The inspection took place on 23 and 24 October 2018 and the first day was unannounced. The previous inspection was carried out in September 2016 and the service was rated ‘Good’ overall. This inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation and therefore this inspection did not examine the circumstances of the incident.

The information shared with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks. We found these risks were mitigated and that the provider had implemented several control measures to help reduce the likelihood of future incidents occurring.

St James House is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 House is a converted church located in the Rusholme area of Greater Manchester. Accommodation is provided over three different levels, accessed by either a passenger lift or stairs. Rooms on the ground floor share communal toilet and shower facilities. On the upper floors, the accommodation comprises single en-suite rooms and two self-contained flats. Each floor has its own kitchen, lounges and dining areas.

The care home is registered with the CQC to accommodate up to 15 people with a learning disability and/or autism. At the time of this inspection there were 13 people living there.

The service delivered care and support that was in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed effectively, food was not always safely labelled, suitable arrangements were not in place to ensure people were protected from the risks of cross infection; assessments did not always identify need and systems in place to assess, monitor and improve the quality and safety of the service provided were not effective. You can see what action we have told the provider to take at the back of the full version of the report. We also made two recommendations relating to nutrition and reviewing equality and diversity awareness and training for all staff.

There was a manager in post who had been registered with the Care Quality Commission since September 2011. 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.

Medicines were not always managed safely. Some medicines were not dated upon opening and where people received time-specific medication, times of administration had not been recorded.

People were not protected from the risk of infection. Cleaning equipment was dirty and records of cleaning undertaken were incomplete. The lack of cleaning in some communal areas was evident on both days of our inspection. Improvements were also needed within the laundry to ensure good infection control systems were in place.

Where assessed needs were identified, detailed and specific care plans were in place and provided sufficient information to help staff support people according to their needs. Assessment of risks to providing that care was also included. Care records we looked at were kept up date through regular reviews. However, when we discussed the spec

This inspection took place on the 14 and 15 September 2016 and the first day was unannounced. The previous inspection took place in July 2014 and no concerns were identified.

St James House is a registered home providing 24-hour personal care and accommodation for a maximum of 15 people living with a learning disability and associated needs. The home is a converted church in Rusholme, Manchester and close to local amenities and transport routes. Accommodation includes self-contained flats and single rooms some of which are en-suite. Facilities include lounges, kitchens, laundry facilities, a sensory room, a hydrotherapy pool and a gym. There are also extensive grounds.

The service had a registered manager who had been in post since 2011. 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.

Everyone we spoke with told us they felt safe living at St James House. All the relatives we spoke with felt their loved ones were safe living there. Staff knew how to keep people safe and were aware of how and to whom they could report any safeguarding concerns.

Staff sought consent from people before providing care or support. The ability of people to make decisions was always assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were always taken in the best interests of people when necessary and applications were made for Deprivation of Liberty Safeguards authorisation appropriately.

Risk assessments were up to date. Care plans were written with the person whenever possible and with their families, with the consent of the person. People had been supported to be involved in identifying their support needs. Pre-assessments included people’s likes and preferences and staff knew the people well.

Staff were observed as being kind and caring, and treated people with dignity and respect. There was an open, trusting relationship between the people and staff. People were well cared for and there were enough staff to support them effectively. The staff were knowledgeable about the needs of the people and had received appropriate training in order for them to meet people’s needs. The recruitment process was robust and all required checks were in place prior to staff commencing work.

Medicines were administered, stored and disposed of safely and in line with the required guidelines. There were appropriate protocols and guidance for staff when people needed ‘as required’ medicine.

We saw people were fully supported to attend activities both within the home and within the community. People could choose what activity they attended and there was scope to change their minds. We saw nearly everyone living at St James House chose to do individual activities but the service provided group activities which they joined in as well. People who were able to, made choices about how they spent their time and where they went each day.

We saw people and their relatives had been asked for feedback about the service they received. There was a record of what actions had been taken to address any identified concerns. Staff worked well as a team; we saw them communicating with each other in a respectful and calm manner. There was an open and transparent culture which was promoted amongst the staff team.

Everyone knew who the registered manager was and felt the service was well-led. All staff said they felt supported and felt they could raise any concerns with the registered manager and they would be acted upon.

We viewed the policies and procedures and saw they were being followed. Quality assurance checks were being completed and when incidents had occurred action had been taken.

