About the service:

St Joseph is a care home that provides personal care for people, some of whom are living with dementia. St Joseph’s is registered to provider care for up to 15 people; there were 13 people living at the home on the day of the inspection.

The registered manager left St Joseph’s in September 2018 to work at the one of the providers sister homes. A new manager is in place and has submitted an application to CQC to become the registered manager. The provider is legally responsible for how the service is run and for the quality and safety of the care provided.

People’s experience of using this service:

• Some improvements had been made in the areas we identified following our previous inspection in August 2017. However, we found that some areas requiring improvement had not been addressed. For example, at the last inspection we recommended that the service explore the relevant guidance on how to make environments more 'dementia friendly.’ At this inspection the required changes were not in place and although the provider had a home improvement plan in place, giving the timescales for the ongoing redecoration of the home no reference was made to providing a 'dementia friendly' environment.

• Improvement was required to ensure facilities and equipment were safe and any required work was carried out in a timely manner. For example, we saw a delay in required work to the passenger lift.

• The provider had quality assurance systems in place, however they were not fully effective as they had failed to ensure action had been taken in a timely way.

• People were supported by staff to stay safe and who understood the need to ensure they consented to the care they received.

• People were cared for by staff who treated them with respect and dignity and encouraged them to maintain their independence.

• Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.

• People’s consent was sought before providing support. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and what this means for people.

• People felt staff listened to and acted on their choices and felt involved in the running of the home, for example, people had been involved in planning the redecoration of their rooms.

• Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing.

• Staff felt supported and said they could talk to management at any time, feeling confident any concerns would be acted on promptly.

• People spoke positively of service and relatives said improvements had been made since the last inspection.

• The provider had a home improvement plan in place, which showed the timescales for the planning redecoration of the home and the planned areas for refurbishment.

• The service worked in partnership and collaboration with other key organisations to support care provision.

Rating at last inspection:

At the last inspection we rated St Joseph as ‘Requires Improvement’ (report published 24 January 2018). At this inspection the overall rating has remained as ‘Requires Improvement.’

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This unannounced inspection took place on 23 August 2017. At our last Inspection in September 2015 we rated the provider as good overall. St Joseph’s provides accommodation for up to 15 older people who require personal care and who may have dementia, a mental health related illness or a physical disability. At the time of our inspection there were 15 people living there.

There was a registered manager in post and they were present at the time of the 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 service is run.

Although people told us they felt safe at St Joseph’s we found risks to people’s health and safety were not always managed safely. Both the registered manager and staff told us they thought there were times when staffing levels were insufficient to meet people’s needs however we saw people’s needs were being met by staff. People were cared for by staff who understood the signs of potential abuse and how to report any suspected abuse. We found the provider operated a safe recruitment system which meant people were supported by staff who were suitable to work with people living in the service.

Although staff had received training it was not always effective in providing the knowledge and skills to support people in the service. The registered manager had protected people’s rights when they lacked capacity to make decisions about their care. Staff were not aware of who had restrictions on how their care was delivered. People had mixed views about the food at the service, however we saw people enjoyed the food and they were given choices. People’s nutritional needs were being met. When people’s health needs changed they had access to other healthcare professionals.

Although people told us staff were kind and caring we saw people spent periods of time with no interaction from staff and there were missed opportunities for staff to interact with people. People told us their privacy and dignity was respected by staff. People were encouraged to maintain relationships that were important to them.

People had mixed views about the opportunities available to spend their leisure time. Although we saw people engaged in group activities we saw no evidence that activities were tailored around people’s individual preferences. People told us they were happy with the care they received. Relatives told us they were involved in the care of their family members. The provider operated a complaints system should people have concerns about the care they received.

Improvements were required in the governance system operated by the provider. People told us the service was well led. Staff were supported in their roles and were involved in the running of the service. People told us they were happy living at St Joseph’s and felt they could approach the registered manager and staff should they need to.

This unannounced inspection was carried out on 23 September 2015.

St Joseph is a care home that is registered to provide care to up to 15 people who do not need nursing care. Some people are living with dementia. On the day of our inspection there were 14 people living in there.

