Archived: Saint Josephs Specialist Care Home

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.

We completed an unannounced inspection of Saint Josephs Specialist Care Home on 14 January 2015. A second day of inspection took place on 27 January and the manager was given notice the day before so they could make arrangements to be available at the service.

Saint Josephs is required to have 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.

Saint Josephs Specialist Care Home registered with the Care Quality Commission on 13 December 2013 and had not previously been inspected.

Saint Josephs 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 six people were supported to live at the service.

At this inspection we found risks associated with the use of restrictive physical interventions (RPI). RPI was being used by staff to restrain people in the service when their behaviour was causing a risk to themselves or others. However, it was not being appropriately managed to ensure the safety of people using the service. Other plans to manage foreseeable risks, for example, how to keep people safe should the building need to be evacuated were also not in place. We also found records of accidents and incidents were not always completed or used to identify how risks could be reduced. Systems for the safe management and administration of medicines were not in place. Some people were prescribed medicine ‘as and when’ they required it but there were no guidelines in place to ensure staff administered this medicine consistently.

We found procedures were not effective at assessing and monitoring the quality of services and identifying, assessing and managing risks. Appropriate authorisations under the Deprivation of Liberty Safeguards (DoLS) had not been requested for some people living at the service.

Recruitment practices were not robust and staff started work before Disclosure and Barring Service checks had been received. Staff practice was not always consistent with the support identified in people’s care plans. This included having insufficient members of staff available to provide the level of support identified. Staff did not receive supervision as often as required and appraisals were not always fully completed to ensure staff members received comprehensive feedback on their performance. We found that staff were motivated and wanted to do their best for people using the service. However, some staff told us the length of time they spent at work due to a shortage of available staff and the lack of support they felt they received was having a negative impact on them.

People told us the manager and director were visible, however some people we spoke with told us they felt the management style was not open and approachable. One person who used the service had been worried about our visit because of what a staff member had told them. Some staff told us they did not feel the ideas they suggested to make improvements were listened to.

Families and other professionals were mostly positive about the service and told us about the amount of effort staff members had made to understand and support the people living at the service. However, some people told us they were concerned over the service not supporting people to access appointments with other professionals for health checks. No complaints had been received by the service since it opened. However, the service had not yet developed ways, other than through the complaints process, to gather feedback from people involved and to develop and improve.

People were supported to make healthy living choices and this included being able choose food that supported a healthy lifestyle. We could see that people’s views and preferences were understood by staff and that people had been supported to take an active part in some aspects of planning and reviewing their care. People’s independence was respected and supported and people took part in activities they enjoyed. People were also supported to gain confidence through participating in activities with staff support and motivation.

You can see what action we told the provider to take at the back of the full version of the report.