About the service: St Joseph's Home – Birmingham is a residential care home that provides nursing care to older people. They were registered to provide care for 38 people and there were 37 living at the home when we visited. The accommodation consists of three floors with shared communal areas on each one. There is also a chapel attached to the home.

People’s experience of using this service:

The service continued to meet the characteristics of good.

• The risks to people’s health and wellbeing were assessed and action taken to reduce them. People were supported by staff who understood how to protect them from avoidable harm. There were enough staff deployed to keep people safe. People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection. There were systems to learn from mistakes including the detailed analysis of accidents and incidents.

• Staff received training to enable them to do their jobs well. People were provided with care and support which protected them from discrimination. They were supported to maintain a healthy diet. Their health and welfare were managed with referrals to other professionals made when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The environment was adapted and upgraded to meet their needs.

• There were kind and caring relationships between people and staff which were based on dignity and respect. People felt involved with decisions and that staff respected their wishes. Staff had a very good understanding of cultural and religious differences and provided support and opportunities to meet these. Families were welcomed at any time.

• People had care and support provided which met their preferences. Complaints were handled appropriately and in line with the provider’s complaints policy. People did not currently receive end of life care but people had discussed their wishes with staff.

• Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

More information is in the full report.

Rating at last inspection: The service was last inspected on 21 June 2016 and was rated good.

Why we inspected: This was a scheduled inspection based on the date the service was registered.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced inspection took place on 21 and 22 June 2016. Our last inspection of this nursing home was in July 2014. At that time we found the provider was compliant with the requirements of the law and meeting the needs of the people living at the home.

St Josephs is a nursing home within a convent. It can provide accommodation and nursing care for up 38 older people. At the time of our inspection there were 37 people living at the home.

There was a registered manager in post; they were present throughout 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.

The staff team had been provided with training on how to protect people from abuse. Staff we spoke with were able to explain a variety of actions and checks they took both individually and as a team to ensure people received the support they needed and were protected where ever possible from harm.

Medicine administration records and stocks of medicine available in the home did not show that people were always getting their medicines at the frequency or in the doses that their doctor had prescribed them. There were more medicines available than records stated there should be. This meant people’s medical conditions were not always being well managed by the use of their prescribed medicines. After the inspection the registered manager informed us of the action they had taken to ensure medicines management improved.

Staff had got to know people well over time, and people we met were happy with the staff who supported them.

People could be certain that their legal and human rights would be protected.

People were being supported to maintain and improve their health. Strong links had been developed with a wide variety of health care professionals and medical staff to ensure people were assessed and treated to help them maintain good health.

People told us they enjoyed the food served and people were given the support they required to eat a wide variety of foods and drink enough to stay healthy.

We observed and heard exceptionally caring and compassionate interactions between staff and people throughout our inspection. People and their relatives consistently praised the approach and attitude of the entire staff team.

There had been no complaints made about the service. There was a robust policy and system to respond to concerns and complaints. This was available in different formats around the home.

The activities and opportunities available to people were varied and people had been supported to attend events that were important to them within the home and the local community. Activities that were of interest to individuals and small groups had been developed as well as activities that appealed to the majority of people living at the home. People benefitted from a wide range of communal spaces in addition to those on the units in which they lived. These included a large dining room on the ground floor, a library, a craft room and a shop staffed by volunteers. There was a chapel where Roman Catholic mass was celebrated daily that people living in the home could attend.

The systems in place to check on the quality and safety of the service had not always been effective. Areas that required improvement and development had not consistently been identified. The manager had ensured that aspects of the home were audited however the outcome of audits had not been used to drive the service provided forward. This had not resulted in people experiencing poor care, but undertaking these audits would have provided the registered provider with assurance about the quality and safety of the service and could have resulted in improved outcomes for people. There was a registered

We visited this service and talked with people to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. There were 35 people living in the home at the time of our visit. Nine of those people were receiving nursing care.

We spoke with seven members of staff, the manager and seven of the people who lived in the home. We observed how people were cared for and how staff interacted with them to get a view of the care they experienced.

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed the interactions between the people who lived in the home and staff. People looked at ease in their surroundings. Staff spoke with them in a calm and friendly manner. There were enough staff on duty to meet the needs of the people who lived at the home.

We saw there were systems in place to ensure people received their medicines safely and as prescribed.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. No applications had been made. The manager understood how this legislation applied to people and protected their rights.

We found that equipment was serviced at regular intervals to ensure it was safe to use.

Is the service effective?

