We inspected this service on 17 September 2018, and the inspection was unannounced.

St Catherine’s Bungalows are part of Father Hudson’s Care, which is the social care agency of the Catholic Archdiocese of Birmingham, a registered charity. St Catherine’s Bungalow’s consists of three purpose built separate bungalows. Each bungalow provides accommodation, with personal care and support, for up to a combined total for 16 adults with a learning disability. At the time of this inspection, 15 people were living there.

A requirement of the services’ registration with us is that they 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. At the time of our inspection visit, there was a registered manager in post.

At the last inspection in January 2016, the service was rated as Good. At this inspection we found people continued to receive a service that was effective and responsive to their needs. However, pressures on staffing levels, which required, the registered manager and assistant managers to cover care shifts had impacted on their managerial oversight of the services provided. The safety and leadership of the service had not been sustained. We identified a breach of the Health and Social Care Regulations that related to how well led the service was. We gave an overall rating of ‘Requires Improvement’.

Staff did not manage medicines safely and people did not always receive their medicines as prescribed. Checks on the safe handling of people’s medicines were not effective.

The provider did not have effective systems in place to monitor the quality and safety of the service people received. The provider did not undertake effective quality monitoring visits to the service.

Risks were identified and risk management plans were in place to support staff to mitigate the risks of harm or injury to people.

Staff recorded when accidents or incidents occurred. However, these were not analysed by the provider or registered manager. There was no system in place to ensure appropriate action was taken to learn from when things went wrong and minimise risks of reoccurrence.

There were sufficient staff on shift who had been recruited in a safe way so as to ensure people were not placed at risk of abuse, harm or injury.

The home was clean and tidy and was purpose-built to meet people’s individual needs.

Staff received training and, overall, used their skills, knowledge and experience to support people. However, staff did not consistently follow all of the training they had been given.

The principles of the Mental Capacity Act (MCA) were followed by the registered manager and staff.

Staff understood their responsibility to report any concerns they had about people’s health and wellbeing.

People were involved, whenever possible, in making decisions about their care and encouraged to express their views.

People had personalised care plans that were detailed and provided staff with the information they needed. People’s concerns and complaints were listened to and responded to.

People were supported at the end of their life by staff who worked in liaison with visiting healthcare professionals.

This inspection took place on 28 January 2016 and was unannounced.

St Catherine's Bungalows are registered to provide care and accommodation for up to sixteen people with a learning disability. The service is provided across three separate bungalows. At the time of our inspection visit there were sixteen people living there.

The service had 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.

People were comfortable with the staff who supported them. Relatives were confident people were safe living in the home. Staff received training in how to safeguard people from abuse and were supported by the provider who ensured safeguarding policies and procedures were in place, and acted on concerns raised. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were identified, minimised and flexed towards individual needs so people could be supported in the least restrictive way possible and build their independence.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed. Regular checks helped ensure medicines were administered safely.

There were enough staff to meet people’s needs effectively. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they had not been able to work until these checks had been completed.

The provider worked with specialist staff to ensure assessments were in place for people who lacked capacity to make decisions so they were protected. Staff and the registered manager had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people before delivering care and support.

Staff were respectful and treated people with dignity and respect. We observed this in interactions between people, and records confirmed how people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals when needed and we saw the care and support provided in the home was in line with what had been recommended. Health professionals told us they were confident the provider managed people’s health effectively. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. People were involved in how their care and support was delivered as much as possible, and where people were unable to communicate their views, staff talked to people’s families or their reprsentatives to ensure people’s care was appropriate to their needs.

Relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems to monitor the quality of the support provided in the home. The provider ensured that recommended actions were clearly documented and acted upon by undertaking regular unannounced visits to the home. As a result, improvements were being made to the service.

On the day of our inspection there were 16 people who lived at the home, which consisted of three separate bungalows. We talked with the manager and looked in detail at the care records for two people. We visited on a weekday and we spoke with two visiting professionals and two relatives. We spoke with the nominated individual and two members of staff.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

Staff understood their role in safeguarding the people they supported. This meant people were kept safe. We saw people were cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of people who lived at the home. There were procedures in place to safeguard people from abuse.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that proper policies and procedures were in place. The manager had an understanding of these safeguards which ensure people’s rights and choices are protected.

