The inspection took place on 18 January 2017 and was unannounced. St Joseph’s Care Home provides residential care for up to 48 people including people who may live with dementia. At the time of the inspection 41 people were using the service.

The home had a registered manager. 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 service is run.

We found that when people’s needs changed this had not always been documented to reflect the changes or to follow best practice.

People felt safe living at St Joseph’s Care Home. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated safe recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People, relative’s and other professionals complimented the staff team for being kind and caring. Staffs were knowledgeable about individuals' care, support needs and preferences. People had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

People had opportunities to be involved in activities and hobbies both inside and out of the home. They were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

This inspection was carried out on 23 July 2015 and was unannounced.

St Joseph’s Care Home is registered to provide accommodation and personal care for up to 53 older people. This includes people who are living with dementia or a physical disability. There were 48 people living at the home when we inspected.

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 and associated Regulations about how the service is run.

When we last inspected the service on 29 September 2014 we found them to not be meeting the required standards in relation to the administration of people’s daily records and guidance for staff about people’s behaviour to enable them to better meet their individual needs. At this inspection we found that they had met the required standards.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Staff were fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People received care that met their individually assessed needs and preferences.

People received their medicines safely and had regular access to health care professionals. People received support where required.

People were provided with a good choice of food and drink and staff had access to accurate and up to date information to help them meet people’s needs.

People felt safe and staff were knowledgeable about how to protect people from the risk of abuse and other areas where they may have been assessed as being at risk. Falls, accidents and incidents were monitored to ensure the appropriate action had been taken. There were regular quality assurance checks carried out to assess and improve the quality of the service.

Staff were kind and people appreciated the positive relationships they had with staff. This was also true for relatives. People were complimentary about the staff providing the service. Choices were given to people at all times. People’s privacy and dignity were respected and all confidential information about them was held securely.

Care plans were personalised and included information about people’s history and interests. Staff were knowledgeable about how to manage people’s individual needs and assisted people to take part in daily activities.

The service was well led by a manager who promoted a fair an open culture. They encouraged staff to take responsibility and supported their professional development. The manager also had a support structure in place from area managers. There were regular supervisions and appraisals to support staff.

We spoke with 14 of the 46 people who lived at St Joseph’s Care Home. They told us that they were well looked after and that the staff were kind and very nice and gentle. One person told us that the staff were fun and made their day light hearted and enjoyable. All of the people said that the staff and managers of the home were easy to talk to and they would talk to the manager if they had a problem. Those people who had spoken to the manager about a problem said that they felt listened to and had their problem resolved without any fuss.

We looked at how the people were respected and involved in the running of the home, how their health and welfare was promoted, how they were kept safe, if there was enough trained staff to care for them and how the home facilitated people making complaints. We found that the home was compliant with all the areas we looked at.

During our visit we had conversations with twelve people who lived at St Joseph’s, three relatives and four members of staff. People who used the service and their relatives told us that they were provided with a good service and that the staff were kind and caring. Individual’s told us that St Joseph’s was a “pleasant” place to be and the staff were “considerate”. People told us that they were comfortable and felt safe. A relative told us that there was “fun and laughter” and staff spent time sitting talking with people.

We identified that people were asked for their views on how the service was being run and how they wished to spend their time.

People were aware of the care plans in place to ensure staff provided them with the care and support they needed.

We observed that staff provided support for people, who were living with dementia, in a way that promoted positive signs of well-being and reassurance.

We noted that there were appropriate systems in place to ensure staff received the training they needed and the quality and safety of the service provided was kept under review.

The people who live at St Josephs were very positive about the care they received. They told us that staff look after them very well and that the staff are helpful and cheerful. They told us that they know that sometimes their needs are difficult to meet and said that the staff are always cheerful, patient and kind. The told us that they like living at St Josephs and that it is very easy to talk to the staff should they have a problem.

We conducted this inspection following information of concern. The information was in relation to the Kingfisher unit of St Joseph’s Care Home. The inspection team was made up of one inspector and was conducted over three visits on the 29 September, the 04 and 06 October 2014.

We set out to answer our five questions in relation to our concerns; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

We found that the home was not meeting the two outcomes we inspected.

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

Is the service caring?

We found that the staff were interacting and engaging with people in a caring and kind way. We saw that care had been taken with people’s appearance to prepare them for the day and that staff treated them in a manner that promoted their dignity and respected their privacy.

Is the service safe?

We found that people who lived in the Kingfisher unit of the home were not always protected from avoidable harm. This is because the home did not have effective systems in place to capture and respond to incidents that put the people and staff at risk. However, we found that the people in the rest of the home were safe.

The staffing levels in the Kingfisher unit were not sufficient to meet the fast changing needs of the people who lived there, many of whom had complex needs.

Is the service effective?

We found that one of the two staff members on duty to care for the people in Kingfisher unit had a poor command of the English language. We were unable to communicate effectively with them. We found that they were an agency staff who had not worked at the care home before.. We observed that this staff member did not know the peoples’ names. They had not been given time to read the people’s care plans and therefore could not have known and understood their needs.

The people in the rest of the home were cared for by a sufficient number of qualified and suitable staff.

Is the service responsive?

We found that the home responded to the needs of most of the people who lived there, except for people who lived in the Kingfisher unit who did not always have their needs recognised and responded to in timely manner.

Care plans were reviewed and updated. However vital information pertaining to the peoples’ behaviours were not included when planning their care and in deciding on the most appropriate care for them.

Is the service well led?

We found that the Kingfisher unit of the home was not managed in an open and transparent manner. The members of the management staff told us that they were not aware of the incidents that had occurred in the unit that could have caused harm to the people.

There were no systems in place to escalate staffs’ concerns about the people and therefore there was no management plan in place to protect the people and the staff who worked in the unit.

By the end of the inspection the provider had responded positively to our concerns and had increased the staffing levels on the Kingfisher unit.