St Josephs Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance of risk at the service and poor managerial oversight.

This service scored 54 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.
The provider based the care at the home on Christian principles, the registered manager told us this did not mean staff were required to be Christian, rather that staff were expected to be kind and honest. The registered manager told us they reminded staff to be calm and quiet to retain the tranquil feel of the home.
People told is they appreciated the religious culture of the home. A person said, “I know there are better places with more modern facilities and more to do, but for anyone who is catholic I would recommend this place. I could go to the chapel twice a day if I wanted to.”
The provider employed staff from varied backgrounds and ethnicities and worked with staff who had disabilities to ensure they could be confident in their roles.
 

The provider had inclusive leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.
Staff and leaders were passionate about care and ensuring a kind and calm environment. However, there were unclear goals at the service. Staff told us that while the registered manager was compassionate, they were unsure that they were proactive in managing the home. The registered manager had recently begun to include staff opinions, via a survey, in changes at the home, but this had not always been the case and some staff told us they did not feel included. A staff member said, “As carers we do our best. I would like more meetings with management so we can share our views. I don’t like a ‘them and us’ culture, we should be a team.”
 

People did not always feel they could speak up and that their voice would be heard.
Staff were happy to speak to CQC, but we received mixed opinions on whether staff felt they could talk to the registered manager. Some staff told us the registered manager did not listen to staff or they did not think it was worth mentioning ideas as nothing happened in the past when they made suggestions. One staff member said, “Carers have made suggestions with regards to residents getting out and about, and management do not listen.”
However, another staff member said, “The manager is good, if I need something I just go and ask.” Staff all told us they were confident to raise safety concerns with the registered manager or provider. However staff did not always notice issues that should be raised with the registered manager as safety issues.
The registered manager hoped to improve staff confidence in speaking up about any issues, not just safety, by demonstrating changes suggested were acted on. ‘
 

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.
The registered manager told us they supported all staff to be able to work to their best ability. They included disabled staff and staff from other cultures in the staff team and worked to ensure that everyone felt welcome and confident in their roles. A staff member told us, “I get on OK with the other staff, there can be trouble but not often, we all get on.”
 

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.
The registered manager lacked oversight of the governance systems in place at the home. Audits were not effective at discovering risk, or inconsistency in care plans. Care plans were kept on both paper and electronic systems and there was no oversight to ensure continuity of information. The registered manager was quick to react when shortfalls were found, and since the inspection they had produced an action plan and had addressed urgent safety issues. The provider and the registered manager acted quickly to concerns identified, however the systems and procedures at the home had failed to identify these issues.
 

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. However, they did not always share information and learning with partners or collaborate for improvement.
The registered manager usually notified CQC when necessary and worked with the local authority quality monitoring team to improve care at the home. However, the local authority told us about safeguarding concerns that the registered manager of St Josephs had not notified us about.
The registered manager was a member of a local registered managers’ group where they discussed care. The provider had recently begun working with outside consultants to improve the service and to address safety issues. They had shared information used to improve a similar service.
 

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.
Staff learned via a mix of online training and shadowing experience staff. Staff were not prompted by the provider to complete mandatory training, and staff lacked monitoring and feedback via one-to-one meetings with the registered manager.
Although the registered manager met with other managers in the region, there was no evidence this led to improvement or change of practice at the home.
People lacked meaningful activities and staff told us this was frequently raised with the management, and nothing had changed. At this assessment we spoke to staff who told us how they were passionate about care, but felt staff were not always listened too. One staff member said the provider was ‘stuck in the past’. The registered manager told us they had recently employed a member of staff to act as activities coordinator although they had yet to start in that role.
A lack of appropriate audits had left risks at the home. The registered manager had reacted quickly to improve safety at the home, however there was a lack of innovation or proactive investigation of risk.
Staff told us how they felt there was potential in the home, but a lack of engagement from the registered manager and the provider. A staff member said, “There is room for improvement at any place you go to, but if we work together this could be amazing.”