At our last comprehensive inspection in April 2018 breaches of regulations were found. This was because the provider was not managing risks appropriately or notifying us when serious incidents had occurred.

We carried out this unannounced focussed inspection of ‘St Jude’s House’ on 15 January 2019. This was to check that improvements to meet these legal requirements had been made. The team inspected the service against two of the five questions we ask about services: Is the service safe and well led?

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

This service is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide accommodation for up to 10 people. At the time of this inspection there were nine people using the service.

At our last inspection we found the provider was not doing all they should to mitigate risks from a person’s behaviour. At this inspection we found the provider was now doing this, but improvements were still required with regards to updating risk assessments and promoting positive risk taking.

The provider had addressed fire risks by arranging for an appropriate fire risk assessment. However, aspects of the premises were unsafe and food hygiene and storage was not always safe. Staff lacked training in food safety.

There were suitable processes to safeguard people from abuse. However, the provider did not monitor incidents and accidents to look for trends and how they could learn when incidents had occurred.

The provider followed safer recruitment processes and people told us they thought there were enough staff to support them safely. Medicines were safely stored and managed.

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.

Managers did not always ensure that people could speak up. Keyworking sessions and tenants’ meetings did not take place regularly. Systems for recording information were sometimes complex and difficult to manage. The provider submitted notifications of significant events as required. The rating of the previous inspection was displayed in the service but not on the provider’s website.

We found breaches of regulations relating to food safety and display of ratings. You can see what action we told the provider to take at the back of the full version of this report. We will return to the service within 12 months of the previous comprehensive inspection report.

We carried out this unannounced inspection on 24 and 26 April 2018. At our last inspection in March 2016 we rated this service ‘good’.

St Jude’s House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation and support to people with mental health needs. At the time of our inspection there were 9 people using the service one of whom was in hospital at the time of our inspection.

The building consisted of 10 bedrooms, a large lounge and dining area, launderette, indoor smoking area and a garden with an outdoor smoking area. The staff office was positioned next to the main communal area.

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.

There were measures in place to address risks to people using the service, however in one high risk situation these were not applied appropriately. Appropriate actions were taken when incidents had taken place. People were safeguarded from abuse by care workers who had a good understanding of the possible signs of abuse. Where money was held on behalf of people this was stored safely but not regularly checked to prevent loss or theft.

Staffing levels were suitable to meet people’s needs safely, but safer recruitment measures were not always followed to check that care workers were suitable for their roles. Staff received appropriate training and supervision to carry out their roles and told us they were well supported by managers.

The provider carried out regular checks of the safety of the property but there was not a suitable fire risk assessment in place. People received their medicines safely, but appropriate records were not always kept of this and sometimes errors in recording were not detected by audits. Managers had good systems of handover and communication in place. The provider was not meeting requirements to display their ratings and to inform us of significant events that had taken place.

People had choice and control over their care as the provider took appropriate steps to obtain consent to care. People’s care plans were reviewed regularly to make sure people’s care met their needs, and the service was responsive when people’s mental health had deteriorated. Information was not presented to people in line with Accessible Information Standards; we have made a recommendation about this. People were supported to maintain good health and the provider worked well with other professionals involved in people’s care. People were encouraged to eat well and to have varied diets.

People’s views were sought through keyworking and residents meetings, although these meetings did not always take place regularly. We observed positive and respectful interactions between people using the service and care workers, and people appeared comfortable approaching care workers for support.

We found breaches of regulations regarding safe care and treatment and notifying the Care Quality Commission of significant incidents. You can see what action we told the provider to take at the back of the full version of this report.

This unannounced inspection took place on 30 January 2016. St Jude’s House provides personal care and accommodation for up to 10 people with mental health needs. 10 people were using the service at the time of the inspection.

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.

The previous inspection of the service took place on 24 September 2014. The service met all the regulations we checked at that time.

People told us they were happy with the care they received at the service. Staff were respectful of people’s dignity and privacy. Staff asked people for their consent before providing them with care and support. Staff supported people in line with their preferences and wishes.

People received safe care and support. Staff understood the types of abuse and neglect which could happen to people and their responsibility to report any concerns to keep them safe. People had received their medicines safely as prescribed. Staff assessed risks to people and had support plans in place to keep them as safe as possible. There were sufficient staff on duty to meet people’s needs.

