St Joseph's - Manchester

The facilities available within the service included private bedrooms with en-suites and communal living areas such as dining rooms, lounges and sitting areas. People also had access to a chapel, a library, an activities room, a hair dressing salon, a hall, a shop, a treatment room, a roof top garden and other well-maintained gardens on site.

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

People, relatives, staff and professionals told us the service was managed exceptionally well. People and their families felt relationships with the staff team were genuine and appreciated the kindness and support offered to them.

The service operated in a way that demonstrated there was an open and transparent culture at the service.

The home worked in tandem with other health professionals to make sure people received the right care and support to maintain good health. This was a priority for them. People’s dining experiences were superb on every day of our inspection and people told us meals were varied and tasty.

People were placed at the heart of the service and they recognised and fully appreciated this. Living at St Joseph’s - Manchester had helped people regain a sense of purpose. They were made to feel important and special.

Staff provided excellent care for people approaching the end of their lives, having received guidance and training from expert health professionals. This compassion and support was also extended to family members at difficult times.

The staff and management team showed a genuine understanding and compassion for the people they supported. They continuously sought to improve people’s experiences of care and strove to maintain safety and security for all.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home excelled at supporting people maintain relationships that were already important to them. It also helped bring people together and form new friendships often, though not exclusively, through shared beliefs and a strong faith.

Staff told us they received the leadership and direction they needed. There were regular meetings, supervisions and access to mandatory and bespoke training. Staff felt appreciated by excellent management, who led by example. Staff morale was high as all staff were happy working at the service and felt a valued part of the team.

The service had effective systems of quality assurance in place which continuously assessed and monitored the quality of the service. This included obtaining feedback from people who used the service, their relatives and professionals. The service promoted an extremely person-centred approach and excellent outcomes for the people who used it.

One of the provider’s values is the participation in the mission of hospitality to the elderly in a committed on-going way, following in the footsteps of its founder, Saint Jeanne Jugan. People living at St Joseph’s - Manchester and their relatives described to us in detail how excellent the home was and the positive impact the service had made to their lives and wellbeing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection we gave the service a rating of good (published 20 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

We last carried out an inspection at St Joseph’s - Manchester on 15 August 2014. We found the service was fully complaint in all five standards we inspected at that time and was meeting legal requirements.

St Joseph’s - Manchester provides nursing and personal care and accommodation for up to 53 older people and people living with dementia. There were 48 people living at St Joseph’s – Manchester at the time of our inspection. St Joseph’s - Manchester is one of eight homes in England run by the Little Sisters of the Poor congregation. Jeanne Jugan is the founder and first Little Sister of the Poor. The homes’ vision is to continue the inspiration of Jeanne Jugan in today’s world, to improve care for the elderly and to promote the elderly’s role in society. The Little Sisters of the Poor congregation adhere at all times to the philosophy and ethics of the Catholic Church.

There was a registered manager in post at the time of this 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.

Staff were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm.A system was in place to identify and assess the risks associated with providing care and support. People’s support plans and risk assessments contained personalised information about an individual’s needs and provided guidance for staff as to the support people needed.

The service had an excellent relationship with a local GP practice and one of these GP’s spent one morning a week in the home undertaking appointments or reviews of people’s medicines. This proactive approach meant that people’s medicines were reviewed in a timely manner and people were treated quickly when necessary or when the service identified the start of any potential illnesses.

People who used the service received safe care and support from a trained and skilled team of staff. The induction of new staff and ongoing training of others was robust and staff told us they received regular support from the registered manager and line managers.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People living at the home, their relatives and other healthcare professionals involved with the service said that the support staff were caring. On the day of our visits we saw people looked well cared for. There was a relaxed atmosphere in the home. The people we spoke with who were using the service, and visiting relatives, told us they were happy with the care provided.

People’s care plans contained information about their likes, dislikes and personal preferences and were person-centred. They contained details about how people liked to be supported in aspects of their care. We received one negative comment about the home not acting upon information provided by a person using the service with regards to a food intolerance.

During our visit we saw examples of staff treating people with respect and dignity. Staff promoted people’s independence by giving them choices and allowing autonomy when it was safe to do so. People using the service and their relatives were consulted and involved in assessments, care planning and the development of the service.

