Archived: Saint Josephs Specialist Care Home

Updated 13 October 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 11 May 2015 and was unannounced. The inspection team consisted of two inspectors. We carried out this inspection in response to some information of concern that had been shared with us.

We observed the care provided to four people living at the home and spoke directly with one person. On the day of the inspection we spoke with two visiting social care professionals and one health care professional who were involved in supporting people’s care at Saint Josephs Specialist Care Home. We spoke with five members of staff, including the new manager and the provider.

We observed how staff spoke with and supported people living at the service and we reviewed the care records for the five people living there. We reviewed other management records relating to the care people received. This included staff recruitment and supervision records, accident and incident records and medicines administration records.

Updated 13 October 2015

We completed an unannounced inspection of Saint Josephs Specialist Care Home on 11 May 2015. We had previously inspected the service in January 2015, where we found breaches in the regulations for people’s care and welfare, assessing and monitoring the quality of service provision, safeguarding people and providing sufficient staffing to meet people’s needs. We took enforcement action and issued warning notices in respect of these regulations. We also found breaches in the regulations relating to the safe use and management of medicines, people’s consent to care and treatment, record keeping, recruitment practices and supporting staff. We made compliance actions against these regulations and at this inspection. At this inspection we found the improvements we required had not been made.

Saint Josephs Specialist Care Home is required to have a registered manager. At the time of our inspection in May 2015 there was no registered manager in place. The former registered manager had left the service on 22 March 2015. 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.

Saint Josephs Specialist Care Home is a care home for up to seven younger adults with learning disabilities or autistic spectrum disorder who require specialised care and support. At the time of our inspection five people were supported to live at the service. People using the service had a range of complex needs in relation to their communication and behaviour.

At this inspection we found inappropriate physical restraint practices and other restrictions were used and had not been detailed in people’s care plans or risk assessments. Appropriate safeguarding processes had not been followed and the provider’s responses to deal with allegations had not protected people from the risk of abuse.

Staff did not know the best way to keep people safe should an emergency evacuation of the building be required. The procedure introduced for staff to identify what area of the building had an activated fire alarm was unsafe and inappropriate. The premises, fixtures and fittings required repair and the provider was not clear when this was going to happen.

The provider’s staff recruitment processes did not ensure staff were safe and suitable to work with the people living at the home. The provider also failed to deploy sufficient numbers of staff to meet people’s needs in a safe way.

Storage of medicines was not adequate as the security of the storage had been compromised through a damaged door. Medicine audits were not effective and medicines that should have been returned to the pharmacy had not been identified. Guidance to ensure people received medicines that they needed, ‘as and when required,’ were not in place. We were not always able to tell if people had received their medicines as prescribed because of recording errors.

Staff did not have adequate knowledge of people’s needs and health conditions. Staff with responsibility for caring for people with complex needs had not read the care plans and risk assessments on how to meet their needs. Revised guidance and information on people’s complex needs was not available for staff to reference. Staff did not receive induction or supervision to ensure they had the right skills and knowledge to support people using the service.

The Deprivation of Liberty Safeguards (DoLS) had not been followed and policies were out of date. The DOLS are a law that requires assessment and authorisation if a person lacks mental capacity and needs to have their freedom restricted to keep them safe. The provider had not recognised or considered that people at the home may have been cared for in a way that deprived them of their liberty. For example, by the use of restraint and restrictions. The requirements of the Mental Capacity Act (MCA) had also not been met. The MCA is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves.

We were not assured people always had a balanced diet as accurate records had not been kept. We also found that people missed health check appointments because the system to manage appointments was not effective. People’s health care needs were not always monitored and assessed appropriately.

People were not consistently supported by caring and kind staff who respected them. Some staff had been swearing while working with people. Some people had experienced stressful events and we could not see evidence to demonstrate they had always been emotionally supported afterwards. We were concerned that people felt pressurised by staff and staff did not listen when people made their own choices. We found people’s privacy was respected.

Opportunities to learn from complaints were not taken, and the provider had not sought the views of people using the service, families, staff or other professionals about the care being delivered or service provided.

The culture of the home was not open or inclusive. The views of staff had not been acted on when opportunities to improve the service could have been taken. Staff were not supported to question their practice and resources were not used to ensure improvements to staffing levels were effective. The provider did not notify CQC about incidents that it was legally required to do so.

The service did not provide people with care that met their needs and promoted their rights and quality assurance systems were inadequate. Records regarding people’s care and welfare had either not been retained by the service or comprehensively completed. Systems and processes to record, assess, analyse and mitigate risks and promote people’s well-being were not being followed.

Following our inspection, the local authority supported people to move from the home to other accommodation. At present, there are no people living at the home.

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