About the service:

St Joseph’s Care Home is registered to provide residential and personal care for up to 36 people. At the time of the inspection there were 35 people living at the service. The service is a purpose built single story building consisting of three living areas and provides care to adults with complex physical needs and learning disabilities and/or autism. Each of the three areas has its own dining room, lounge and sensory room. There is a large garden area with outdoor seating. The service also operates a day care centre on site.

People’s experience of using this service:

In June 2017 CQC published Registering the Right Support. This along with associated good practice guidance, sets out the values and standards of support expected for services supporting people with a learning disability and/or autism. As part of our inspection we assessed the service in line with this guidance.

Current good practice guidance encompasses the values of choice, independence, inclusion and living as ordinary a life as any citizen. We found that St Joseph's did not always apply the values and principles of Registering the Right Support and other best practice guidance. This is because the guidance promotes that people should be cared for in smaller community based settings as opposed to larger congregate settings. We found that the service did not always actively explore and promote people moving on and transitioning into supported living settings. This meant that outcomes for people did not fully reflect the principles and values of Registering the Right Support. We have made a recommendation with regards to this.

Despite the service's size and layout, we saw that the ethos and cornerstones of practice which underpinned the service, was the deliverance of person centred care. The service was split into three areas each supporting 12 people. The lounge areas were situated next to the kitchen and this helped create a more social space and homely atmosphere. Staff did not wear uniforms and staffing arrangements meant it felt like less like an institution. Some people were supported on a one to one basis and so were actively involved with everyday choices such as having a bath or shower and activities within the local and wider community. The service involved people's relatives and encouraged them to have a say in how their loved ones care should be delivered. Most of the people at St Joseph's were not able to speak with us but we saw from our observations that people appeared settled and content. Relatives of people at the service told us they considered St Joseph's as a permanent home for their loved one.

At the last inspection we found that the service was not meeting legal requirements in relation to medication management. At this inspection, we found that medicines were administered and managed safely and that. Regular checks and audits were carried out to determine the quality of care and to achieve compliance with regulations.

People and their relatives told us they felt safe living at St Joseph’s. Staff understood their responsibilities in relation to safeguarding people from abuse and mistreatment.

Arrangements were in place with external contractors to ensure the premises were kept safe.

Effective recruitment processes helped to ensure new staff were suitable to work with vulnerable people.

The service/ registered manager analysed incidents and accidents monthly. This helped to identify any potential trends and to increase people's safety from harm.

Care records showed that people’s requirements and needs were identified and people were referred appropriately to external health professionals when required. Records contained information about people's preferred routines and information about how best to emotionally support and communicate with them. People enjoyed participating in activities which were meaningful to them both in the local and wider community. Some people had enjoyed holidays with family memb

This inspection took place on 12 and 19 November 2018 and was unannounced on the first day.

St Joseph’s Care Home is registered to provide residential and personal care for up to 36 people. At the time of the inspection there were 36 people living at the service. The service is a purpose built single story building consisting of three units and provides care to adults with complex physical needs and learning disabilities. The service also operates a day care centre. Each of the three units has its own dining room, lounge and sensory room. There is a pleasant garden area with outdoor seating.

As the service provides care to people with learning disabilities, the care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

St Joseph’s is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection a registered manager was in post. A registered manager is a person who has registered with 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 last inspected the service on 5 February 2016 when we rated the service as being 'Good.'

At this inspection, we found the service to be in breach of ‘Safe, care and treatment’ and ‘Good governance’ which are breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because systems in place to manage topical medication, thickening agent, PRN medications (as and when required medication) and controlled drugs were not being properly managed and systems to manage the quality and safety of the service were not always effective.

We found that topical medicines were not managed safely. Topical medicines are medicines which are usually applied to the skin such as creams, gels and ointments.

We also found that the use of thickener in fluids was not recorded on people’s fluid input charts. Thickener is a prescribed product and is used to reduce the risk of choking for people with swallowing difficulties.

We looked at the management of PRN medication. We found that for some people who were on PRN medication (such as pain relief), staff had not recorded the time of administration meaning it was not possible to identify whether the correct amount of time had elapsed between doses.

Controlled drugs were not always managed safely. Controlled drugs are subject to the Misuse of Drugs Act and associated regulations and so require extra checks.

We found that for one person with a PEG feed, the care of the PEG had not been recorded on the MAR chart. We spoke to a senior member of staff about this who advised us the care had been carried out but had not been formerly documented.