There were enough staff on duty to meet people’s support needs and to provide activities for them. People’s access to activities was very good; we saw that people were supported to get out and about on organised trips. People were encouraged to maintain relationships that were important to them and the service actively involved and welcomed family members to events held at the home.

We saw and people told us that their faith was very important to them and the home supported people to maintain their faith. This was helped by an on site chapel which was accessible to all.

Staff told us that they felt supported by the registered manager and their line managers. Formal supervisions and annual appraisals took place and staff we spoke with felt valued and listened to. Regular team meetings were also held and staff were able to raise any issues or concerns at these meetings. Staff were proud to work at the home.

The service had effective systems of quality assurance in place, which measured the outcomes of service provision. Systems were in place which continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

The recruitment procedure at the care home was robust and effective. All security checks had been completed before any new employee was allowed to start work at St Joseph`s. This helped ensure only people who were fit to work with vulnerable people were employed at the care home.

A whistleblowing policy was used at the care home and staff were aware of it. Two staff members we spoke with explained the policy to us. One told us, "I would go straight to the manager if I thought something was wrong."

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us an application for a DoLS had been made in July 2014. We saw the required paperwork had been completed appropriately and the application had been authorised by the local authority.

Is the service effective?

During our inspection we looked at five care plans for people who used the service at St Joseph`s care home. All five had been signed by the individual person. Consent forms for medication administration and the taking of photographs had been signed by the person. This showed the person had been involved in creating their care plans and agreed to them.

People`s needs were taken into account with the signage and layout of the service. This meant people moved around the care home freely and safely. The home had been adapted to meet the needs of people with mobility problems, for example wheelchair users.

Is the service caring?

Staff were patient and supported people in a caring, unhurried manner. Staff members interacted positively with people and encouraged them at all times.

Some people had limited mobility and we saw staff supporting them between rooms which kept the person safe from the risk of falls. Staff members took their time to understand people`s different communication styles which helped ensure people had their needs met in accordance with their care plans.

Is the service responsive?

People were involved in a range of social activities inside and outside the care home. St Joseph`s had its own minibus which enabled people to stay involved within their local community. We saw evidence that people had their religious needs met at the care home.

The complaints procedure was displayed on the walls around the care home. We looked at the last complaint received and saw it had been managed appropriately.

Is the service well-led?

The care home had effective procedures in place that monitored the quality of service provided to people who used the service. This helped ensure the service provided to people continued to improve.

We saw evidence that the care home worked well with other agencies. This helped ensure people received appropriate treatment when they needed it. One the day of our inspection, two community nurses attended the home.

Overall, we found people were happy living at St Josephs and made positive comments about the service. Comments included; 'I've been here a while now and I'm looked after very well. The staff treat me with respect and dignity which I like' and 'Excellent care. The staff show love, care and patience all the time. I feel my needs are met living here. The staff help me with my personal care and getting around the place as I'm not as steady on my feet anymore'.

We also spoke with visiting relatives throughout the day. Comments included; 'My 'x' is very happy living here. 'X' is always immaculately turned out. The general care, dignity and compassion here is outstanding. I think we were so lucky to be able to get 'x' in here. We have great confidence in all the staff'.

We looked at how people's nutrition and hydration requirements were met and observed part of the lunch time period. This was an organised occasion and people who required assistance to eat and drink were appropriately supported by staff.

We checked equipment at the home was safe for people to use and was well maintained. This included checks of hoists, slings and wheelchairs.

We looked at the systems in place to monitor the quality of service provision. These included regular audits, surveys and meetings between staff and people who used the service.

'The girls are always round the place. I'm never short of help. I never see any trouble whatsoever. Every one is friendly.....'

'It's a safe home, morning, noon and night.'

'Sometimes the staff are not very sympathetic and on one I was spoken to sarcastically.'

'The meals are always delicious.'

One person commented they didn't get any fruit and that an alternative was not provided.

'I'm quite comfy and quite happy with things the way they are. A doctor came to see me. Thanks be to God I'm healthy.'

'My daughter comes every week. I would talk to her but everyone is very good and very kind.'

Relatives of the people who used the service said they were very happy with the way their relative was looked after. One person described the staff as 'very approachable'. Their comments included:

"The home was recommended to us and when we visited we fell in love with the place. She has a lovely bedroom and it is kept immaculate. She has family pictures all over the place and her own armchair. She loves it here. It's a very stable staff.'