Staff assessed people’s needs and had individual support recovery plans which showed the care and support they required. People received support as planned and which met their individual needs.

People contributed to the reviewing of the support they needed and received input from staff and healthcare professionals involved in their care. People’s support was in line with the legal requirements of the Deprivation of Liberty Safeguards (DoLS) and principles of the Mental Capacity Act (MCA) 2005.

People accessed the health and care services they needed. People had sufficient food which they liked.

People, their relatives and staff found the manager approachable and open to ideas and feedback. The registered manager held meetings with people to get their views about the service. People understood the complaints procedure. The registered manager had looked at complaints and addressed them in line with the service’s procedures.

The registered manager undertook checks on the quality of the service and made improvements when necessary. Staff felt supported in their role to provide care to people. The registered manager worked in partnership with healthcare professionals to ensure people received the support they needed.

Staff attended training and had the skills and knowledge to support people with their mental health needs. Staff felt supported in their roles and received regular supervision. Staff felt confident the registered manager valued their ideas to improve the service.

This was a follow up inspection which focused on checking whether the provider had made the required improvements following our last inspection on 11 July 2014 where we found that people were not protected from the risk associated with unsafe and unsuitable premises.

At this inspection we answered the question: Is the service safe?

The home was safe. People told us that they felt safe and secure. The home was clean and adequately maintained and was in good state of repair at the time of our visit.

This inspection was carried out by an inspector who helped answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People told us they felt safe living at the service. Staffing levels were adequate and staff were trained and competent in their roles. Staff were aware of how to respond to emergencies and there was support available 24 hours a day.

Assessments were undertaken to identify any risks to people that used the service and actions were taken to address the identified risk. Fire systems were checked regularly to ensure they worked properly.

There was loose carpet on the stairs which could pose a risk of trips and falls. People told us that they had found mice in their rooms. The management told us that they were aware of the problem and had reported it to the organisation’s maintenance team but had not called out pest control.

Is the service effective?

People were involved in the assessment of their care needs and in developing their support plans. Their support plans were tailored to reflect their individual needs and the outcomes they wanted to achieve. Other health and social care professionals were involved where required.

Is the service caring?

People were supported by attentive staff. Staff were patient, encouraging and caring. They spoke to people with respect. We saw positive interactions taking place. People told us that staff were nice and listened to them. People commented that they liked living there and liked the staff. We saw that staff were not rushed and spent time with people and engaged them in activities.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Staff understood the individual needs of the people who used the service and supported them accordingly. Care plans and risk assessments were reviewed monthly to reflect changes in people’s needs.

Is the service well-led?

There were a range of quality assurance systems in place by the provider. They consulted with people who used the service, their relatives and staff using various methods such as surveys and meetings to obtain their views on service delivery.

Staff told us they were clear about their roles and responsibilities. Staff had regular supervision sessions, appraisals and team meetings to ensure they were adequately supported to do their jobs effectively.

People had access to information before they went to live at the home. They were able to visit the home several times before making a decision to live there. People told us they were involved in making decisions and consented to their care and treatment. One said " I get good choices and sign if I agree."

We observed people were involved in the community and were encouraged to become more independent. We found that people's care needs were assessed and plans put in place to manage their needs, which included managing any potential risks to their safety and wellbeing.

The staff gave people a choice of healthy food to eat which was freely available in the kitchen. We saw people were supported to eat a healthy diet which was especially important if they were on a special diet due to their health needs, for example if they had diabetes.

People received their medicines in accordance with their prescribed needs. There were effective arrangements in place to manage the different types of medicines used by the people who used the service.

We saw the records of people who used the service were kept accurate and up to date. Other records relevant to the management of the services were accurate and fit for purpose.

We visited the provider on 15 January 2013. We looked at the personal care and treatment records for the people who use services and observed how people were being cared for. We talked with people who use the services as well as with family members and/or representatives. We also talked to members of staff and other stakeholders.

People who use the service told us that they were generally "very happy" and that they liked the food available on site. People also told us that they had a choice of activities and that they felt able to "tell people what they wanted". Other people we spoke to said that they were kept informed and updated by the staff and they had found the staff to always be friendly when they visited or made contact with the staff group.