We undertook an inspection of St Joseph’s - Manchester on 26 and 27 October 2016. The first day of inspection was unannounced which meant the provider did not know we were coming.

We last carried out an inspection at St Joseph’s - Manchester on 15 August 2014. We found the service was fully complaint in all five standards we inspected at that time and was meeting legal requirements.

St Joseph’s - Manchester provides nursing and personal care and accommodation for up to 53 older people and people living with dementia. There were 48 people living at St Joseph’s – Manchester at the time of our inspection. St Joseph’s - Manchester is one of eight homes in England run by the Little Sisters of the Poor congregation. Jeanne Jugan is the founder and first Little Sister of the Poor. The homes’ vision is to continue the inspiration of Jeanne Jugan in today’s world, to improve care for the elderly and to promote the elderly’s role in society. The Little Sisters of the Poor congregation adhere at all times to the philosophy and ethics of the Catholic Church.

There was a registered manager in post at the time of this inspection. 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.

Staff were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm.A system was in place to identify and assess the risks associated with providing care and support. People’s support plans and risk assessments contained personalised information about an individual’s needs and provided guidance for staff as to the support people needed.

The service had an excellent relationship with a local GP practice and one of these GP’s spent one morning a week in the home undertaking appointments or reviews of people’s medicines. This proactive approach meant that people’s medicines were reviewed in a timely manner and people were treated quickly when necessary or when the service identified the start of any potential illnesses.

People who used the service received safe care and support from a trained and skilled team of staff. The induction of new staff and ongoing training of others was robust and staff told us they received regular support from the registered manager and line managers.

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.

People living at the home, their relatives and other healthcare professionals involved with the service said that the support staff were caring. On the day of our visits we saw people looked well cared for. There was a relaxed atmosphere in the home. The people we spoke with who were using the service, and visiting relatives, told us they were happy with the care provided.

People’s care plans contained information about their likes, dislikes and personal preferences and were person-centred. They contained details about how people liked to be supported in aspects of their care. We received one negative comment about the home not acting upon information provided by a person using the service with regards to a food intolerance.

During our visit we saw examples of staff treating people with respect and dignity. Staff promoted people’s independence by giving them choices and allowing autonomy when it was safe to do so. People using the service and their relatives were consulted and involved in assessments, care planning and the development of the service.

There were enough staff on duty to meet people’s support needs and to provide activities fo

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

The recruitment procedure at the care home was robust and effective. All security checks had been completed before any new employee was allowed to start work at St Joseph`s. This helped ensure only people who were fit to work with vulnerable people were employed at the care home.

A whistleblowing policy was used at the care home and staff were aware of it. Two staff members we spoke with explained the policy to us. One told us, "I would go straight to the manager if I thought something was wrong."

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us an application for a DoLS had been made in July 2014. We saw the required paperwork had been completed appropriately and the application had been authorised by the local authority.

Is the service effective?

During our inspection we looked at five care plans for people who used the service at St Joseph`s care home. All five had been signed by the individual person. Consent forms for medication administration and the taking of photographs had been signed by the person. This showed the person had been involved in creating their care plans and agreed to them.

People`s needs were taken into account with the signage and layout of the service. This meant people moved around the care home freely and safely. The home had been adapted to meet the needs of people with mobility problems, for example wheelchair users.

Is the service caring?

Staff were patient and supported people in a caring, unhurried manner. Staff members interacted positively with people and encouraged them at all times.

Some people had limited mobility and we saw staff supporting them between rooms which kept the person safe from the risk of falls. Staff members took their time to understand people`s different communication styles which helped ensure people had their needs met in accordance with their care plans.

Is the service responsive?

People were involved in a range of social activities inside and outside the care home. St Joseph`s had its own minibus which enabled people to stay involved within their local community. We saw evidence that people had their religious needs met at the care home.

The complaints procedure was displayed on the walls around the care home. We looked at the last complaint received and saw it had been managed appropriately.

Is the service well-led?

The care home had effective procedures in place that monitored the quality of service provided to people who used the service. This helped ensure the service provided to people continued to improve.

We saw evidence that the care home worked well with other agencies. This helped ensure people received appropriate treatment when they needed it. One the day of our inspection, two community nurses attended the home.

As part of our inspection we spoke with people who used the service, visiting relatives, staff and the registered manager.

