Archived: St Josephs

Updated 4 October 2016

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.

The inspection took place on 24 August 2016 and was unannounced.

The membership of the inspection team included two inspectors and a specialist advisor. Our specialist adviser was a nurse with expertise in end of life care and wound care.

Information was gathered and reviewed before the inspection. This included statutory notifications. These are events that the care home is legally required to tell us about.

The methods that were used included talking to people using the service, relatives and interviewing staff. We also undertook observations of care and support and reviewed care plans. We also examined other records in relation to the running of the service. We spoke to two visiting health professionals, nine people living in the service, one relative, eight staff as well as the manager, deputy manager and regional manager.

Updated 4 October 2016

The inspection took place on 24 August 2016 and was unannounced. The previous inspection of 27 July 2015 found the service required improvement. There were breaches in regulation that related to staffing levels, the environment and the systems in place to oversee quality and drive improvement. We followed up these areas at this inspection.

Since the last inspection there has been a change of provider and the new management team had begun to introduce new systems and procedures. We found substantial progress had been made but the service was not yet providing safe and effective care for all the people who lived there. The environmental issue raised at the last inspection about access to and from the annex was not yet resolved. Therefore the requirement from the previous inspection remains outstanding. The provider has told us that there was a risk assessment in place to reduce the likelihood of harm and no admissions were planned to this part of the service. People living there had the opportunity to move into the main building and they were planning to undertake changes to the building to improve access although this requires approval from the planning authority. Therefore we plan to monitor this matter going forward, but will not escalate our powers of enforcement.

St Josephs is a care home for 60 older people some of whom are living with a diagnosis of dementia. The unit that accommodates people living with dementia is called Gainsborough and has twenty seven bedrooms and a separate living space. The service also has an annex with a separate living area which adjoins the main home. On the day of our inspection there were 46 people in total living in the service.

A manager was new post and had commenced employment three months prior to the inspection. The manager told us that they had made an application for registration to become the registered manager for St Josephs. 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.

People told us that they liked living in the service and that they felt safe and well cared for. Staffing levels had been identified as problematic at the last inspection but we found improvements had been made. People were supported by a stable staff team and there were sufficient numbers of staff available to respond to people’s needs and keep them safe. Robust recruitments systems were in place to check on new staff suitability for the role.

Medicines however were not consistently well managed and while we found examples of good practice we also found omissions in the management of controlled medications and topical creams. The manager had already identified the issues about creams and had a plan to address this. They took steps to immediately address the other issues by undertaking supervisions and increased auditing.

Risks were identified and there were systems in place to ensure that people at risk had access to equipment to protect them, such as hoists and pressure relieving mattresses. Checks were undertaken to make sure that equipment was working effectively and the environment was safe.

A programme of training was underway to ensure that staff skills and knowledge was up to date. While this was not yet complete and there remained some shortfalls, there was greater oversight and more effective planning.

People had good access to health care professionals when they needed support or treatment. However we found that the support provided to people with specific health conditions such as diabetes needed to be strengthened and staff provided with clearer guidance to prevent harm.

People liked the food and the meals served looked nutritious and nicely presented. People told us that they had good relationships with staff and felt listened to and respected. Efforts were made to retain people’s independence and autonomy. Care plans were in the process of being rewritten in the new provider’s format but this was being undertaken in a managed way to ensure continuity of care. Those we saw were generally informative and reflected people’s choices and preferences.

People had access to activities which promoted their wellbeing and there were systems in place to ascertain their views about the care they received.

Everyone we spoke with including staff, relatives and people living in the service expressed confidence in the new management of the home and the more open approach. Staff were motivated and positive. The manager was clear about the areas that needed to develop and was involving people and staff in the process. Audits were undertaken to identify shortfalls and some of the areas we identified were areas that the manager was aware of and had an action plan in place setting out how they intended to improve.

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