St Joseph is required to have 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. At the time of our inspection the manager had been in post over three months but had not submitted an application to become the registered manger. This is a breach of the conditions of registration.

People were protected from abuse because staff were aware of the actions to take if they had any concerns and were able to identify the signs that would indicate if a person was unhappy.

People were supported to receive safe care before there were sufficient numbers of suitably trained staff that were aware of the needs of people they supported. The recruitment process ensured that only people suitable to work in the home were employed.

People were involved in planning their care so that they received care and support that met their individual needs.

People received care from a staff team that knew them well and benefited from opportunities to take part in activities that they enjoyed and that were important to them and that met their spiritual needs.

People were supported to have food that they enjoyed and meal times were flexible to meet people’s needs.

People were supported to remain healthy because they received their medicines as prescribed and were able to see health care professionals as required.

People’s right to privacy and dignity was promoted and people’s independence was encouraged.

Staff sought people’s consent before providing care and support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) were to be followed.

Systems were in place to monitor the quality of the service but these could be more robust to ensure people received a consistent high quality service.

At our last inspection on 22 May 2013 we saw that people received their medicines but the systems for the management of medicines could be improved.

At this inspection we looked at the medicines for three people, spoke to one member of staff and the acting manager. We saw that people were relaxing in the lounges. Some were watching television, one was reading a newspaper and one was chatting with a visitor.

We saw that systems had been put in place to improve the management of medicines. Staff we spoke with were aware of the new systems and using them. We saw that audits pf boxed tablets were carried out on a daily basis. The storage of medicines ensured that medicines were stored safely and at the required temperatures. Protocols had been put in place to ensure that medicines that were administered on an "as and when required basis"were given in a consistent way by staff. This meant that people received their medicines as prescribed.

During our visit we spoke with eight people, two staff, the registered manager and the provider.

People we spoke with told us positive things about the home. One person told us, “The food is great.” Another person told us, “All staff are very good. No complaints from me.”

We saw that staff treated people with respect and dignity. Staff spoke with people in a respectful way using their preferred names. People were relaxed in the presence of staff. We saw that people were supported to make choices and their decisions were respected.

People’s care needs had been assessed, staff were aware of people's needs and plans were in place to deliver care in a personalised way.

People's health care needs were met through community health services. There were systems in place to identify and manage risks to keep people safe.

People received their medicines as prescribed but the management of medicines in the home could be improved.

Systems were in place to monitor the quality of the service on an ongoing basis.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drinks available in the home. This inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector who was joined by an Expert by Experience; people who have experience of using services and who can provide that perspective, and a practicing professional with a medical background.

There were 13 people living in the home at the time of our inspection. We spoke with nine people about their experience of care at St Joseph. We spoke with four staff, the acting manager and one relative who was visiting the home. To help us understand people's experiences we observed lunch in the two areas of the home used for eating.

People we spoke with said that staff treated them well and that their privacy and dignity was respected. Most people had single bedrooms but people in shared rooms had privacy curtains to ensure that they could have privacy when they wanted.

We saw that staff had a good rapport with people and showed their knowledge about people’s needs and treated them as individuals. People who lived in the home told us that staff was available if they needed help. One person told us “I get the help I need, they look after us well.”

People were able to make choices in relation to daily living. One person told us, “We can go up (to bedrooms) in the day, we could have a nap if we wanted to.” People enjoyed their food and choices of meals were available to them. One person told us, “The food’s not too bad, we get a good choice.” This showed that people were able to make choices about their day to day lives.

During our visit we observed that people received food and drinks regularly throughout the day ensuring they did not become malnourished or dehydrated.

Staff was knowledgeable about how to safeguard people from harm and what actions they would take to ensure that people were kept safe.

Records were appropriately stored and accessible when needed. This means that people’s information was kept safe and accessible only to people who needed to have access.

We were not able to speak with many of the people in the home due to their health needs. The people we spoke to told us that they were happy in the home. They told us that the home was kept well maintained and clean.

Relatives told us that they were happy with the care being provided. Some relatives would like be kept informed more about people’s welfare.

We saw that people were generally assisted in the way that they wanted. Care workers did not always pay attention to small details which sometimes upset people.

People received care from staff that were trained and knew how to support people.