One member of staff told us, “Residents are happy and healthy, I’d be happy for my family to be here.”

Is the service effective?

We looked at the meals provided to people. We saw people had a good choice of meals. We were told that people’s food was served in a way that supported them to eat safely. For example, some people had soft food or pureed diets because they had been identified as being at risk of choking.

We saw that people were treated with dignity and care. Care plans were linked to people’s individual needs, for example, in relation to nutrition and mobility. Staff had a good understanding of people’s care and support needs and knew them well. The service worked well with other agencies and services to make sure people received their care safely and effectively.

A relative told us, “I think it’s wonderful, and they treat X very well indeed.”

Is the service caring?

All staff were aware of peoples choices, preferences and support needs. We found the care and support was delivered with dignity and respect, and was very person centred. We saw the staff and manager were patient and gave encouragement when supporting people.

All the staff we spoke with expressed compassion and kindness towards the people they supported. A visiting professional told us, “They are absolutely superb. The quality of care is very good. A full thumbs up.”

Is the service responsive?

We spoke with the manager who told us she involved other professionals in people’s care when their needs changed. This meant their care could continue to be provided safely and appropriately. Staff were aware that people’s needs varied throughout the day and responded accordingly. A relative told us, “They are very good, we have regular monthly meetings. It’s the best place I could find for my child.” A visiting professional told us, “Any issues with the residents are dealt with immediately, any suggestions I make are taken into consideration.”

Is the service well-led?

There was a clear structure of supervision responsibilities within the staff team. Staff we spoke with told us they thought the manager was approachable and provided good support. The manager was aware of her responsibilities in meeting the essential standards of quality and safety.

We looked at quality assurance systems. The systems in place to ensure the quality of the service was regularly assessed and monitored were not robust. This meant that the shortfalls in the service had not been identified and addressed to ensure ongoing improvement for the people living there.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

Some people had complex communication needs and were not able to verbally communicate with us. We therefore used a number of different methods to help us understand the experiences of people who used the service. This included talking to people, looking at records and observing the care being delivered. During this visit we spoke with two people who used the service, a visiting family member and five members of staff.

We saw that relationships between people, staff and the managers were positive and friendly and people appeared relaxed and comfortable in their surroundings.

People had care plans in place that contained information to assist staff with meeting their care and support needs. Staff members we spoke with knew about people's needs and were able to tell us about them.

A visiting family member told us, “I am so pleased with the care my relative receives here.”

People were supported to take part in recreational activities that were interesting and stimulating so that they had a meaningful lifestyle. People were able to choose what activities to be involved in, for example, shopping, eating out, swimming and going on holiday.

Systems were in place to ensure that medicines were managed appropriately on people's behalf.

A visiting family member we spoke with confirmed they knew how to make a complaint if they needed to. They said, “Any issue I’ve raised regarding X’s care has been dealt with immediately.”

We visited St Catherine's Bungalows on 14 May 2012. The visit was unannounced so that no one who lived or worked in the home knew we were coming.

The home is made up of three separate bungalows, each of which has a designated staff team. We spent time in each of the bungalows and spoke with some people who lived there and members of staff on duty during our visit. We sampled three sets of care records across the three bungalows and spoke with the manager of the service.

Many people who live at St Catherine's Bungalows have complex communication needs and we were not able to speak with them to understand their experience of living in the home. We observed the interaction of members of staff with people and saw that people were relaxed and comfortable with the staff team.

We looked at care records and found that people's needs had been assessed and risks to their health and well being identified. Measures had been implemented to make sure people were not subject to the risk of harm.

We saw there were rooms available for people to spend time in which had been fitted with sensory equipment to help them unwind. Staff told us people enjoyed this experience.

We observed many personal touches around the home. There were photographs of people taking part in activities and picture menus to help people make choices about the meals and drinks. We saw that people had adapted seating so that they could relax and take time out of their wheelchairs.

Some people told us about the range of activities they had taken part in such as going out for meals, making cakes and doing the garden. We saw that records had been completed which described people's interests and the arrangements in place to make sure they had opportunities to undertake them.

The staff we spoke with told us they enjoyed working at the home and felt well supported by the manager. We were told that training opportunities were frequent and planned to ensure staff had sufficient skills and knowledge to meet people’s needs.

We saw there were systems in place which measured quality within the home and that improvements had been made as a result of audits and surveys.