St Josephs Nursing Home

St Josephs is a nursing home providing regulated activities accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 24 people. The service provides support to people who have a range of care and nursing needs including Parkinson’s disease, frailty of age, diabetes and people living with dementia. At the time of our inspection there were 22 people using the service.

St Joseph’s accommodates 24 people over two floors in one adapted building. The care home is attached to a convent and people have direct access to a shared chapel.

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

Quality assurance processes failed to have identified the concerns found at inspection in relation to fire safety. Record keeping of paper documents was disorganised and some records of health and safety checks were missing.

Electronic care planning and risk management had recently been introduced and needed time to become embedded within the day to day running of the service. Care plans and risk management processes were current and up to date. Information provided enough guidance to ensure people's needs were met and risks were mitigated.

Safe recruitment systems and processes were in place. A formal induction was being developed by the provider. Training was provided for staff to ensure they could carry out their role safely and effectively. People told us they felt safe. Staff had received safeguarding training and were able to demonstrate their understanding and responsibilities to reduce the risk of harm to people.

Peoples nutritional needs were met. People who required specialist diets or additional support had their needs met. Mealtime experiences were positive people told us they had plenty to eat.

People and staff provided positive feedback on the management of the service. People were treated with kindness and compassion and staff were friendly and respectful. People and their relatives told us they were happy with the service they received. Staffing levels were enough to meet people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the

least restrictive way possible and in their best interests; the policies and systems in the service supported

this practice.

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 inadequate (published 9 March 2022) and there were breaches of regulations. 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.

This service has been in Special Measures since 23 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. 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 COVID-19 and other infection outbreaks effectively.

We carried out an unannounced focused inspection of this service on 21 October 2021(published 9 March 2022). Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, fit and proper persons employed, need for consent, and good governance.

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, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Josephs on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Josephs Nursing Home is a 'care home'. The home provides accommodation and nursing care for up to 24 people. The home is built over two floors and shares a chapel with the adjacent Convent. The service was tailored for, but not limited to, people from the Roman Catholic Church. At the time of our inspection there were 18 people living at the home with a range of nursing needs and some people were living with dementia.

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

Information in people's care records was not enough to help ensure safe care. People were not always protected from avoidable harm as risks to people's health and safety had not been identified or assessed. Risk management and care plans did not contain enough detail and person-centred information to accurately reflect the needs of people. There was a failure to assess and mitigate known risks to people such as those associated with specific health conditions, falls and choking. Processes were not in place to ensure records provided adequate information for staff to provide safe and effective care.

People were not always protected from the risk of abuse because allegations of abuse were not reported or acted upon to prevent reoccurrence. People were at risk of receiving medicines they no longer needed, or risks associated with medicines given outside prescribing guidelines. Staff had not undergone pre-employment checks to ensure they were safe and of suitable character to work with people.

Quality assurance and management systems were not effective in monitoring care or enabling the managers to effectively govern the service. Information collated was not sufficient to provide oversight and ensure managers could analyse data or identify themes and trends from which improvements could be made.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this.

New staff members completed an induction and training which the provider considered essential to their role. Staff were experienced and some had undergone training in areas of practice in which they held a special interest and would enhance their knowledge and skills. Although formal supervision had not been taking place, staff told us they felt supported and had regular contact with the management team.

People had been protected from the spread of infection and the COVID-19 pandemic. The managers and staff had maintained safe and effective infection, prevention and control practices which were in line with current government guidance.

People and their relatives were complimentary about the staff and the care they received. One person said, “The staff are so friendly and caring and could not ask for more.” A relative told us, “We have met many members of staff who are all lovely caring people.”

People’s spiritual and religious needs were met on a regular basis. People were able to attend Mass in the chapel and listen to the service on their television or radio which people told us they enjoyed.

People were supported to eat and drink enough and had access to external health professionals for care and support. Staff knew people well and respected their choice and preferences.

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

Rating at last inspection

The last rating for this service was Good (published 25 October 2017).

Why we inspected

The inspection was prompted in part due to concerns identified as part of our direct monitoring approach (DMA). The concerns related to the service not having a registered manager and a lack of reporting events notifiable to CQC. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the safe key question. 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 COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Josephs Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to consent, safe care and treatment, safeguarding, recruitment, how the home is managed and failing to report notifiable events as required.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the key questions, it will no longer be in special measures.

We found the following examples of good practice.

People told us they felt safe with the infection control and prevention measures that were in place. The layout of the service had been changed to support social distancing. For example, in the dining room chairs were spaced apart from each other.

All visitors and contractors were required to undertake Lateral Flow Device Tests (LFD) on arrival. Visiting was in line with government guidance and had been adapted throughout the pandemic to ensure visiting was compliant with government guidelines.

All people and staff participated in regular whole home testing for Covid-19. Personal Protective Equipment (PPE) was readily available to staff, people and visitors. Staff wore and used PPE appropriately.

Some ancillary staff such as those working in the kitchen worked in cohorts. This reduced the risk of transmission between staff.

The layout of the service had been changed to restrict movement between the care home and the attached convent. Arrangements had been made for people to continue to participate in Mass using the gallery above the chapel. To adhere with social distancing, numbers were restricted, however Mass was also transmitted through live audio into people’s bedrooms.

