy about living at Joseph House. One person said, "I wouldn't live anywhere else".

Another person told us, "The staff help me when I need it, although my boyfriend helps me get around, and we have been to some nice places when we go out".

Several people we spoke with during the visit told us, "We wouldn't like to live anywhere else". Another person said, "I go to all the residents meetings and we talk about what we are going to do, such as where we are going for our Christmas meal and what entertainers we want".