This inspection took place on 28 September 2017 and was unannounced.

St Joseph’s Nursing Home provides accommodation and nursing care for up to 24 older people. The home is built over two floors and shares a chapel with the adjacent Convent. The service was tailored for, but not limited to, people from the Roman Catholic Church. At the time of our visit there were 21 people living at the home. The people living there are older people with a range of physical needs and some people were living with dementia.

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 the last inspection on 7 and 9 June 2016, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always managed safely or recorded correctly. They were also in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not sought feedback from people for the purposes of continually evaluating and improving the service and some people were unhappy with the activity provision. The service received an overall rating of 'Requires Improvement', and after our inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches. At this inspection we found improvements had been.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine when they needed it. People were supported to maintain good health and had access to health care services.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People had access to and could choose suitable leisure and social activities.

People and relatives told us they felt the service was safe. People were protected from the risk of abuse because staff understood how to identify and report it. One person told us “This is a very safe place to be and I am content here”

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us “Very good, no complaints, let’s put it this way the plate goes back always empty”. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One member of staff told us “We get training and updates, I have completed equality and diversity recently and moving and handling”.

There was a homely and relaxed atmosphere at the home. People and rel

The inspection took place on 7 and 9 June 2016 and was an unannounced inspection.

St Josephs Nursing Home provides accommodation and nursing care for up to 24 older people. The home is built over two floors and shares a chapel with the adjacent Convent. The service was tailored for, but not limited to, people from the Roman Catholic Church. At the time of our visit there were 24 people living at the home, including three people who were visiting for respite care.

There was a calm and peaceful atmosphere at the service. Many people told us that they had chosen the home for its spiritual tradition and that they enjoyed attending daily Mass in the chapel, or watching it on the internal television channel. Relatives spoke positively about the service and the care provided.

At our last inspection, in December 2014, we asked the provider to take action to ensure that they were working within the principles of the Mental Capacity Act 2005 and to ensure that the Commission was notified of specified incidents as required by law. The provider and former registered manager had taken action to address these concerns. At this visit, we found that these requirements had been met.

The service did not have a registered manager. A new manager had been appointed in February 2016 and was due to begin the process of registering with us. 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 spoke highly of the care that they received and told us that the staff were very kind. Some people, however, told us that they felt bored and that they wished for more social activity. They told us that staff were busy and had little time to chat. Staff told us, however, that most people were happy to attend Mass daily and to rest after lunch. We found that the provider had not asked people for their views and feedback on the service, or for ideas to improve their experience, since 2014.

Medicines were not managed safely. We found concerns with the storage, recording and disposal of medicines.

People felt safe at the home. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse.

People told us that staff treated them with respect. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

There were enough staff to keep people safe. People told us that they were not rushed and that they received a high standard of care. Staff had received training and felt supported by the management, including through supervision and appraisal. Staff monitored people’s health and took prompt action to address any concerns. People had access to healthcare professionals and appropriate referrals were made for guidance or additional support.

People enjoyed the food and were offered a choice of meals. Staff were attentive to people’s needs and supported those who required assistance to eat or drink. People’s weight was monitored and prompt action taken if any concerns were identified.

The new manager was active in monitoring the care that people received and was developing the system used to audit the service. People, their relatives and staff felt confident to raise issues or concerns with the manager. Where concerns had been identified, actions were recorded and addressed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection took place on 31 December 2014. It was unannounced.

St Joseph’s Nursing Home provides personal and nursing care for up to 24 older people. At the time of our inspection there were 22 people living at the home. Accommodation was arranged on two floors in single rooms. Shared areas included a dining room, sun lounge and enclosed garden. The nursing home was on the same site as St Joseph’s Convent, and people could access the convent chapel balcony from inside the home. The service was tailored for, but not limited to, people from the Roman Catholic Church.

There was a registered manager in post. 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.

A visitor described St Joseph’s Nursing Home as “a particularly nice home”. Staff received training which prepared them to identify and report when people might be at risk of harm or poor treatment. People were protected against other identified risks. They were supported by sufficient numbers of staff, and the necessary checks were made before new staff started work. People’s medicines were stored and administered safely.

People consented to their care and treatment where they were able to do so. However we were not assured that the legal requirements were followed where people lacked capacity to make specific decisions.

Staff were supported by a system of training, supervision and appraisal to provide care and support that met people’s needs. People described the food as very good, and they were able to eat a healthy, varied diet. People could access healthcare services as they needed them.

Staff were able to develop caring relationships and spend time socialising with the people they supported. They respected their individuality and treated them with respect. People were informed about the support available to them and were able to participate in decisions about their care.

People were able to follow their preferred routines. Leisure activities, entertainments and social events were conducive to the calm, contemplative atmosphere in the home. People were happy with this and preferred to spend time in the privacy and quiet of their rooms.

People received care, support and treatment according to their needs. These were reviewed regularly and changes made if necessary. The service had a complaints procedure. One complaint had been received in the last year, and had been dealt with appropriately.

The provider had systems in place to monitor the quality of service provided. Accidents and incidents were recorded and followed up internally. There was an effective management system which promoted teamwork. St Joseph’s Nursing Home was characterised by a calm, contemplative atmosphere which reflected the Roman Catholic foundation of the home. When an accident occurred which resulted in a serious injury to a person, the provider did not notify us.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see the action we told the provider to take at the end of the full version of this report.

People we spoke with told us that care was delivered to meet their needs and with their consent. People said that staff listened to them and respected their decisions.

We found that people's care was based on an individual needs assessment and planned and delivered to ensure their safety and welfare. A person told us "I like it here - I like all the people, staff and residents, everyone is so friendly and kind". A person's relative told us "care is excellent, the relationships with staff are very good, they are genuine - it's a real home".

People told us that they felt safe in the home and we found that people were supported by staff who knew how to identify abuse and what to do if they had any concerns.

We found that most of the staff had been working in the home for many years. People and their relative's told us that this was important to them because staff knew and understood people's needs very well. We found that the provider carried out the appropriate checks to make sure the staff they employed were suitable for their role.

We found that the provider had a system in place to deal with complaints. We saw that information was made available about the complaints procedure and that complaints were responded to appropriately. People we spoke with told us they could raise their concerns and complaints with the manager.

We spoke with three people living in the home individually and with a group of five people in the dining room. They told us they were very happy with the care in the home. They told us they were treated with respect and that call bells were answered quickly. We were told by all of the people that the food was very good and plentiful.

People told us they were asked about their wishes about daily living, their choices in meals, their religious preferences. One person told us "I am happy here. This home is better than other ones I have been in".

There is a limited activities programme which people spoken with said they were happy with. The majority of the people living in the home were involved in the spiritual aspect of the home.

Outcomes relating to safeguarding and quality assurance were inspected in August 2012 and were found to be compliant.

Care needs were assessed and people told us these needs had been met. One person told us that they had a bath every day which was their preference.

Medicines were handled safely in the home.

A general practitioner (GP) who frequently visited the home was spoken with and we were told the people "were very well looked after by a very considerate and observant staff".

Two relatives were spoken with and one told us that the home was "fantastic" and that they had "struck gold" in finding a place here for their family member. The other told us that their family member was looked after "extremely well

We spoke with three people living in the home and they told us they were very happy with the care in the home. They told us they were treated with respect and that call bells were answered quickly.

We were told by two of the people that the food was very good/ excellent; another told us there could be more variety.

We spoke with people living in the home, we were told that people were very happy with the care in the home, that the staff were kind and polite and that they were very happy with the food. One person’s comments summed it up, “I am all the better for being here, I like the company and the food is excellent”.