St Joseph’s Nursing Home provides accommodation and nursing care for up to 24 older people. The home is built over two floors and shares a chapel with the adjacent Convent. The service was tailored for, but not limited to, people from the Roman Catholic Church. At the time of our visit there were 21 people living at the home. The people living there are older people with a range of physical needs and some people were living with dementia.

The home had a registered manager. 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 the last inspection on 7 and 9 June 2016, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always managed safely or recorded correctly. They were also in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not sought feedback from people for the purposes of continually evaluating and improving the service and some people were unhappy with the activity provision. The service received an overall rating of 'Requires Improvement', and after our inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches. At this inspection we found improvements had been.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine when they needed it. People were supported to maintain good health and had access to health care services.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People had access to and could choose suitable leisure and social activities.

People and relatives told us they felt the service was safe. People were protected from the risk of abuse because staff understood how to identify and report it. One person told us “This is a very safe place to be and I am content here”

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us “Very good, no complaints, let’s put it this way the plate goes back always empty”. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One member of staff told us “We get training and updates, I have completed equality and diversity recently and moving and handling”.

There was a homely and relaxed atmosphere at the home. People and relatives found the management team approachable and professional. One person told us “The manager is very accessible”. Another person said “Management is here every day and I can talk to them anytime”.

Quality assurance audits were completed by the registered manager to ensure a good level of quality was maintained. We saw audit activity which included medication, care planning and infection control.

St Josephs Nursing Home provides accommodation and nursing care for up to 24 older people. The home is built over two floors and shares a chapel with the adjacent Convent. The service was tailored for, but not limited to, people from the Roman Catholic Church. At the time of our visit there were 24 people living at the home, including three people who were visiting for respite care.

There was a calm and peaceful atmosphere at the service. Many people told us that they had chosen the home for its spiritual tradition and that they enjoyed attending daily Mass in the chapel, or watching it on the internal television channel. Relatives spoke positively about the service and the care provided.

At our last inspection, in December 2014, we asked the provider to take action to ensure that they were working within the principles of the Mental Capacity Act 2005 and to ensure that the Commission was notified of specified incidents as required by law. The provider and former registered manager had taken action to address these concerns. At this visit, we found that these requirements had been met.

The service did not have a registered manager. A new manager had been appointed in February 2016 and was due to begin the process of registering with us. 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.

People spoke highly of the care that they received and told us that the staff were very kind. Some people, however, told us that they felt bored and that they wished for more social activity. They told us that staff were busy and had little time to chat. Staff told us, however, that most people were happy to attend Mass daily and to rest after lunch. We found that the provider had not asked people for their views and feedback on the service, or for ideas to improve their experience, since 2014.

Medicines were not managed safely. We found concerns with the storage, recording and disposal of medicines.

People felt safe at the home. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse.

People told us that staff treated them with respect. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

There were enough staff to keep people safe. People told us that they were not rushed and that they received a high standard of care. Staff had received training and felt supported by the management, including through supervision and appraisal. Staff monitored people’s health and took prompt action to address any concerns. People had access to healthcare professionals and appropriate referrals were made for guidance or additional support.

People enjoyed the food and were offered a choice of meals. Staff were attentive to people’s needs and supported those who required assistance to eat or drink. People’s weight was monitored and prompt action taken if any concerns were identified.

The new manager was active in monitoring the care that people received and was developing the system used to audit the service. People, their relatives and staff felt confident to raise issues or concerns with the manager. Where concerns had been identified, actions were recorded and addressed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We found that people's care was based on an individual needs assessment and planned and delivered to ensure their safety and welfare. A person told us "I like it here - I like all the people, staff and residents, everyone is so friendly and kind". A person's relative told us "care is excellent, the relationships with staff are very good, they are genuine - it's a real home".

People told us that they felt safe in the home and we found that people were supported by staff who knew how to identify abuse and what to do if they had any concerns.

We found that most of the staff had been working in the home for many years. People and their relative's told us that this was important to them because staff knew and understood people's needs very well. We found that the provider carried out the appropriate checks to make sure the staff they employed were suitable for their role.

We found that the provider had a system in place to deal with complaints. We saw that information was made available about the complaints procedure and that complaints were responded to appropriately. People we spoke with told us they could raise their concerns and complaints with the manager.

People told us they were asked about their wishes about daily living, their choices in meals, their religious preferences. One person told us "I am happy here. This home is better than other ones I have been in".

There is a limited activities programme which people spoken with said they were happy with. The majority of the people living in the home were involved in the spiritual aspect of the home.

Outcomes relating to safeguarding and quality assurance were inspected in August 2012 and were found to be compliant.

Care needs were assessed and people told us these needs had been met. One person told us that they had a bath every day which was their preference.

Medicines were handled safely in the home.

A general practitioner (GP) who frequently visited the home was spoken with and we were told the people "were very well looked after by a very considerate and observant staff".

Two relatives were spoken with and one told us that the home was "fantastic" and that they had "struck gold" in finding a place here for their family member. The other told us that their family member was looked after "extremely well