Archived: Joseph House Nursing Home

Joseph House Nursing Home is a residential care home that provides personal and nursing care for up to 20 older people aged 65 and over. At the time of the inspection there were 13 people living at the service. This included two people who were in hospital.

People’s experience of using this service:

People told us they were treated with care, kindness and respect. People and their relatives were consistently encouraging about the caring attitude of the staff and confirmed there were positive interactions between them.

People told us they were safe. The service had effective safeguarding arrangements in place to protect people from harm and abuse.

People’s care and support needs were documented and staff had a good understanding and knowledge of these and the care to be delivered. Suitable arrangements were in place to manage risk. Minor improvements were required to ensure people received their medication as they should.

Suitable numbers of staff were available to meet people’s needs and recruitment arrangements were robust.

Staff received appropriate training and newly employed staff completed an induction. Staff felt valued and supported by the registered provider and manager and received formal supervision and an annual appraisal.

The service ensured they worked collaboratively with others and people were supported to access healthcare services when needed.

People’s rights were upheld and they were supported by staff in the least restrictive way possible.

People told us the service was well-led and managed. Quality assurance arrangements enabled the registered provider and manager to monitor the quality of the service provided and staff performance.

Rating at last inspection:

Following the last inspection, the rating of the service was ‘Requires Improvement’ (Last report published June 2018). Although the service was rated ‘Requires Improvement’ no breaches of regulation were cited.

Why we inspected:

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

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. 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

Joseph House Nursing Home is a large detached building situated in a quiet residential area in Shoeburyness and close to all amenities. The premises is set out on two floors with the majority of people using the service having their own individual bedroom and adequate communal facilities available for people to make use of within the ground floor.

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.

At a previous unannounced comprehensive inspection of this service carried out on the 9 and 10 October 2017, we found breaches with regulatory requirements relating to Regulation 9 [Person centred care], Regulation 10 [Dignity and respect], Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing]. As a result of our concerns the Care Quality Commission took action in response to our findings by rating the service as ‘Inadequate,’ placing the service into ‘Special Measures’ and amending the provider’s conditions of registration. At this inspection, we found the service had made significant improvements and was now rated ‘Requires Improvement’.

The Local Authority had placed a restriction on the service provision following our last inspection to the service in October 2017. This inspection was completed on the 23 and 24 April 2018 and was unannounced. At the time of this inspection there were 14 people living at the service. We found the service had made significant improvements and was now rated ‘Requires Improvement’.

Our key findings across all the areas we inspected were as follows:

Arrangements were much improved to assess and monitor the quality of the service provided. There was a positive culture within the service that was person-centred, open and inclusive. The registered provider and registered manager were able to demonstrate a better understanding and awareness of the importance of having suitable quality assurance processes in place and demonstrated better oversight of what was happening within the service. The registered provider visited the service at regular intervals and the registered manager was now located within the main hub of the care home. This was a significant improvement and had resulted in better outcomes for people using the service. Though the above was positive, improvements were still required to ensure these arrangements in place were as effective as they should be, particularly where actions and recommendations were to be followed-up and addressed.

Staffs practice now ensured people living at the service received safe and effective care. This related to people who required specific support and specialist equipment to mobilise safely and where people were at risk of choking as a result of eating and drinking difficulties. Arrangements were now in place to review and investigate events and incidents and to learn from these. Care plans now covered all aspects of a person’s individual care and support needs and risks to people were clearly identified and managed to prevent people from receiving unsafe care and support. People’s healthcare needs were met. Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Suitable arrangements had been made to ensure that people’s rights and liberties were not restricted and people’s capacity to make day-to-day decisions had been considered and assessed.

With the exception of fire safety and fire drills training, staff received appropriate training and this was now embedded in their everyday practice. Newly employed staff were assigned a mentor and received a robust induction. Formal supervision arrangements were in place and staff confirmed they felt supported by the registered provider and registered manager. Improvements were needed to ensure where discussions held as part of formal supervision arrangements required follow-up action, these were completed and an audit trail in place to demonstrate actions taken. Recruitment practices were safe but checks relating to external contractors had not been considered.

People were able to participate in a variety of social activities each morning; however consideration was required to ensure these were routinely available in the afternoons and also afforded people the opportunity to access local community based activities.

Improvements were needed to ensure staff that had overall responsibility for fire safety at the service were appropriately trained. Additionally, where actions and recommendations were recorded, namely from the external fire contractor’s report, these were actioned and addressed. Infection control arrangements were generally satisfactory with the exception of the laundry room as this area required a thorough deep clean.

Although people told us staff cared for them in a kind and caring manner and whilst the majority of care practices was observed to be positive, improvements were required to the service’s dining arrangements. This referred specifically to serviettes, condiments and drinks being readily available. Staff’s practice whilst supporting people to eat and drink required improvement and where recommendations were highlighted following a review of the ‘dining experience’, these had not been followed-up and actioned. The deployment of staff throughout the day was noted to be appropriate but a review of night-time staffing levels was required to ensure this was appropriate in relation to people’s assessed needs.

Building renovations and refurbishment were in progress within the first floor to create new bedrooms with en-suite facilities and communal space. Improvements were needed to maximise the suitability of the premises for people living with dementia.

We have made recommendations about ensuring where staff have been delegated specific responsibilities, suitable training is provided and recognised national guidance relating to fire safety is followed.

You can see what action we told the provider to take at the back of the full version of the report.

Joseph House Nursing Home provides accommodation and personal care for up to 20 older people and people living with dementia. This inspection was completed on 9 and 10 October 2017 and there were 19 people living at the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the Care Quality Commission. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

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.

There was a lack of provider and managerial oversight of the service. Quality assurance checks and audits carried out by the registered provider and registered manager were not robust, as they did not identify the issues we identified during our inspection and had not identified where people were placed at risk of harm and where their health and wellbeing was compromised. The registered provider and registered manager were unable to demonstrate how they identified where improvements to the service were needed and lessons learned so as to ensure compliance with regulatory requirements and the fundamental standards.

The majority of staff were aware of their responsibilities with regard to safeguarding people from abuse and knew how to report concerns. However, robust procedures and processes that make sure people are protected had not always been considered and followed.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered and risk assessments had not been developed for all areas of identified risk. People were at risk of harm due to poor manual handling practices by some members of staff.

The registered provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, we observed some interactions which were not respectful or caring and failed to ensure people were treated with respect and dignity.

Pre-admission assessments provided insufficient information to inform people’s care plan and the risks that might be posed to people using the service, staff and others. Not all of a person’s care and support needs had been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for them becoming anxious and the steps staff should take to comfort and reassure them. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia.

Staff newly employed at the service had not received a robust induction and where staff were assigned a mentor; the role of the mentor was not effective in monitoring staff’s practice and providing sufficient guidance and support. Training and development was not sufficient in some areas to demonstrate that people's care and support needs were fully understood by staff. Staff’s knowledge and understanding of the main principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards was poor. Where significant decisions were needed and the rationale to evidence these were in people’s ‘best interests’ had not been recorded.

People were supported to have enough to eat and drink. People were supported to maintain good healthcare and have access to healthcare services as and when required. Medication practices and processes were safe and ensured people received their prescribed medication.

The majority of staff knew the care needs of the people they supported and people told us that staff were kind and caring.

You can see what actions we told the provider to take at the back of the full version of the report.