St Josephs Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safety of the premises, and the ways people’s medicines were managed at the service, poor risk management and incomplete staff documentation.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Staff were kind and helpful, but the service lacked a culture of proactive learning to improve safety. The registered manager and staff we spoke with were content with the way care was provided. Staff told us they reported changes in people’s needs that might need a new risk assessment to the registered manager.
Mandatory training was completed, however staff supervisions and meetings with the manager did not always happen in line with the service’s policy. Staff were not always aware of safety issues, such as poor medicines management, and had not acted to remove out of date items from a cupboard. After our visit the registered manager told us there had been a thorough audit of medicines and all out of date medicines removed.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Care plans were available as paper or electronic copies. While electronic copies of people’s care plans should enable a service to print a current record for other health care professionals this relies on them being frequently and appropriately updated. Records we saw were lacking in detail and often had conflicting information, meaning continuity of care could be compromised if a person moved services. We did not see evidence anyone had been harmed by the lack of clear records; however this was an area that required improvement.

After our visit the registered manager acted to move all care plans completely to the electronic system and cease use of the paper plans.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. Staff understood the importance of safeguarding and the registered manager reported concerns to the local authority safeguarding team. However, Section 42 safeguarding enquiries and their outcomes were not always reported to the CQC. The registered manager worked closely with the local authority to address issues raised by visiting healthcare professionals. Staff had received appropriate training in safeguarding and how to ensure people’s care was safe. A staff member told us, “I would talk to staff if I saw unsafe practice and if they ignored me, I would tell the manager.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met.

While authorisation had been applied for, we found one application had expired, the registered manager did not have full oversight of the documentation for people. No one was harmed by this and the registered manager immediately acted to reapply for the authorisation, and told us they would conduct an audit of DoLS paperwork.

The provider did not work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff knew people well which enabled them to provide appropriate safe care. However, care plans did not always contain detailed risk assessments to show how care should be provided safely. Some areas of risk were ignored or had not yet been addressed, for example, a care plan stated both that a person required bed rails and that there was no risk assessment required for the use of bed rails.

People were not always involved in managing their risks, the registered manager said, “People should be involved, but this has slipped recently.”

People had access to areas of the home that were not safe for people living with dementia, for example unlocked medicines rooms. A person told us there were hot pipes in their room, they said they would like them boxed in as they became very hot. This was a risk that had not been addressed by the provider.

After our visit the registered manager acted to lag the hot pipes, and the medicines rooms were fitted with code locks to prevent unauthorised access.

The provider did not detect and control potential risks in the care environment. They did not make sure equipment, facilities and technology supported the delivery of safe care.

Areas of the home were unsafe. Window restrictors were not in place on upper floors, nor were there risk assessments in place to ensure this was the safest option. Cleaning cupboards were not locked, and chemicals were not stored safely. A bedroom at the home had exposed hot pipes running down a wall.

Immediately after the inspection the registered manager risk assessed all windows and ensured those above the ground floor were fitted with restrictors.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,supervision and development. However, staff worked together well to provide safe care that met people’s individual needs.

Staff files were incomplete. While new staff received all appropriate safety checks, some staff were working without evidence they were safe to work in a healthcare environment. Not all staff had references from previous roles, and some staff had not provided photographs to enable the service to confirm their identity. Immediately after the assessment visit the registered manager applied for all appropriate checks, and completed a staff file audit.

St Josephs is a nursing home and there were registered nurses on duty to care for people at all times. Some nurses had second jobs in the NHS and received extra training from that employer.

Staff training was not always completed in the timeframe laid out by management. Staff told us management did not follow up to ensure they had completed training, although there was a chart on the wall in the staff room to remind them what needed to be completed. We saw the training matrix and this confirmed training was not up to date. Supervisions and appraisals were planned to be carried out alternately, every six months; however, we saw not all staff had received an appraisal or supervision as proposed. The manager said, “I try to do them [supervisions] yearly, but I do them all so it’s a huge task.”

After the assessment visit the registered manager told us there would be an audit of staff training and all staff would be monitored in future to ensure training was completed in a timely manner.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Housekeeping staff had not all received training in health and safety, or the Control of Substances Hazardous to Health. Some cleaning materials were not stored safely, and some spray bottles were refilled and did not have appropriate labelling. There was no evidence anyone had come to harm, but this was an unsafe practice and needed improvement.

After our visit the registered manager told us they had ensured any cleaning materials would be labelled appropriately, and doors to the cupboards were fitted with code locks to prevent unauthorised access.

The home was clean. Housecleaning and laundry staff were onsite every day. Staff had access to personal protective equipment (PPE) such as gloves and masks, and people told us staff used them appropriately. A person said, “They are very hot on gloves. I had at one time 2 types of lotions, they changed the gloves in between. If staff have a cold, they wear their masks.” A management audit showed staff used PPE correctly.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Nursing staff administered and recorded medicines. There had been concerns as to the accuracy of the recording of medicines raised by the local authority and some medicines had been found to be out of date. At this inspection there were still some topical medicines out of date and stored insecurely. Medicines Administration Record (MAR) charts were not always completed and some had gaps in the administration records.

Where people had medicines administered covertly staff did not ensure the foods containing the medicines were fully consumed by the person.

Some medicines were retained at the service after people left the home, against the home’s own medicines policy.

Medicine storage room temperatures were recorded daily, however, there was no guidance on the record chart for staff as to the acceptable temperatures or what to do if the temperatures were outside of the safe range.

People were able to manage their own medicines if they wished, staff also supported people in the minimum way possible, so people were able to remain independent with their medicines.