Care service description

St James Care 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.

St James Care is registered to accommodate up to 16 people who have mental health needs arising from their alcohol dependency and who want to continue to drink. It is owned and managed by the Society of St James, a major charity in south Hampshire supporting homeless people and people with needs arising from alcohol and substance dependency.

Rating at last inspection

At our previous inspection in May 2016, we found the service met the requirements of the regulations and was good overall, but there were improvements to be made with respect to measures in place to make sure people were safe. At this inspection the provider had made improvements in this area, the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Rating at this inspection

At this inspection we found the service remained good overall and had improved to outstanding in responsive.

Why the service is rated good

People’s care and support achieved outstandingly positive outcomes. People with complex needs received support to achieve goals which in some cases were genuinely life changing and life saving. The service was valued by other professionals as a unique residential care service for people with long-standing alcohol dependency.

People were protected against risks to their safety and wellbeing, including the risk of abuse and inappropriate care, risks associated with medicines, and the risk of the spread of infection. There were sufficient suitable staff deployed to support people safely. There was a positive attitude to learning from incidents and near misses.

People were supported by staff with the relevant skills and knowledge. Care and support were delivered according to detailed and up-to-date assessments and care plans. People were happy with the food and choices offered. The provider worked with other services for people to access the healthcare services they needed. The provider complied with legal protections in place for people who lacked mental capacity. 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.

There were positive, caring relationships between people and the staff who supported them. The provider supported people to be actively involved in decisions about their care and support. The service people received had a very positive impact on their dignity, independence, self-esteem and confidence.

There were appropriate management systems in place, and staff were motivated in a supportive, empowering atmosphere. The provider engaged people who used the service and staff to identify improvements. There were excellent relationships and partnerships with other health and social care services.

Further information is in the detailed findings below.

We carried out this unannounced inspection on the 4, 6 & 18 May 2016. St James Care provides accommodation and support for up to 16 people with mental health issues associated with alcohol dependency. The Society of St James provides support for people to manage their alcohol dependency safely and support people who are homeless. At the time of our inspection there were 14 people living at the home.

There was a new manager in post who was in the process of becoming registered with CQC. 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.

We found people’s safety was compromised in some areas. There was no hand sink in the laundry as recommended by the Department of Health’s guidance on infection control. However, the home had acted promptly and a sink had been installed while we were carrying on the inspection. The risks to people were minimized through risk assessments and staff were aware of how to keep people safe. However, risk assessments were not robust enough for people who smoked in their bedrooms. Relevant recruitment checks were conducted before staff started working at St James Care to make sure staff were of good character and had the necessary skills. However, there were unexplained gaps in staff employment histories.

There were enough staff to meet people’s needs. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. People were supported to receive their medicines safely from suitably trained staff and medicines were stored, administered and audited effectively.

Staff received regular one to one sessions of supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an appropriate induction programme before being permitted to work unsupervised.

Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day. People were able to access healthcare services.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

The manager maintained communication with people through residents meetings. They consulted people about all aspects of the service and acted on their feedback. People were supported and encouraged to make choices and had access to a wide range of activities. The provider sought feedback through the use of quality assurance questionnaires and used the results to improve the service. The provider and manager used a series of audits to monitor the quality of the service.

A complaints procedure was in place. There were appropriate management arrangements in place and staff felt supported.

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was unannounced. When we last inspected the service on 01November 2013 we had found they were in breach of regulation 12, cleanliness and infection control. The provider produced an action plan to show how they intended to improve the service. At this inspection we confirmed that the actions the provider told us they would take to address these concerns had been actioned. St James Care is a registered care home specialising in care for people with mental health issues associated with alcohol dependency. The Society of St James provides support for people to manage their alcohol dependency safely when they do drink and support for people who are homeless. The service provides accommodation and personal care for up to 15 older persons over the age of 50. Due to tragic unforeseen circumstance there is currently no registered manager in place. An acting manager had been appointed and a permanent manager had just been appointed. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff understood the needs of the people they supported. They told us how they encouraged and enabled people to be as independent as they could be. People were able to contribute to their care planning. Staff were aware of people’s preferences and encouraged them to make choices when possible. Staff spoke with people in a caring, compassionate way and were attentive to people’s needs. People told us they got on well with staff and felt they were treated well. Where people did not have the capacity to make particular choices, meetings were held to agree decisions made were in the person’s best interest.