An inspector and a specialist advisor visited this service on 28 July to carry out an inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During this inspection we spoke with two relatives, four care staff and members of the management team. We spoke with four people who lived at St James House. We were unable to ascertain the views of all the people who lived at the home because they could not always give their verbal opinions on the service they received. We also looked at records and spoke with a visiting health professional. The registered manager was not present during the inspection; however we did speak with them following the inspection. Below is a summary of what we found.

Is the service caring?

People were being involved as far as possible in planning and consenting to their support and were enabled to make decisions about matters which affected them.

Our observations showed us people were treated with respect and two relatives told us they were happy with the care and support provided. One relative told us; “(My family member) is cared for properly at St James.”

Is the service responsive?

We saw people were encouraged to give feedback on the service in the form of

surveys, and a complaints procedure was in place to enable people to raise areas of concern if they wished to do so. We spoke with four care staff who gave examples of how they responded to changes in people’s needs and wishes and one relative told us; “ I’ve never had to complain or even comment about anything but if I did, I’m certain they would be interested in what I had to say and they would sort it out.”

Is the service safe?

We saw systems were in place to ensure people were safe. The CQC monitors the operation in care homes of the Deprivation of Liberty Safeguards (DoLS). We looked at documentation which showed us that when necessary the correct processes were followed. We spoke with staff who explained the processes they would follow if they had suspicions people were at risk of harm or abuse. We saw some staff had received specific training to enable them to support people, however some staff had not and some training required updating. We concluded improvements were required in this area.

Is the service effective?

We saw people received support from other health professionals as required and were supported to attend hospital appointments if required. During the inspection we spoke with two relatives who told us they felt the home enabled their family members to live fulfilling lives.

Is the service well led?

We looked at a sample of audits and saw there were systems in place to identify when improvements were required. The staff we spoke with told us if any actions were required, they were informed of these through meetings with the manager and at supervisions. We spoke with two relatives who told us they found the manager and staff approachable and they would speak with them if they had any concerns.

People who used the service at St James House had limited verbal communication skills in relation to answering direct and in depth questions about their care and support. We talked with a visiting relative and a visiting health professional who also gave their opinion about the service at St James House.

Each person we talked with was positive about the quality of the service provided. People who used the service told us about how they felt or about their plans for the day. People smiled and looked happy and relaxed.

Comments from people who used the service included:

"I’m going out to Sea World later.” And “Yes it’s ok, it’s nice.”

During our visit to St James House we saw people were relaxed and staff communication was positive and effective.

We found that people who used the service were treated with respect and systems were in place to enable people to give the appropriate consent to their care and treatment.

We saw that food and nutrition met the needs of people who used the service.

We saw staff were employed in sufficient numbers and had the required skills and experience to meet people’s needs.

We saw systems in place to check whether a good quality service was being provided. We found that the provider took actions to make changes in response to the findings of their audits and the information provided by people who used the service.

People living in St James House had limited verbal communication skills in relation to answering direct and in depth questions about their care and support however those who gave verbal comments told us they were happy living at the home. We talked with three people.

Comments included:

“Yes I like it here.”

And

“I’m fine thank you, I’m happy.”

The third person told us about their plan for the day and their comments did not relate to how they felt about the service. We saw however that this person appeared relaxed and content at the service.

Other people smiled and made positive gestures about their life at St James House.

We found a robust system in place for supporting people to manage their finances safely though more information about extra charges may benefit people using the service and their representatives.

We found people were treated respectfully and given support to say how they wanted to be helped.

We found that people using the service were supported to do different things such as cooking, dancing, swimming, artwork, horse riding, using the hydropool and shopping.

We found that medication management promoted the safety and well being of people who used the service.

We saw that the recruitment process for new staff was robust and protected against employing unsuitable people.

We found that complaints were treated seriously, dealt with openly and learning points identified so that improvements to the service could be made.

People living in St James told us they were happy living there. We were given thumbs up for their life in the home.

We found people were treated respectfully and given support to have their say in how they wanted to be helped. They were supported to do the things they wanted to do.

People told us they liked doing different things. We looked at records that showed us activities people did such as baking, riding bicycles, dancing, swimming, puzzles, horse riding, using the hydro pool and shopping. Staff helped them. We looked at their weekly planners that helped them remember what they did on different days. These were in a format they could understand and included the use of pictures.

We found people were kept safe in the home and when they went out. They were represented in their best interests. They were cared for by staff that were trained well and were always available to support them all the time.