This inspection took place on 02 March 2017 and was unannounced.

St Joseph’s is registered to provide accommodation and support for up to 18 people. At the time of this inspection there were 18 people living there. The service provides support to people who have an acquired brain injury, a neurological disorder and/or a physical disability. The home is run by Nugent Care, an organisation that provides support services to people in the North West of England.

The home 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.

At our last inspection of the home in April 2016 we asked the provider to make improvements with regards to medication management and protecting people’s legal rights. At this inspection we found that improvements had been made.

People living at the home told us that they liked the staff team. They said that they felt safe living there, knew how to raise a concern and always got the support they needed. People also told us that they liked the meals provided and that they felt staff listened to them.

No safeguarding incidents or complaints had been reported about the home in the past year. Polices were in place to provide guidance for staff in the event of a safeguarding concern or a complaint and staff knew how to follow these.

People’s medication was safely managed and they received support as needed to take it. Support was also provided by staff to help people monitor their health and seek health advice when needed.

People received support to make as many decisions for themselves as they were able to. Where people lacked the ability to make more important decisions then the home had taken step to ensure their legal rights were followed.

There were enough staff working at the home to meet people’s needs in a timely manner. Staff were kind and caring and treated people with respect. They spent time talking with people and knew people well. Staff had received training to enable them to undertake their role safely and effectively. They were skilled in altering their communication methods to suit the person they were interacting with.

St Joseph’s is a purpose built single story home. There is sufficient space within the home and grounds for people with mobility aids to get around easily. Adaptations to the building including a small kitchen and bathing facilities to help people be as independent as they are able to and wish to be. Regular checks had been carried out on the environment and equipment to ensure the home was a safe place for people to live, work and visit.

The registered manager knew people well and was a visible presence within the home. We saw that people living there felt confident to approach her and staff told us they felt supported.

Audits and checks were in place and completed to check the safety and quality of the service provided.

This inspection was carried out on 5 and 9 of February 2016. The first day of the inspection was unannounced.

St Josephs is registered to provide accommodation and support for up to 18 people. At the time of this inspection there were seventeen people living there. The service provides support to people who have an acquired brain injury, a neurological disorder and/or a physical disability. The home is run by Nugent Care, an organisation that provides support services to people in the North West of England.

The home 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.

At this inspection we found a breaches of regulations. This was because medication had not always been safely and properly managed and people did not always receive safe care and treatment. We also found that people’s legal rights were not being fully protected.

You can see what action we told the provider to take at the back of the full version of the report.

Systems for managing people’s medication were not always effective; this meant that medication was not always managed safely.

The people living at St Josephs and their relatives liked and trusted the staff team they said they had always been treated well. People told us that they thought St Josephs was a safe place to live. Staff knew people’s individual needs, choices and communication methods well and spent time talking with people.

Systems and training were in place to help staff identify and deal with any allegations of abuse that arose.

The premises were well maintained with systems in place for checking the safety of the building. Staff were aware of the actions they should take in the event of an emergency occurring. The building was purpose built and provided people with the adaptations and facilities they needed to get around the home with ease.

There were sufficient staff working at the home to meet the needs of the people living there although some staff and some of the people living there felt at times staff were very busy. Suitable systems were in place for recruiting, training and supporting staff, this helped to ensure they were suitable to work with people who may be vulnerable.

The provider had not always recognised when people living there may require the protection of a Deprivation of Liberty Safeguard being applied for on their behalf. People told us that they had always been supported to make everyday decisions for themselves and that they or their relatives had been consulted about their care.

People had received the support they needed with their healthcare. However care plans did not always reflect people’s support needs or provide clear guidance for staff to follow on how to support people effectively.

A choice of meals was available within the home and staff did their best to meet people’s preferences. The majority of people told us that they liked the meals provided. The support provided to people at mealtimes did not always lead to a calm, relaxing occasion for people to enjoy.

Staff were satisfied with the training that had been provided to them. However we identified and the provider confirmed that not all staff had received training in the more specialist needs some of the people living at the home had. This had been identified by the provider who was taking steps to address this.

The people living at St Josephs and their relatives felt confident that any concerns they raised would be listened to and acted upon.

The home had a clear management structure in place that acted as a role model for staff. People liked and trusted the manager who they felt listened to them and acted on any concerns or queries they had. Systems were in place for checking the quality

During our visit we spoke to four people about the home this included two team leaders, a care worker and the maintenance man. We also spoke to two relatives of the people who lived at St Joseph’s and a volunteer who told us “it’s a great place”.

Relatives comments included: “The staff are very good…it doesn’t matter what time of the day you visit it’s always the same…feel (my relative) is safe” and “I can come here anytime and she would be getting the same care… (it’s) well managed here”.

There were seventeen people who currently lived at the home. The majority of them had acquired brain injuries and/or a neurological disability and/or a physical disability. We observed interaction between the people who lived at St. Joseph’s and the staff on duty and it was clear that their needs were well known to staff. It appeared that people living there were happy and content and they were given the support they needed.

We spoke to six of the people who lived at St. Joseph’s. One of the people we spoke with told us “if I’ve got a problem or feel upset there’s always someone I can talk to. All the staff get along with each other they work as a team and accommodate (us) the best they can”.

We asked staff what it was like working at St Joseph’s and one of the care workers we spoke with told us “I think we all work well to be honest and everyone knows what everyone else is doing. There is good communication”.

During this visit we spoke in depth with three people who live in the home and with three staff members.

All the people we spoke with told us they were happy with the care and support they received. People told us they were able to make choices and decisions and were able to participate in various activities. Comments included, "I enjoy shopping with my key worker" and "I'm going out after lunch".

At the time of our visit we were told the care planning system had recently been reviewed. However we found the current records did not always reflect the care and support being given and often contained duplicate information. This was discussed with the person in charge who assured us improvements would be made.

People told us they had no complaints about the service but knew who to speak to if they were unhappy. Comments included, "I can talk to the staff and they would sort any problems out" and "I can say if I am not happy or if something is bothering me". People who we spoke with told us they were treated well and had no concerns about the service or with individual care staff. They said they were often asked if they were comfortable and happy.

Staff told us they were given the training and support they needed. We found there was sufficient staff to meet people's needs. Everyone we spoke with made positive comments about the staff team. They said, "The staff are great" and "The staff are friendly; everyone gets on well".