St James House

St James House is a residential care home. The service provides support with personal care and

accommodation to people with a range of support needs, including younger and older adults with a learning disability, autism or mental health support needs.

Services for people with learning disabilities and or autism

The service was registered to provide support to up to 15 people and there were 13 people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because the size of the service was not having a negative impact on people. The building design blended into a local residential area and there were no identifying signs outside to indicate it was a care home. People were encouraged to access the community and undertake person centred activities.

People’s experience of using this service and what we found

People and their relatives told us the service was safe. We observed a calm and relaxed atmosphere during our site visit. Medicines, recruitment and infection prevention and control were managed safely. Individual and environmental risk assessments were detailed and up to date.

People, relatives and staff told us there was a positive culture within the service that promoted people’s choices and independence. Care records were person centred and the service had effective quality assurance processes in place to ensure the service was always improving.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 February 2019) with breaches in Regulations 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 and 24 October 2018. Breaches of legal requirements were found in Regulations 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We also looked at infection prevention and control measures under the safe key question during an inspection in August 2020. This was a targeted inspection looking at the infection control and prevention measures the provider has in place. As part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read all our previous reports, by selecting the ‘all reports’ link for St James House on our website at www.cqc.org.uk.

Follow up

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

We found the following examples of good practice.

People who had been advised to self-isolate were supported by staff to safely access the garden and a lounge area of the home was specifically allocated to them. This promoted wellbeing and independence for the individual.

People were supported to access the sensory room. People could have allocated time slots in the sensory room. There was time between slots for cleaning of the equipment.

People were supported by staff to understand testing. People were shown videos of the testing process and given guidance in an easy read format. People were able to watch someone being tested to help their understanding of the process. This supported people to make an informed decision.

Further information is in the detailed findings below.

The information shared with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks. We found these risks were mitigated and that the provider had implemented several control measures to help reduce the likelihood of future incidents occurring.

St James House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St James House is a converted church located in the Rusholme area of Greater Manchester. Accommodation is provided over three different levels, accessed by either a passenger lift or stairs. Rooms on the ground floor share communal toilet and shower facilities. On the upper floors, the accommodation comprises single en-suite rooms and two self-contained flats. Each floor has its own kitchen, lounges and dining areas.

The care home is registered with the CQC to accommodate up to 15 people with a learning disability and/or autism. At the time of this inspection there were 13 people living there.

The service delivered care and support that was 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.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed effectively, food was not always safely labelled, suitable arrangements were not in place to ensure people were protected from the risks of cross infection; assessments did not always identify need and systems in place to assess, monitor and improve the quality and safety of the service provided were not effective. You can see what action we have told the provider to take at the back of the full version of the report. We also made two recommendations relating to nutrition and reviewing equality and diversity awareness and training for all staff.

There was a manager in post who had been registered with the Care Quality Commission since September 2011. 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.

Medicines were not always managed safely. Some medicines were not dated upon opening and where people received time-specific medication, times of administration had not been recorded.

People were not protected from the risk of infection. Cleaning equipment was dirty and records of cleaning undertaken were incomplete. The lack of cleaning in some communal areas was evident on both days of our inspection. Improvements were also needed within the laundry to ensure good infection control systems were in place.

Where assessed needs were identified, detailed and specific care plans were in place and provided sufficient information to help staff support people according to their needs. Assessment of risks to providing that care was also included. Care records we looked at were kept up date through regular reviews. However, when we discussed the specific needs of people relating to sexuality, we found the service could benefit from further training on this subject and we have made a recommendation associated with this.

The provider did not have effective systems in place to monitor, review and assess the quality of service to help ensure people were protected from the risks of unsafe or inappropriate care.

Current menus we looked at showed there was a variety of meal choices including fruit and snacks. During our inspection, most of the meals on offer were ready-meals. We asked the provider to review food and drink offerings to ensure they were varied, suitable and nutritious.

The provider’s recruitment process helped to ensure staff employed were suitable to work with vulnerable people. All relevant documentation including references was collected prior to staff commencing employment.

Staff were aware of their responsibilities in protecting people from abuse and could demonstrate their understanding of the procedure to follow so that people were kept safe.

Staff had the right knowledge and skills and received continuous support to function in their roles. Relatives told us staff were competent. Staff received an induction and mandatory training prior to working with people. There was evidence that staff were supported with ongoing training as required.

The requirements of the Mental Capacity Act 2005 were being met. Appropriate arrangements were in place to assess whether people could consent to their care and treatment.

The service supported people to access relevant health care professionals and medical attention. Care records evidenced the provider had good links with people’s health care professionals.

People and relatives told us staff were kind and compassionate. Staff carried out their duties in a professional and friendly manner and were seen to support people in a patient and unhurried way. People were treated with dignity and respect; we spoke with the registered manager about exploring how communal toilets and bathrooms could be locked without compromising people’s safety.

People’s independence was encouraged according to their abilities. This was evident through our observations and conversations with people and staff.

There was an effective complaints process in place and people had information about making a complaint. This was provided in an accessible format.

Where these needs were assessed and planned for, people were supported to participate in activities within the home and the local community which helped to promote their independence and choice.

There were policies and procedures in place to provide staff with the appropriate guidance and support to carry out their roles.

Regular staff and management meetings were held which gave the staff and management teams the opportunity to discuss their work with peers.

St James House is a registered home providing 24-hour personal care and accommodation for a maximum of 15 people living with a learning disability and associated needs. The home is a converted church in Rusholme, Manchester and close to local amenities and transport routes. Accommodation includes self-contained flats and single rooms some of which are en-suite. Facilities include lounges, kitchens, laundry facilities, a sensory room, a hydrotherapy pool and a gym. There are also extensive grounds.

