Joseph House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were monitored closely with high staffing levels to keep them safe. Staff, who were mostly agency staff, did not always have full knowledge of some safety aspects including risks relating to fire and to people’s behaviour when they became distressed. Fire risk management needed to be more robust and the provider has taken steps to address this as soon as we identified issues.

We saw limited evidence of risk assessment to enable people to take positive risks to widen their experiences and increase independence.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us they felt their family member was kept safe and no concerns were raised with us. One person who used the service told us they had experienced verbal abuse from another service user. This was a known incident, and we saw there were plans in place aimed to address it.

Staff were able to tell us how to spot the signs which would indicate a person was being abused. They knew how to report concerns within the service and externally. Staff had received safeguarding training and told us they felt this training equipped them to carry out their safeguarding responsibilities.

We saw good safeguarding practices were in operation. Records documented how people, who were at risk from abuse, had been kept safe and action taken to address any safeguarding concerns.

The provider had systems and processes in place to raise and manage safeguarding concerns. Appropriate concerns had been referred to the local authority safeguarding team and the Care Quality Commission notified. Some staff’s breakaway and restraint training was not up to date which meant we could not be fully assured all people who used the service would be safe in the event of an incident where a person became distressed. The provider has already taken steps to address this. There were robust procedures in place to safeguard people from the risk of financial abuse.

Most people were not able to talk to us easily about the risks they faced and how these were managed. One person told us they used to like baking but said they were not supported to do this at the service. It was not clear if this was related to risk, but we noted people were not routinely supported to take risks safely, to increase their independent livings skills, for example.

Relatives told us they felt the service was safe and managed their family member’s risks well. One person commented, ‘In [my relative’s] room there is crash mat by [their] bed, which is alarmed in case [they] lands there, [they have] non-slip socks to wear, a lock for [their] room and many other safety measures around the home to keep [them] and others safe’. Another commented, ‘They do a lot of risk assessments before [my relative] tries anything, like going to the gym, or [riding a] bike. This is new now and they are good at supporting us as family, what to do to help [my relative] stay active.’

Some staff were not clear about all the documented risks people faced. Risks relating to people’s distressed behaviours, fire and topical medicines were not fully understood by all. A newer staff member had been supporting people without the required training in safe holds should the person become distressed. Staff were able to tell us about epilepsy management and most understood one person’s complex needs relating to this condition well.

People were subject to high levels of monitoring courtesy of generous individual staffing levels. In several cases there were 2 staff to 1 person. Despite this high level of staffing, some people were not routinely supported to undertake activities which could increase their skills and widen their experiences, such as regular access to the community. The service was not always proactive when it came to risk management. Where people had behaved in a way which had meant a strategic approach was needed, we found the service occasionally reacted restrictively. This was designed to keep people safe but risked treating people more as a child than an adult.

Some risks were very well documented within care plans and showed the involvement of the people they related to. However, information about risk was not always clearly identified. Appropriate risk training for staff was not in place for all and some staff demonstrated an incomplete knowledge. For example, risks relating to topical creams and the accompanying increased risk of fire were not understood by several staff. This risk had not been factored into a risk assessment for a person who smoked.

There was also a culture of being risk averse. People were quite closely monitored and safeguarded against identified risks rather than encouraged to take managed risks to increase their independence. Since our inspection visit the provider has taken these concerns on board and has assured us some additional training has been provided.

People were supported to maintain a safe and clean environment. Most relatives told us they felt the environment was safe for their family member. One person explained, ‘[My relative] is safe in Joseph House because there are numerous safety measures helping my relative to stay safe.’

Staff demonstrated an awareness of safety procedures and equipment. They were confident in the use of various pieces of moving and handling equipment and had received training. We noted some cleaning concerns with the service’s milk dispenser, despite staff telling us this was regularly cleaned. We also noted a large catering sized tray of pasta bake had been left out rather than refrigerated. Staff were seen to go in and out of the kitchen area but nobody took any action until we asked about it. Staff then told us it would be thrown away. We could not be certain food safety knowledge was fully embedded. The registered manager and deputy acknowledged the safety issues we identified and told us they were taking immediate steps to address them.

The environment was mostly well maintained. The building is historic, and floors were uneven in places which could present a trip hazard. However, handrails were provided for people to aid mobility. Where people’s rooms had to be adapted to keep them safe, we found this had been carried out. The resulting changes for one person meant their room was totally bare except for a bed and a chair. The provider told us they had ordered some new items for this person. In the intervening period the person had no stimulation from television, books, magazines or radio in their room which was a concern. The extensive grounds enabled people to have access to outside space and activity, which most did with staff support. We noted a door in the conservatory had had the lock mechanism removed. The provider was unaware of this but, on checking with engineers, confirmed the door would still connect to the alarm system and only the casing had been removed.