Overall, we found people were happy living at St Josephs and made positive comments about the service. Comments included; “I’ve been here a while now and I’m looked after very well. The staff treat me with respect and dignity which I like” and “Excellent care. The staff show love, care and patience all the time. I feel my needs are met living here. The staff help me with my personal care and getting around the place as I’m not as steady on my feet anymore”.

We also spoke with visiting relatives throughout the day. Comments included; “My ‘x’ is very happy living here. ‘X’ is always immaculately turned out. The general care, dignity and compassion here is outstanding. I think we were so lucky to be able to get ‘x’ in here. We have great confidence in all the staff”.

We looked at how people’s nutrition and hydration requirements were met and observed part of the lunch time period. This was an organised occasion and people who required assistance to eat and drink were appropriately supported by staff.

We checked equipment at the home was safe for people to use and was well maintained. This included checks of hoists, slings and wheelchairs.

We looked at the systems in place to monitor the quality of service provision. These included regular audits, surveys and meetings between staff and people who used the service.

Generally the people who used the service were happy with the care they received, however a few people raised some concerns about they way they were looked after. Their comments included:

“The girls are always round the place. I’m never short of help. I never see any trouble whatsoever. Every one is friendly.....”

“It’s a safe home, morning, noon and night.”

“Sometimes the staff are not very sympathetic and on one I was spoken to sarcastically.”

“The meals are always delicious.”

One person commented they didn’t get any fruit and that an alternative was not provided.

“I’m quite comfy and quite happy with things the way they are. A doctor came to see me. Thanks be to God I’m healthy.”

“My daughter comes every week. I would talk to her but everyone is very good and very kind.”

Relatives of the people who used the service said they were very happy with the way their relative was looked after. One person described the staff as ‘very approachable’. Their comments included:

"The home was recommended to us and when we visited we fell in love with the place. She has a lovely bedroom and it is kept immaculate. She has family pictures all over the place and her own armchair. She loves it here. It’s a very stable staff.“

People living in the home who spoke to us said that staff respected their privacy and that they were treated with respect. One person said, “The staff are excellent. They are so kind”

When asked, people said they were able to choose when to get up, and go to bed and what they want to do during the day. One person said “I always get up early, I always have done.” Another person said, “I like to spend a lot of the day in my room alone. Staff respect that, but they always let me know what activities are going on so I can go down if I want.”

People were complimentary about the care and support they received. One person said “The Sisters and the staff are so good to me. I wouldn’t want to be anywhere else.” Another person said “I had to wait a while to get in here but it was worth it.”

Comments from people that the home included that the home was a ‘happy home’ where staff were so considerate. One person living in the home said, “This is by far the best home I have been in.” A relative said, “The staff are wonderful, so caring". Staff spoken to said that St Joseph’s was the best home they had worked in.

People spoken to welcomed the opportunity to have their spiritual needs met but were clear that there was no pressure to be involved in the spiritual life of the home. Several people attend Mass daily, others weekly and others never attend. One person said, “I don’t go [to mass] but it is there for those who want to. Another person said, “My faith is important to me and I needed to live somewhere that would help me continue it.”

Leisure activities were plentiful according to people living in the home. One person said “There are lots of things to do here, lots of activities.” Another person told us “I get involved in a lot of things here. I choose the things I want to do.”

People said they felt safe and well looked after. One person said, “Everyone here is so kind, but if you were concerned about anything you would just tell the Sisters.”

Staff said they had a good induction and training. One member of staff said, “I had a long induction and then I shadowed people for a week or so, before I started looking after people”. Another member of staff told us, “I have had loads of excellent training. This is the best place I have worked at.” One member of staff told us, “We have supervisions every couple of months and staff appraisal”. Another member of staff said “We have regular supervisions but we can talk to the Sisters anytime.”

People living in the home said relatives spoken to said they felt the home was managed well and that they were well supported. One person said, “This is the best, we are so lucky.” A relative told us, “We are so pleased with the care here, everyone is just so good.”

Staff said they felt well supported by the registered manager - Mother Deidre and other senior staff. One member of staff told us, “I could talk to the Sisters and to senior staff anytime, they are all so supportive, so considerate.” Another member of staff said, “If I need advice I can go to anyone for help particularly the Sisters. They are so caring.”