We inspected this service on 13 and 14 August 2018, the inspection was unannounced on 13 August. We told the manager one inspector would return to complete the inspection on 14 August. The inspection was carried out by one inspector, an assistant inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

St Joseph’s is part of Father Hudson’s Care, which is the social care agency of the Catholic Archdiocese of Birmingham, a registered charity. St Joseph’s provides accommodation with personal care and support for up to 59 adults. St Joseph’s specialises in care for people living with types of dementia and is divided into four ‘wings;’ Pearl, Topaz, Jade and Ruby. Short stay care (respite) is offered by the home. At the time of this inspection, 47 people were living at the home.

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. The previous manager had de-registered with us in June 2018 and, at the time of our inspection visit, the new manager, who came into post in July 2018, was in the process of applying to become registered with us.

We last inspected this service on 4 February 2016 and gave an overall rating of ‘Good.’ However, we had found people did not consistently receive a safe service and rated the safety of the service as ‘Requires Improvement’.

As a part of this inspection, we looked to see whether the provider had made the necessary improvements. Overall, they had not and we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The safety and how well led the service was required improvements. The overall rating for the service has changed to Requires Improvement.

Actions to mitigate risks to people had not always been taken by the provider. Some first-floor bedroom windows opened to arm’s length which posed potential risks of serious injury to people. People did not have individual personal emergency evacuation plans to say how they should be supported in the event of an emergency.

The provider had systems in place to monitor the quality and safety of the service people received, but these were not always effective.

There were sufficient trained 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.

Individual risk management plan, such as preventing people getting sore skin, described actions for staff to take so that risks of harm or injury were mitigated. However, actions to mitigate risks were not always followed by staff.

Medicines were stored and handled safely. People had their prescribed medicines available to them. Some medicine recording errors had occurred and whilst these were addressed by staff, medicine audit information lacked detail.

Staff on shift met people’s individual needs. People were able to take part in activities and received good pastoral care. Staff worked in liaison with visiting healthcare professionals in meeting people’s health and care needs.

Staff received training and, overall, used their skills, knowledge and experience to provide effective and responsive care to people.

Further information is in the detailed findings below.

This inspection took place on 04 February 2016 and was unannounced.

St Joseph’s is registered to provide care and accommodation for up to 60 older people. The service is provided across four ‘wings’ over two floors. At the time of our inspection visit there were 59 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 and relatives were confident people were safe living in the home. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. However, recordings they were expected to make when raising safeguarding concerns had not always been completed. 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. However, risk assessments were not always up to date and checks had not identified this.

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 designed to ensure medicines were administered safely had not always identified gaps in people’s medication records.

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 were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people 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. Where restrictions were in place, legal processes had been followed to ensure they were in people’s ‘best interests’, and applications for legal authorisation had been sent to the relevant authorities.

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 and 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. Where people were unable to communicate their views, staff talked to people’s families or their representatives 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 in place to monitor the quality of the support provided in the home. However, these systems had not always worked as intended. Gaps and inconsistencies in record keeping had not been identified.

During our inspection we spoke with four people who lived at St Joseph’s, one visitor, seven members of staff and the registered manager. We also looked at some of the records kept to support staff in providing the correct care to people who use the service.

Some people were unable to share their experiences of living at St Joseph’s so we spent time with them in communal areas to observe their care and support.

People told us that staff respected their privacy and dignity and they confirmed they were involved in the way their care was provided. A visiting family member told us, “People are always treated with respect here. The staff are very caring.”

People and a visiting family member told us they were happy with the care and support provided. One person said, “They look after us very well.” A visiting family member commented, “Definitely, this is a very good home.”

Staff knew about the needs of the people they were caring for. We looked at care records for four people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

Staff told us they received excellent support from the management team. A staff member told us, “The door is always open to chat with a manager if you have any questions.”

Our observations throughout the inspection demonstrated that staff engaged in a positive way with people. We saw when people needed assistance staff were on hand to help them.

We visited St Joseph's on 9 August 2012. The visit was unannounced so that nobody who lived or worked at the home knew we were coming.

During our visit we spoke with the provider, manager, assistant managers and three members of care staff. We also spoke with three people who lived in the home and two visitors. We looked at four sets of care plans and care records, staff training records and quality assurance records.

People told us they were happy living in the home. One person commented, "They (the staff team) look after me well. The food is excellent, I have my hair done and the gardens are lovely."

We saw that care staff knew people at the home well and spoke with them in a friendly, respectful way. We saw that care staff were sensitive to people's needs and offered them support when assistance was requested or indicated.

We observed that people took part in activities they told us they enjoyed. One person said, "There is often something going on." We saw posters advertising events and activities so that people could decide whether to attend.

People's cultural and spiritual needs were considered as part of their plan of care and there were frequent opportunities for attendance at church services in the home and local community.

Care staff were positive about working in the home. We were told there were regular training sessions to enable staff to develop their skills and knowledge and provide effective care for people who lived at St Joseph's.

People, their visitors and staff told us the management team were approachable and kind. We were told, "They do their utmost for the people here."