The provider had a system of audits and checks aimed to ensure a safe environment. These were carried out according to the provider’s own schedule, but some actions were not always followed up in a timely way.

The provider had commissioned an external fire risk assessment to be carried out but had not acted promptly on all its findings. Where the report had clearly recommended a particular room should only be occupied by a person without any mobility issues, we found the occupier required support with their mobility. There was no specific risk assessment for this issue which placed the person, and potentially supporting staff, at risk in the event of a fire evacuation. The fire risk assessment, which had been signed off by the provider, also identified the external metal fire exit should be reviewed by a structural engineer but this had not been actioned. This exit was not being used at the time of our inspection visit but could be used as an additional exit in case of emergency.

Other checks to health and safety equipment and installations were carried out regularly and action taken where concerns were identified.

Relatives told us they felt staffing levels were good and, where their family member needed additional staffing to keep safe, this was always provided. Relatives were happy with the skills of the staff and some people who used the service were able to tell us they liked the staff who supported them. Relatives were aware of the extremely high proportion of agency staff working on any shift but had mostly positive things to say about these staff. One relative said, ‘Most of staff are not English, they are Indians and sometimes there is a language barrier, but standards of care and the caring nature of carers is second to none. I observed [them] last time I visited [at]mealtime. Patience, care, conversation and being there to help it was something I never seen. Even agency staff are of high working standards. They might not have full knowledge of learning disabilities, but they work very hard and respect well people in their care.’

Staff told us there were always enough staff and where people had been assessed as 1 or 2 to 1 staffing, this was always provided. Although most staff were from an agency, they knew the service’s own staff and management well and told us they felt confident asking for clarification if they were not sure about how to provide a particular element of a person’s care. However, some staff lacked some key knowledge and had not been proactive about areas of the role they were unsure of. Staff, including agency staff, told us they received a good induction before taking on their role and continued to have regular supervision sessions.

Staffing levels were good and were provided in line with people’s assessed needs. However, some staff we spoke with lacked the skills and knowledge to ensure people always had consistently safe care. The majority of staff were agency staff who were block booked for consistent staffing. Staff demonstrated a mixed understanding of people’s needs. Some had a very clear understanding and others lacked some key knowledge relating to fire, safe techniques to manage people’s distress and people’s rights. The provider accepted feedback about this and immediately started to address this.

Some staff were seen to be very kind and dutiful in their roles, with easy conversations and good relationships. However, we also noted quite a formal 1 to 1 relationship in some cases with very minimal, if any, conversation. Some agency staff in particular did not appear confident enough in their dealings with the people they were supporting and were seen to stand over them which gave the impression of a custodial rather than a supportive role.

We observed a new member of the agency night staff received a period of shadow shifts where they were supernumerary before they were expected to support people in a 1 to 1 situation.

Permanent staff were safely recruited and all staff received an induction. Agency staff received the same induction but some agency staff’s induction had not ensured some key information and processes were fully embedded. One agency staff member had not had key breakaway training, even though they were supporting a person with this documented as being essential in their care plan. This placed them and others at potential risk of harm. Since our onsite assessment the provider has increased this training to ensure all staff have the required skills and training in this area.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives were happy with the way the service administered their family member’s medicines. One relative commented, ‘As far as I know everything about [my relative’s] meds is in order, and [they] have them regularly.’ People received their medicines as prescribed and on time.

Only senior permanent and agency staff were trained to administer medicines. Staff told us they felt they had the training and oversight to ensure they administered medicines safely. However, some staff did not demonstrate an understanding of the additional fire risks posed by topical creams, which can be highly flammable if traces remain on people and their clothing.

Medicines were mostly well managed. Stock control was good and oversight of medicines administration was in place. Staff received appropriate training and support. Competencies for staff (to check their practice was safe) included agency staff and were carried out by the provider. The additional fire risks posed by topical creams had not been identified despite these being clearly documented in a warning label on the medicine one person was using at the time of our assessment visit. Protocols for when staff should use occasionally medicines (PRN) were in place, but we found some would benefit from a more detail to guide staff. The provider told us they were about to introduce an electronic system to order and record medicines which aimed to further reduce the possibility of any error and make processes more robust.

We observed staff administering medicines and found they were methodical and procedures were clear. Staff administered medicines on time and staff took their time with each person, so administration was not rushed.