People's care and health needs were assessed and planned for. People were consulted about their care and how they wanted their care delivered. Specialist pressure relieving, mobility and equipment needs had been identified in care plans where required.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

The people who lived in the home confirmed that they were able to visit with people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were available at all times, showed patience and gave encouragement when supporting people. One person told us, “It’s very good here.” Another person said, “If I buzz for help the staff come.”

People using the service, their relatives, friends and other people involved with the service completed regular satisfaction surveys. The suggestions and ideas voiced by people were followed up.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s needs had been assessed before they moved into the home and care plans reflected people’s assessed needs. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

Records confirmed people’s preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities and were able to maintain relationships with their friends and relatives. Most people chose to live at the home so that they could continue to practise their chosen faith whilst living there. The home is run by a Roman Catholic order. One person told us, “I go to chapel every day, it is the one thing I wanted to come here for.”

Records showed that staff responded quickly to changes in people's health. We saw people had access to a variety of health care providers to ensure their needs could be met. One person told us, “I see the chiropodist and I’ve had new glasses.” Another person said, “The doctor comes once a week if I need to see him I can.”

Is the service well led?

The registered manager had been in post for two years. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There were systems in place so people who lived in the home could share their views about how the home was run. The manager was able to give us examples of actions taken and changes that had been made as a result of listening to the people living in the home.

There were systems in place to ensure the quality of the service was regularly assessed and monitored.

At the time of our last inspection of the home we found that the provider had failed to notify us, as required, of two accidents in the home. The findings of this inspection showed that compliance had been achieved.

At the time of our last inspection, we found that the provider had not been compliant with the regulation regarding assessing and monitoring the quality of service provided. The findings of this inspection identified that improvements had been made in this area.

There were thirty seven people living at the home at the time of our visit. Five of these people were receiving nursing care. We spoke with ten of the people living at the home and the staff that were supporting them. We received positive comments in support of the service provided.

People told us that they were happy with how their care and support needs were being met and that staff were available at the times they needed them. They told us that staff supported them in a respectful manner and offered them choices of how and where they wanted to spend their time. A person using the service told us “I am very happy living here, I am looked after well.”

People told us about the quality and choice of food and drink available. They told us that they were satisfied about the choice and quality of meals and that food and drink was readily available to them. A person using the service told us “If we don’t like what is on the menu, we can always ask for something else.”

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns. People using the service told us “I feel safe here,” and “I would talk to the staff if anything was troubling me.”

Most people chose to come to live at the home so that they could continue to practice their religious faith. The home is run by a Roman Catholic order- The Little Sisters of the Poor. The home is part of this working order and mass is said daily. However, people of any denomination could live at the home. A person using the service told us “I go to the chapel every day because I like doing this.”

People had opportunities to take part in recreational activities both within and outside of the home and people were encouraged to be as independent as possible. A person using the service told us “I went to play bingo yesterday. I really enjoyed it.”

Arrangements were in place so that people were involved in monitoring the quality of service provided. This meant that they had opportunities to put forward any suggestions for improvements. A person using the service told us “I enjoy going to monthly meetings to discuss the home.”

The provider had failed to tell us about two recent accidents that had involved people using the service. This meant that we had not had the opportunity to take action if needed.

There were 37 people living at the home at the time of our visit. Of these people, 34 were receiving residential care and three were receiving nursing care. We spoke with eight of these people and the staff that were supporting them. We spoke with a visitor that was at the home. The home is run by a Roman Catholic order - The Little Sisters of the Poor. The home is part of this working order and Mass is said daily. The vast majority of people living at the home were of the Roman Catholic faith. However, people of any denomination were accepted at the home.

People told us that they were happy living at the home and that they were satisfied with how their care needs were being met. People told us that they could not find fault with the home.

During our visit we observed the care and support being provided at the home. We saw that staff supported people in a respectful manner. We saw that the staff greeted people by their preferred names and offered them choices of how and where they wanted to spend their time. One person told us “I have felt a bit poorly over the past few days, so the staff have respected my wishes and have left me in my room to rest;” and “I am happy with the timings of my day.”

People told us that they were comfortable living at the home and that the home was always clean. A person that was living at the home told us “It is spotlessly clean, you couldn’t ask for better.”

During our review, we requested information from the primary care trust about the quality of the service provided at the home. They told us that overall they did not have any concerns about the quality of care people received. However they had identified that improvements were needed regarding care records. The findings of our visit identified that some improvements had been made in this area.