We undertook this unannounced inspection on 8 and 14 November 2018. St Joseph's Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to accommodate a maximum of 19 older people with dementia. On the day of this inspection there were 16 older people with dementia living in the home.

At our last comprehensive inspection on 26 February 2016 the service met the regulations we inspected and was rated Good. At this inspection we found the service to be deficient in some areas and have rated it as Requires Improvement.

People who used the service and their relatives informed us that people had been treated with respect and dignity. The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse.

There were suitable arrangements for the administration of medicines and medicines administration record charts (MAR) had been properly completed.

There was a record of inspections of equipment carried out by specialist contractors. However, the premises were not well maintained and some areas of the building were in need of repairs and redecoration. We found a breach of regulation in respect of this.

There were a lot of leaves at the front of the building. These may pose a slip hazard when wet. Some fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Individual personal emergency and evacuation plans (PEEPs) were prepared for people to ensure their safety in an emergency. We however, noted that the fire risk assessment of the premises had not been updated to include the arrangements for people who smoked. There was no fire evacuation plan for the premises with guidance on how evacuation should be conducted. This is needed to ensure that care workers are aware of the procedure to follow in the event of a fire. We found a breach of regulation in respect of this.

The home had a recruitment procedure in place to ensure that care workers recruited were suitable and had the appropriate checks prior to being employed. We however, noted that two care workers’ records did not include a second reference. These were provided by the registered manager during our second visit to the home. The staffing levels were adequate. Care workers had received a comprehensive induction and training programme. There were arrangements for staff support, supervision and appraisals.

The care needs of people had been carefully assessed and attended to. Appropriate care plans had been prepared which reflected the choices and preferences of people. The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The dietary needs of people had been assessed and arrangements were in place to ensure that people received adequate nutrition. Some people including two people with diabetes had made improvements in their health as a result of the care provided.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS. Mental capacity assessments had been carried out for people who used the service.

People were encouraged to be as independent as possible. The home had an activities organiser and people could engage in various social and therapeutic activities which were appropriate for

We undertook this unannounced inspection on 26 February 2016. St Joseph's Care Home is registered to provide personal care and accommodation for a maximum of 19 people, some of whom may have dementia. At this inspection there were 15 people living in the home.

At our last inspection on 1 September 2014 the service met all the regulations we looked at.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People living in the home had varying degrees of dementia. Some of them could not provide us with comments regarding the care provided. Some were able to tell us about their experiences and views. They informed us that they were satisfied with the care and services provided. They said they had been treated with respect and felt safe living in the home. There was a safeguarding adults policy and suitable arrangements for safeguarding people.

Staff were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and recorded. Staff prepared appropriate care plans which involved people and their representatives. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records. People’s healthcare needs were monitored. Staff worked well with community healthcare professionals to ensure that people’s needs were met. This was confirmed by relatives we spoke with.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings and one to one sessions had been held for people and the minutes were available for inspection. The home had an activities programme to ensure that people were encouraged to participate in social and therapeutic activities.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and some people who spoke to us could confirmed that they had been given their medicines. This was also confirmed by relatives we spoke with.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their manager. There were enough staff to meet people's needs. Teamwork and communication within the home was good.

People and their representatives expressed confidence in the management of the service. The results of the last satisfaction survey and feedback from people and their representatives indicated that they were mostly satisfied with the care and services provided. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence.

The premises were clean and no offensive odours were detected. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire sa

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led? During the inspection we spoke with two people using the service, three relatives, two care workers, and the registered manager.

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

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

Is the service safe?

The relatives of the people using the service told us that they were confident that people were safe. Staff were clear about their roles and responsibilities and felt well supported by management staff.

Staff understood their role in safeguarding the people whom they supported and reporting any concerns they had to the manager. We saw there was appropriate and concise advice available for staff to refer to if they had safeguarding concerns. The home had systems in place to identify, assess and manage risks relating to the health, welfare and safety of people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

Equipment used by the staff to care for people was appropriate, although in one case we found that whilst an item of equipment had been serviced there was no sticker displayed on it to inform staff that this had occurred and the equipment was safe to use.

Is the service effective?

Relatives of people using the service told us they were happy with the way their loved ones were treated and staff were “a good team”.

Risk assessments had been carried out where necessary and these were used in the planning of effective care.

We saw minutes from staff meetings and saw staff communicated between each other. They were guided by an effective system of documentation, which ensured there was continuity in the care that was delivered. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Is the service caring?

We saw people were given the opportunity to participate in activities and staff supported people to take part in religious and cultural festivals. We observed the care people were receiving and how staff interacted with them. We saw people using the service were spoken to respectfully and staff used a caring approach . Relatives of those using the service commented on the caring nature of staff towards their relative.

Is the service responsive?

The home had a system in place for learning from incidents and complaints. We saw where care had been below the standard expected the registered manager had taken steps to ensure systems were changed to ensure this was not repeated.

We saw that the staff integrated the advice given by various health professionals into the care that was provided to people. Written notes about people's health and care were completed by staff . People received individualised care, which was responsive to their interests and preferences. A variety of activities were available for people to participate in as they chose. Activities were geared specifically to those who were affected by dementia. People's care and health was monitored closely and junior staff escalated quickly to their senior colleagues if they were concerned.

Is the service well-led?

The home was led by an experienced manager who understood their role and took steps to ensure care was of a standard people would expect. The home was supported by a senior team who undertook monitoring and checks of the quality of the service. Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

We used a number of different methods to help us understand the experiences of people using the service, because many of them had complex needs which meant they were unable to tell us their experiences. The relatives of a person who used the service visited the person every day and told us that they were very happy with the care the home provided. They said, “They look after our relative very well.”

