Archived: St Joseph

St Joseph is a residential care home providing personal and nursing care to 12 people aged 65 and over at the time of the inspection. The service accommodates people in one adapted building and can support up to 15 people.

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

The provider remained in breach of the regulations due to poor risk management in relation to the safety of the premises, infection control concerning COVID-19, fire safety and failing to ensure risks related to people’s needs and incidents at the home were always effectively assessed. The provider did not adequately review incidents to look for potential themes and to ensure all necessary action was taken to keep people safe. People and relatives felt the service was safe and staff we spoke with knew how to respond to safeguarding concerns, although not all staff had received training in this area and other areas related to the safety of the service. Feedback indicated there were not always enough staff to support people safely. Processes for staffing levels and recruitment were not robust. Medicines audits had helped promote safe practice although we identified some further improvements needed. Improvements were underway to the safety of the premises yet we identified further hazards which we asked the provider to address.

The provider remained in breach of another regulation because systems and processes failed to ensure the quality and safety of the service. We needed to prompt the provider to address shortfalls in the safety of the service, some of which they had identified but not addressed. Systems had also failed to ensure risks were adequately assessed and that records in relation to risks were accurately maintained. We identified the provider was in breach of a third regulation because CQC had not been notified as required about specific incidents and events concerning three people living at the home.

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 27 June 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on breaches identified at the last inspection in March 2020.

We carried out an unannounced comprehensive inspection of this service on 11 March 2020. 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 and good governance systems.

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 remains as Inadequate. 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 Joseph 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 continued breaches in relation to safe care and treatment and good governance at this inspection. We also identified a third breach in relation to the provider’s requirement to notify CQC about specific incidents and events at the service.

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

After our inspection we made a referral to West Midlands Fire Service and informed the local authority of our inspection findings. We will continue to work with partner agencies and 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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 five key questions it will no longer be in special measures.

St Joseph’s is a residential care home providing personal care to 15 people aged 65 and over some of whom are living with dementia in an adapted building consists of 11 single rooms and two shared rooms. At the time of the inspection there were 14 people using the service.

The current registered manager of St Joseph’s has made an additional application to CQC, to become the registered manager of another of the providers homes. They are currently overseeing the running both services. This arrangement is not effective in ensuring good outcomes for people. The provider is legally responsible for how the service is run and for the quality and safety of care provided.

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

Since our last inspection some improvements to the environment, to meet the needs of people living with dementia had been made. However, we found some areas requiring improvement had not been met.

We found a fire risk assessment undertaken by an external fire safety risk assessor in May 2019 had not been acted upon, putting people living or working at the service, at risk.

Audits carried out by the service did not include checks on the environment for things such as; Infection prevention and control, the condition of and suitability of furniture, items being stored inappropriately which posed a risk to people and areas of improvement within the home.

We found medication management was not always robust and correct procedures were not always followed for the safe receiving and recording of medication.

During the inspection we saw poor standards of infection control. Some people’s assessed need for a specialised dietary needs were not always adhered to putting people at risk of choking.

People we spoke to told us the food was very good, they had choice and enjoyed the meals.

Risk assessments within peoples care plans were not always up to date and did not reflect peoples current need of support.

We saw new staff members were not supported with a robust and safe induction prior to commencing supporting people. We also found the recruitment process was not always followed to ensure those working had all necessary checks completed prior to commencing working.

We saw and were told by people that they felt they were cared for during our inspection. However, we saw people’s privacy was not always respected.

Activities did take place and some who took part did appear to enjoy them but there was no evidence to show these were activities of people’s choice. No feedback of what people enjoyed or liked was gained or documented to enable the provider develop activities in line with people’s wishes.

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

The last rating for this service was Requires Improvement (published 25 April 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve the service.

At this inspection enough improvement had not been made and the provider was still in breach of regulations and is now rated as inadequate. This service has been rated requires improvement for the last three consecutive inspections and we continue to have serious concerns. The service has a track record of failing to provide good standards of safety and it does not assess or properly manage environmental and equipment risk.

Why we inspected

This was a planned inspection based on the previous rating.

Some actions were taken by the provider to mitigate the risk, during the inspection.

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

Enforcement

We have identified breaches in relation to the safe care and treatment of people using the service and poor systems and process’ to assess, monitor and improve the quality and safety of the service and mitigate risks at this inspection.

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.

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.

We are mindful of the impact of 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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

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 five key questions it will no longer be in special measures.

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.

St Joseph is a care home that provides personal care for people, some of whom are living with dementia. St Joseph’s is registered to provider care for up to 15 people; there were 13 people living at the home on the day of the inspection.