The service was also in breach of Regulation 17 ‘Good governance’ of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because systems to manage the quality and safety of the service were not always effective. Although we saw evidence that the service carried out regular audits and had identified issues, it was not always recorded as to what action had been taken and by who. In some instances, action plans had not been implemented to say what actions would be completed.

Some of the medication audits we looked at highlighted medication errors, it was not clear from the audits as to whether action to address those issues had

This inspection took place on 5 and 8 February 2016 and was unannounced.

St Joseph's care home is a 36 bedded purpose built home for adults with complex physical needs and learning disabilities. It is located in Formby and owned and managed by The Frances Taylor Foundation.

A registered manager was 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.

The registered manager and the team promoted extremely strong values in relation to the vision of the organisation which was ‘that people lead life to the full - with their dignity respected, independence supported, and uniqueness valued.’ The culture was remarkably caring, with the people who lived in the home at the heart of everything. The registered manager was able to demonstrate an in-depth knowledge of the people who lived at the home, and the staff team they led. Relatives we spoke with confirmed how caring the staff team were, they were especially complimentary about the caring attitude of the registered manager, deputy manager and the staff team.

When speaking to staff, and from our observations around the service, we could see highly personalised and spontaneous acts of kindness taking place between staff and people who lived at the home. Relatives we spoke with told us that the staff were skilled and thoughtful.

Care plans were personalised and very detailed, encompassing important information about each person so as to enable the staff to know them as an individual, and explain how their needs should be met. Relatives told us they were involved and included in their family members care and support and that communication between themselves and the staff team was exceptional. Relatives told us they felt their family member was valued highly and were listened too.

Peoples independence was promoted in the least restrictive way possible. Risk assessments identified any possible risks, and there was a plan in place to help keep people safe, whilst encouraging them to partake in new activities. The registered manager and the staff team demonstrated a good knowledge of The Mental Capacity Act 2005 (MCA) and their roles linked to this legislation.

Staff were trained and skilled in all mandatory subjects, and additional training which was taking place within the organisation. Staff we spoke with were able to explain their development plans to us in detail and told us they enjoyed the training they received. Staff told us they could approach the management team anytime and ask for additional support and advice, and were able to give us examples of how they had done this in the past.

Staff spoke highly of the organisation’s values and all of the staff we spoke with told us they were proud to work for the organisation. Staff said they benefited from regular one to one supervision and appraisal from their manager, and they felt empowered to raise any concerns or issues.

There was a safeguarding and a whistleblowing policy in place, which staff were familiar with.

Quality assurance audits and feedback was collected regularly from staff, relatives and people living at the home, and was analysed and responded too appropriately. We could see the registered manager was using this feedback to continually improve the service. Other quality assurance audits we saw were highly detailed and responded appropriately to shortfalls identified within the service provision, complete with working action plans and target dates for completion.

Medication was managed safely within the service.

Menus were in place and incorporated peoples choices and preferences. The management team had recently attended specialist training to improve the quality of pureed food for people who lived at the

We undertook this inspection to follow up on an action plan for improvements required for records management found during our inspection in July 2013.

At this inspection we found the improvements had been made and the implementation of new documentation had increased the quality of care records.

People's individual hard copies of care files were stored securely within each unit of the home, with limited access to seniors and management.

The home had introduced an electronic care records system and this was appropriately maintained with access control and server back ups.

The home had a range of policies and procedures in place to support record keeping, accessing information, data protection and confidentiality.

St Joseph’s home was managed as three individual care homes, Woodlands, Seaview and Pinelodge until the change in November 2012. The last inspections for Pinelodge and Seaview had areas of concern which have been reviewed during this inspection.

There have been organisational changes and proposed plans which have raised concerns from relative’s throughout the on-going two year consultation. These have also been considered during the inspection process as a number of relatives are still feeling unsettled by the change.

The home provides care for complex physical needs and learning disabilities, with accommodation for 36 people. Most of the people who lived in St Joseph’s were unable to communicate verbally so we spoke with their family members to ask them to share with us their views and experience of care being provided.

One relative told us “There have been some changes but we are delighted with the high standard of care. There has been sufficient communication and meetings with people’s relatives regarding the proposed changes. The management have listed to our concerns about the removal of nursing care and they have planned for a nurse to be on site during 9am to 5pm daily.”

We spoke with two members of staff who told us they felt well supported by the management. They said focus groups had been set up to provide staff with assistance with the increased training plan and during the change process.

Feedback was limited from people who lived at Pine Lodge due to varying levels of communication. We therefore spent time observing the support people received and their responses to this.

We interviewed a number of relatives to gain their views about the home and some of the comments we received have been included in the report.