Archived: St Joseph

Updated 10 October 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by three inspectors. One inspector worked off site reviewing records and making phone calls to people’s relatives and with staff employed at the service. Two inspectors visited the service on 27 August 2020.

Service and service type

St Joseph is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager had left the service in August 2020 and the service was being managed by the area manager.

Notice of inspection

We gave a short period notice of the inspection because of the risks associated with COVID-19 and to ensure everyone remained safe during our inspection site visit.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people living at the home, four relatives and a healthcare professional about their experience of the care provided. We spoke with six members of staff including senior care workers, care workers, a cleaner and chef.

We reviewed a range of records. This included four people’s care records and three people’s medication records and medication audits. We looked at four staff files in relation to recruitment. We also looked at training data and quality assurance records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

During the inspection, we met and spoke with the area manager who had taken over managing the service since the registered manager had left. The area manager is also the nominated individual for the service. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We will refer to this person as the area manager throughout the report.

After the inspection

We continued to seek clarification from the provider to validate evidence found and continued calls as part of our inspection.

Updated 10 October 2020

About the service

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.