The registered manager left St Joseph’s in September 2018 to work at the one of the providers sister homes. A new manager is in place and has submitted an application to CQC to become the registered manager. The provider is legally responsible for how the service is run and for the quality and safety of the care provided.

People’s experience of using this service:

• Some improvements had been made in the areas we identified following our previous inspection in August 2017. However, we found that some areas requiring improvement had not been addressed. For example, at the last inspection we recommended that the service explore the relevant guidance on how to make environments more 'dementia friendly.’ At this inspection the required changes were not in place and although the provider had a home improvement plan in place, giving the timescales for the ongoing redecoration of the home no reference was made to providing a 'dementia friendly' environment.

• Improvement was required to ensure facilities and equipment were safe and any required work was carried out in a timely manner. For example, we saw a delay in required work to the passenger lift.

• The provider had quality assurance systems in place, however they were not fully effective as they had failed to ensure action had been taken in a timely way.

• People were supported by staff to stay safe and who understood the need to ensure they consented to the care they received.

• People were cared for by staff who treated them with respect and dignity and encouraged them to maintain their independence.

• Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.

• People’s consent was sought before providing support. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and what this means for people.

• People felt staff listened to and acted on their choices and felt involved in the running of the home, for example, people had been involved in planning the redecoration of their rooms.

• Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing.

• Staff felt supported and said they could talk to management at any time, feeling confident any concerns would be acted on promptly.

• People spoke positively of service and relatives said improvements had been made since the last inspection.

• The provider had a home improvement plan in place, which showed the timescales for the planning redecoration of the home and the planned areas for refurbishment.

• The service worked in partnership and collaboration with other key organisations to support care provision.

Rating at last inspection:

At the last inspection we rated St Joseph as ‘Requires Improvement’ (report published 24 January 2018). At this inspection the overall rating has remained as ‘Requires Improvement.’

Why we inspected:

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

Enforcement:

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

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

There was a registered manager in post and they were present at the time of the inspection.

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.

Although people told us they felt safe at St Joseph’s we found risks to people’s health and safety were not always managed safely. Both the registered manager and staff told us they thought there were times when staffing levels were insufficient to meet people’s needs however we saw people’s needs were being met by staff. People were cared for by staff who understood the signs of potential abuse and how to report any suspected abuse. We found the provider operated a safe recruitment system which meant people were supported by staff who were suitable to work with people living in the service.

Although staff had received training it was not always effective in providing the knowledge and skills to support people in the service. The registered manager had protected people’s rights when they lacked capacity to make decisions about their care. Staff were not aware of who had restrictions on how their care was delivered. People had mixed views about the food at the service, however we saw people enjoyed the food and they were given choices. People’s nutritional needs were being met. When people’s health needs changed they had access to other healthcare professionals.

Although people told us staff were kind and caring we saw people spent periods of time with no interaction from staff and there were missed opportunities for staff to interact with people. People told us their privacy and dignity was respected by staff. People were encouraged to maintain relationships that were important to them.

People had mixed views about the opportunities available to spend their leisure time. Although we saw people engaged in group activities we saw no evidence that activities were tailored around people’s individual preferences. People told us they were happy with the care they received. Relatives told us they were involved in the care of their family members. The provider operated a complaints system should people have concerns about the care they received.

Improvements were required in the governance system operated by the provider. People told us the service was well led. Staff were supported in their roles and were involved in the running of the service. People told us they were happy living at St Joseph’s and felt they could approach the registered manager and staff should they need to.

At this inspection we looked at the medicines for three people, spoke to one member of staff and the acting manager. We saw that people were relaxing in the lounges. Some were watching television, one was reading a newspaper and one was chatting with a visitor.

We saw that systems had been put in place to improve the management of medicines. Staff we spoke with were aware of the new systems and using them. We saw that audits pf boxed tablets were carried out on a daily basis. The storage of medicines ensured that medicines were stored safely and at the required temperatures. Protocols had been put in place to ensure that medicines that were administered on an "as and when required basis"were given in a consistent way by staff. This meant that people received their medicines as prescribed.

People we spoke with told us positive things about the home. One person told us, 'The food is great.' Another person told us, 'All staff are very good. No complaints from me.'

We saw that staff treated people with respect and dignity. Staff spoke with people in a respectful way using their preferred names. People were relaxed in the presence of staff. We saw that people were supported to make choices and their decisions were respected.

People's care needs had been assessed, staff were aware of people's needs and plans were in place to deliver care in a personalised way.

People's health care needs were met through community health services. There were systems in place to identify and manage risks to keep people safe.

People received their medicines as prescribed but the management of medicines in the home could be improved.

Systems were in place to monitor the quality of the service on an ongoing basis.