Staff received appropriate checks prior to working with people to ensure they were suitable. They received a comprehensive induction and had access to a wide range of training events. They received regular supervisions and support where they could discuss their training and development needs. The provider had appropriate recruitment processes and made sure staff were trained and supported to deliver care required.

People were able to manage their alcohol intake in a safe and monitored way by drinking within the service. They were involved in agreeing the amount and the strength of the alcohol they drank. This meant people did not go into withdrawal or become too intoxicated. Health professionals were available to support people with their dependency.

People’s changes to their care and support needs were recorded in their personalised care plans. They were able to contribute to discussions around their care and could change make changes to their care plans by talking to staff. The provider asked people for their opinions on the quality of care they received and responded to comments and complaints received in a timely and appropriate manner.

There were appropriate management arrangements in place and staff and people told us they had no problems in talking to managers about any concerns. People were actively involved in developing the service through regular meetings with staff and the provider. Regular audits of the quality of the service were carried out to ensure the safety and welfare of people. There were sufficient numbers of staff to meet the needs of people.

People who used the service told us they were satisfied with the care and support they received. They said staff made sure they were given information about and understood the service, and they were able to come and go as they wished. People told us their rooms and other facilities met their needs and were kept clean. They were complimentary about the staff. One person said, “They are good people here.”

A social care professional told us they were impressed by the service provided to a “niche population” with “unique needs”. They confirmed people were involved in the planning and delivery of their care. A family member visiting their relative said, “Everything’s fine. They are lovely.”

We found the staff were caring and responsive, respected the people using the service and involved them in their care and support. People were protected against risks associated with the management of medicines. Staff were supported to provide care and support that met people’s needs. The premises were suitable for the provision of safe care and were kept clean. However the service was not following Department of Health guidance on the prevention and control of infections.

At our previous inspection in December 2012 we had found that essential standards were not being met with respect to safeguarding people who used the service from abuse. During this inspection we checked that actions had been taken to address this. We also inspected other standards as part of our planned schedule of inspections.

People using the service told us they were happy with the care provided and staff made sure they had agreed to their care. They knew they could complain about the service if they had reason to. One said they were confident any problems raised would be dealt with. A healthcare professional told us the service cooperated with other providers effectively.

We found the service made efforts to ensure people consented to their care and support and was aware of the processes to follow where people’s capacity to make decisions was in doubt. People’s needs were assessed and care was delivered according to their plans. The service worked with other providers where necessary to meet people’s needs. People were protected from the risk of abuse and were cared for in a clean environment. Staff were supported to provide the required standard of care. There was an effective complaints process.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with two people who use the service. They told us that they were happy living at the home and felt safe and well cared for.

We spoke to six people who use this service. All were very positive about their experiences as residents. They felt that their opinions were respected.They also felt that the care they received was tailored to meet their needs and was safe and appropriate. All were positive about the quantity and quality of food on offer and could participate in social activities if they wished. One person stated that the home was “the best place I have lived”.

We spoke with seven people using the service. They said that their care needs had been assessed and that care was delivered according to their plans. They were involved with their assessments and care planning. They said they felt safe and were confident that if they had any problems they would be dealt with properly. There were enough staff to provide the care required and they did not have to wait too long when they needed support. One person said that the staff were "super people, very patient". Another person said that staff were "generally fine".

We found that people's dignity and privacy were respected, and that the care and treatment delivered were based on individual, person-centred plans. Risks affecting people's safety and welfare had been identified and assessed. However, some action plans to deal with identified risks were unclear and unspecific. People's personal information and records concerning the management of the service were kept securely and were available when needed. We found that people were not protected from the risk of abuse because staff had not been given timely refresher training in safeguarding vulnerable adults.