Joseph House

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.

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.

We assessed one quality statement from this key question and the overall score for this section has been determined using scores from the last inspection. People who used the service were able to exercise some choice and control in relation to their care. Care plans contained specific information to guide staff about people’s preferences. However, some aspects of the service showed people were not encouraged to pursue their goals and aspirations or take assessed risks towards them. People were cared for, but the service needed to be more proactive when considering people’s choice and control over their own lives.

We assessed one quality statement from this key question and the overall score for this section has been determined using scores from the last inspection. During this assessment we identified people who used the service, especially those with learning disabilities, did not all have full access to their local communities despite high staffing levels. People’s goals and aspirations were captured in records, but the service was not always sufficiently proactive.

Systems and processes designed to oversee the safety and quality of the service were not always robust. We identified concerns relating to fire safety, staff knowledge, oversight of some health conditions, consent, auditing and overall culture of the service. External professionals questioned the culture of the service, which they found risk averse and not encouraging of people’s independence. We also found this to be a concern. The lack of effective oversight in a number of areas constituted a breach of Regulation 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the individual sections below. The provider, who was also the registered manager was often at the service and was held in high regard by staff and by the majority of relatives we spoke with. The provider was very open to our feedback and immediately began to review the concerns we had raised, and sent us a detailed action plan immediately after the onsite visits were concluded.