The service had a registered manager who had been in post since 2011. 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.

Everyone we spoke with told us they felt safe living at St James House. All the relatives we spoke with felt their loved ones were safe living there. Staff knew how to keep people safe and were aware of how and to whom they could report any safeguarding concerns.

Staff sought consent from people before providing care or support. The ability of people to make decisions was always assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were always taken in the best interests of people when necessary and applications were made for Deprivation of Liberty Safeguards authorisation appropriately.

Risk assessments were up to date. Care plans were written with the person whenever possible and with their families, with the consent of the person. People had been supported to be involved in identifying their support needs. Pre-assessments included people’s likes and preferences and staff knew the people well.

Staff were observed as being kind and caring, and treated people with dignity and respect. There was an open, trusting relationship between the people and staff. People were well cared for and there were enough staff to support them effectively. The staff were knowledgeable about the needs of the people and had received appropriate training in order for them to meet people’s needs. The recruitment process was robust and all required checks were in place prior to staff commencing work.

Medicines were administered, stored and disposed of safely and in line with the required guidelines. There were appropriate protocols and guidance for staff when people needed ‘as required’ medicine.

We saw people were fully supported to attend activities both within the home and within the community. People could choose what activity they attended and there was scope to change their minds. We saw nearly everyone living at St James House chose to do individual activities but the service provided group activities which they joined in as well. People who were able to, made choices about how they spent their time and where they went each day.

We saw people and their relatives had been asked for feedback about the service they received. There was a record of what actions had been taken to address any identified concerns. Staff worked well as a team; we saw them communicating with each other in a respectful and calm manner. There was an open and transparent culture which was promoted amongst the staff team.

Everyone knew who the registered manager was and felt the service was well-led. All staff said they felt supported and felt they could raise any concerns with the registered manager and they would be acted upon.

We viewed the policies and procedures and saw they were being followed. Quality assurance checks were being completed and when incidents had occurred action had been taken.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During this inspection we spoke with two relatives, four care staff and members of the management team. We spoke with four people who lived at St James House. We were unable to ascertain the views of all the people who lived at the home because they could not always give their verbal opinions on the service they received. We also looked at records and spoke with a visiting health professional. The registered manager was not present during the inspection; however we did speak with them following the inspection. Below is a summary of what we found.

Is the service caring?

People were being involved as far as possible in planning and consenting to their support and were enabled to make decisions about matters which affected them.

Our observations showed us people were treated with respect and two relatives told us they were happy with the care and support provided. One relative told us; '(My family member) is cared for properly at St James.'

Is the service responsive?

We saw people were encouraged to give feedback on the service in the form of

surveys, and a complaints procedure was in place to enable people to raise areas of concern if they wished to do so. We spoke with four care staff who gave examples of how they responded to changes in people's needs and wishes and one relative told us; ' I've never had to complain or even comment about anything but if I did, I'm certain they would be interested in what I had to say and they would sort it out.'

Is the service safe?

We saw systems were in place to ensure people were safe. The CQC monitors the operation in care homes of the Deprivation of Liberty Safeguards (DoLS). We looked at documentation which showed us that when necessary the correct processes were followed. We spoke with staff who explained the processes they would follow if they had suspicions people were at risk of harm or abuse. We saw some staff had received specific training to enable them to support people, however some staff had not and some training required updating. We concluded improvements were required in this area.

Is the service effective?

We saw people received support from other health professionals as required and were supported to attend hospital appointments if required. During the inspection we spoke with two relatives who told us they felt the home enabled their family members to live fulfilling lives.

Is the service well led?

We looked at a sample of audits and saw there were systems in place to identify when improvements were required. The staff we spoke with told us if any actions were required, they were informed of these through meetings with the manager and at supervisions. We spoke with two relatives who told us they found the manager and staff approachable and they would speak with them if they had any concerns.

Each person we talked with was positive about the quality of the service provided. People who used the service told us about how they felt or about their plans for the day. People smiled and looked happy and relaxed.

Comments from people who used the service included:

"I'm going out to Sea World later.' And 'Yes it's ok, it's nice.'

During our visit to St James House we saw people were relaxed and staff communication was positive and effective.

We found that people who used the service were treated with respect and systems were in place to enable people to give the appropriate consent to their care and treatment.

We saw that food and nutrition met the needs of people who used the service.

We saw staff were employed in sufficient numbers and had the required skills and experience to meet people's needs.

We saw systems in place to check whether a good quality service was being provided. We found that the provider took actions to make changes in response to the findings of their audits and the information provided by people who used the service.

Comments included:

'Yes I like it here.'

And

'I'm fine thank you, I'm happy.'

The third person told us about their plan for the day and their comments did not relate to how they felt about the service. We saw however that this person appeared relaxed and content at the service.

Other people smiled and made positive gestures about their life at St James House.

We found a robust system in place for supporting people to manage their finances safely though more information about extra charges may benefit people using the service and their representatives.

We found people were treated respectfully and given support to say how they wanted to be helped.

We found that people using the service were supported to do different things such as cooking, dancing, swimming, artwork, horse riding, using the hydropool and shopping.

We found that medication management promoted the safety and well being of people who used the service.

We saw that the recruitment process for new staff was robust and protected against employing unsuitable people.

We found that complaints were treated seriously, dealt with openly and learning points identified so that improvements to the service could be made.