Joseph House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Although people’s needs were assessed, sometimes records were not accessible and some key information was difficult for staff to find. The provider had recently begun to use a new electronic record system and told us they thought this concern would soon be addressed as staff became more familiar. People’s health needs were mostly well managed and well recorded. However, some staff were not clear and sometimes people had not received the oversight of their health and care needs that was required.

Where people lacked capacity to consent to aspects of their own care, including those people who were being legally deprived of their liberty, processes and understanding needed to be improved.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care needs were assessed before they began receiving a service. Relatives told us they were happy with the way their family member’s needs were assessed and felt they had opportunities to discuss any changes as they occurred. One relative told us about a particular aspect of their family member’s care. They said, ‘I am not sure if this is written in [My relative’s] care plan. I will ask the manager to have a look and make an addition.’

People’s care needs were assessed before they began receiving a service. Relatives told us they were happy with the way their family member’s needs were assessed and felt they had opportunities to discuss any changes as they occurred. One relative told us about a particular aspect of their family member’s care. They said, ‘I am not sure if this is written in [My relative’s] care plan. I will ask the manager to have a look and make an addition.’

Care plans had recently been moved over to an electronic recording system. Staff had received training in using the new system, but some were still not clear and oversight of people’s needs was not comprehensive. Where people had specific needs, these were known to staff, including agency staff but not always captured in people’s care records. For example, one agency staff member told us that a person, ‘Likes three meals a day and not really snacks. Drinks squash but no tea or milk, likes to spend the last half an hour in the shower with hot water at 38 or 39 degrees on [their] head.’ None of these specific person-centred care needs were reflected in the person’s care plan. Staff told us they pass this kind of information on verbally but could not explain how all staff would know this key information.

A person newly admitted to the service had their needs reviewed quickly and a basic care plan with key information was immediately put in place.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

Relatives were positive about the way the service worked with other health and social care professionals to provide care for their family member. One relative commented on an aspect of their family member’s care, following a change. They said, ‘We all had team meeting with [the]way forward recommended by consultant. It was very helpful, and I was pleased by outcomes. All I know is that staff from Jospeh House are following recommendations.’

There was an acknowledgement that some agency staff had less knowledge of some issues affecting people with a learning disability, but this was not considered a major issue. Some relatives mentioned poor communication skills on the part of some workers, mostly related to English not being people’s first language. Again, this was not thought to be a major issue. One relative commented, ‘Sometimes there is a language barrier, but standards of care and caring nature of carers is second to none.’

Staff and leaders spoke positively about their working relationships with external colleagues. The registered manager told us they felt well supported by the local authority and had a good working relationship with commissioners. Senior staff told us they liaised with local healthcare services to ensure people’s needs were met. Agency and permanent staff told us they worked well together.

We received limited feedback from partners and where feedback was given it was negative. One healthcare colleague stated the service did not always ensure a continuity of care. They stated, ‘They continued to use the same support plans that were devised before our intervention. They refused to follow the communication recommendations, the chance for [the person who used the service] to engage in the local community.’

The registered manager told us they had experienced frustrations trying to engage with other health and social care colleagues at times. They said this had delayed people receiving the required changes to medication.

Local authority partners said they worked well with the service but did not always find them proactive enough when considering people’s future needs and moving the service on.

Within the service staff and management teams worked together but the high number of agency staff meant there was a risk of people not receiving consistent care. Agency staff were managed both by the provider and by their own agency and communication protocols between the two were not formalised.

Agency staff worked alongside permanent staff, with agency staff making up a large majority of staff, particularly at night which was entirely staffed by agency staff. Staff mostly knew people well and were considered part of the team by the provider. They attended staff meetings and training both at the service and that provided by the agency. Some of these staff told us they did not communicate with external health and social care partners and this was very much left to the management team.

People were supported to manage their health. Relatives felt staff ensured their family member’s health was monitored and well managed. One person said, ‘My relative has regular eye tests, dental work done in the past. I would be informed about any other professional’s visits by carers either by phone or when I visit.’ This mirrored other relatives’ feedback to us.

Staff knowledge and understanding of people’s healthcare needs was mixed. Records were in place relating to people’s healthcare needs, and most were extremely detailed, and staff knew them well. However, some newer and agency staff needed a better understanding of fundamental parts of people’s care. For example, we asked one staff member about a person’s stage 3 kidney disease and how this impacts them. The staff member, who was supporting the person that day, was unaware of this condition. They were also unable to tell us how they would establish if the person had any continence issues as they did not know where to find this information. This risked missing a potential problem with this person’s continence.

A senior member of staff was unable to locate the overview of one person’s health needs as they were not used to the new system.

Although care plans recorded people’s healthcare needs well in most cases and there were some detailed plans for people, there were some gaps. Some aspects of people’s healthcare needs were not clear, and staff demonstrated an incomplete knowledge as a result.

Oversight of people’s health was also very mixed. We noted some weight loss and weight gains for people had been routinely recorded but action had not followed where concerns should have been identified. Oversight of weight monitoring and continence charts needed to be tighter to ensure concerns were not missed. Routine health monitoring was good and people were supported to attend for health checks, hospital and GP appointments where needed.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Many people living at the service had limited capacity to make major decisions about their care, although people were often able to give their consent to routine decisions about their daily life. None of the relatives we spoke with expressed any concerns about how the service ensured their family member had given consent to their care.

We observed staff establishing consent before providing care and support. Staff politely encouraged people, but expectations of the provider were that rules were to be respected. Some staff did not demonstrate an understanding of people’s right to refuse aspects of their care, whilst others were very clear on this, so it was a mixed picture. One staff member told us about a person who had lost a significant amount of weight and was now severely underweight. They said, ‘[The person] is stubborn and most of the day refuses dessert. [They do] not like snacks, sweet things’. This person’s relative had confirmed this but there was a lack of understanding about the person’s right to make choices about their food. Efforts appeared to centre on encouraging the person to eat things they did not want. The possible impact of this may have contributed to their consistent weight loss which had not been referred to any outside professional. Staff had received training in the Mental Capacity Act 2005 (MCA), which establishes a person’s ability to consent to care and treatment according to a structured process. We found the principles of the MCA were not understood by all staff and we received conflicting information about some people’s rights. Where people had their liberty restricted for their own safety under the Deprivation of Liberty Safeguards (DoLS), staff were not clear. One senior agency staff member told us, ‘All are free to leave,’ and another said, ‘Only carers can leave – there is a keypad.’ There was a risk people would not have their rights fully protected.

The provider had processes in place to establish people’s capacity to consent. If people were deemed not able to give valid consent, decisions were taken in their best interests in line with the structured process set out in the Mental Capacity Act 2005 (MCA). Capacity assessments, which had been carried out by both internal and external assessors, were mostly of good quality. However, we did identify some covered multiple areas of a person’s life and were not related to a particular decision. Some paperwork was missing and records did not always evidence the involvement of the person. The provider told us the assessments were being reviewed to put onto the new system and assured us they would ensure all the required information was captured during this process.

There were no MCA assessments and associated records relating to people sharing rooms. There were 3 shared rooms and there was no rationale recorded for how this had been decided to be in the best interests of both people, if unable to consent themselves. The provider told us due to one person’s nighttime needs, ‘We felt sharing would be better for [them]’. However, there was no record of any discussion or documented meeting about this. We had no reason to suspect people were not happy sharing but there was a risk of people's rights not being fully respected. We also noted one shared room was directly overlooked by another person’s bedroom window resulting in a lack of privacy for all 3 people. This had not been identified as an issue by the provider. The provider began a process of review of these rooms directly after the inspection visit.