We spent a period of time observing four people who could not talk with us in the communal area of the home. Our observations showed that staff had time to speak with people and to give them individual attention. We noted several examples of staff speaking with people and treating them with respect. However we also observed a few examples of poor interactions with people, when staff spoke with a person but did not wait for a response from them.

We looked at the care plan files for six people who were receiving end of life care. The care plans were written in plain English and showed the person's wishes and preferences.

The infection control procedures included clear instructions for hand washing and we saw reminder posters for washing hands in all communal areas. The daily cleaning log covered all areas of the home and showed that each bedroom was deep cleaned periodically. However we observed some areas of cleaning that had not been attended to due to the absence of the domestic scheduled to work that day.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. All the people we observed showed evidence of a positive mood for most of the period of our observation. We noted several examples of staff speaking to them and treating them with respect, and in accordance with their care plans.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. All care plans had current assessments for the person's health needs, including the risk of falls, pressure care and mobility.

People who use the service were protected from the risk of abuse. The provider responded appropriately to any safeguarding concerns. We saw evidence of training for all staff in safeguarding of vulnerable people.

The provider had robust procedures for quality assurance and audits. We saw evidence of regular audits of procedures for maintaining health and safety in the home. The provider sent out quarterly satisfaction surveys to staff, people using the service and their relatives and acted on any comments that were made.

During the inspection we talked with three people using the service, one relative and three staff to get their views about the quality of services that are provided in the home.

We observed that staff on most occasions talked to people and explained things to them before providing care and support to them. Whilst people or their relatives were kept informed of changes in the condition of people, we found limited evidence of their involvement when care plans were drawn up for people or when there were limitations to people's freedom such as when bed rails or sensor mats were used. During the inspection we observed people’s choices were respected by staff. We saw people offered choices for meals and activities.

Our inspection has identified some areas that needed improvement for people to experience safe and appropriate care and support. We found that care planning did not always address all the individual needs of people such as when their needs challenged the service. Accidents and incidents although recorded, were not fully investigated to identify their causes, so that action could be taken to prevent these from happening again. In a few cases where there were suspicions that abuse could have occurred, these had not been referred to the local authority safeguarding adults team to ensure these incidents were appropriately investigated.

Mr Khan's name appears on this report as they were still registered as a manager but not in post during the visit.

We did not receive a lot of feedback from people who use the service. We were however able to talk to visitors when they came into the home and observe the way staff cared and supported people. The service had also carried out satisfaction surveys of relatives, staff and stakeholders. The findings were used in this report with the manager’s permission.

During the inspection people told us that staff were ‘kind’ and gave them the opportunity to make choices. All six relatives who responded to questionnaires thought that the home promoted the independence of people. All respondents to the question on privacy said that the service promoted the privacy of people in meeting personal care needs.

People said that staff supported them appropriately to meet their needs. A respondent to satisfaction questionnaires said people received “excellent support from staff” and another said “our relative is always clean and tidy”. A third said “we are satisfied with the attention our relative receives”.

People and relatives told us that the range and content of meals served to people was appropriate for them. People said that they enjoyed their meals. All relatives who responded to satisfaction questionnaires said that the dining arrangements in the service were satisfactory. Five said that they were happy with the meals and the choices available in the home, that took into account people's likes and dislikes.

Relatives said that people were offered choices in their daily life and that their choices were respected. For example people’s choices of meals and how they spend their time were respected by staff. We observed that people, who were able to, were free to move to different areas of the home. Some sat on their own, others took part in communal activities or sat in a group.

Relatives told us that they could not remember if they had seen the care records of people who use the service but said that staff kept them informed of the changing conditions of people.

Relatives informed us that people received a good standard of care. One relative said that the person they come to see, had been in the home for many years and they were happy in the home. Another relative said that they had some concerns about the standard of personal care but once these were raised with management, these were addressed and resolved.

Relatives said that people liked their meals and were able to choose from two options. They reported that people were supported appropriately by staff to eat their meals.

In view of the major concerns identified in Outcome 4 Care and welfare of people who use services the Care Quality Commission served a Warning Notice on the Registered Provider.

People who were able to provide feedback told us that they were happy with the care and support they received in the home. We observed that people looked relaxed in the home and that they were given an opportunity to make decisions about what they wanted to do during the course of the day. Visitors were satisfied with the standard of care and support that people received and said that the service kept them informed about the care of people. They reported that there were regular home meetings with people who use the service and their families.

Visitors told us that they were involved in the care of people and have had an opportunity to look at the care records when reviews were conducted. We found that at times people’s needs were not comprehensively recorded and identified for care plans to be put in place and for staff to be fully aware of the needs of people.

Visitors said that there were social and recreational activities in the home for people and there was at least one activity every day. We observed activities on both days that we visited and we noted that most staff engaged with people and explained what they were doing. We saw two staff supporting and calming a person who was restless. A few members of staff did not engage with people while attending to them to explain what they were doing and to gain their cooperation.

People and visitors talked favourably about the meals and said that the meals were tasty and that the choices and likes and dislikes of people were accounted for. We observed lunch and noted that people were assisted to eat their meals without any interruptions, with the staff member sitting with the person.

People and visitors said that the home is normally kept clean. They were satisfied with the standard of decoration of the bedrooms of people.

People reported that they could complain to staff if they wanted to and visitors who have raised concerns previously said that their concerns were taken seriously by the service and responded to in a timely manner.