Enter and View Report: St Joseph's

In October 2024, we visited St Joseph's, a care home run by Nugent Care. St Joseph’s is registered to provide accommodation and support for up to 18 people. At the time of this inspection there were 18 people living there with one in hospital. The service provides support to people who have an acquired brain injury, a neurological disorder and/or a physical disability. 

Summary

Overall, during our visit, we observed that St Joseph’s Care Home has many strengths that make it a good environment for people to live. The building is purpose built, accessible and designed and decorated to a high standard. There is obviously a lot of care and attention given to the care home by staff and every area we saw was spotless with a high level of cleanliness.

The interactions we saw between staff and residents were positive. Staff and residents seemed to have built very close bonds and there were lots of good-hearted banter between residents and staff. Staff appeared to care deeply about the residents, and this was mirrored by some of the residents. That a volunteer continues to attend the home to support residents after working there for many years speaks to a culture of caring staff at St Joseph’s.

Staff were open about the challenges they face, and staffing levels was brought up as a concern by multiple staff members and residents. Staff and residents seem to feel that their ability to engage in activities and experience life outside the care home is impacted by current staffing levels. This seems to be further impacted by communication challenges with the linked GP Sandringham Medical Centre and The Royal Liverpool University Hospital. Management has advised that new pathways such as the community matron and contract with the GP’s pharmacist is now in place.

Recommendations 

We make the following recommendations for St Joseph’s Care Home:

• Leadership at the care home to have an open conversation with existing staff and residents about staffing levels and the impact it is having especially on activities for residents.
• The relationship with the current linked GP Sandringham Medical Centre or Royal Liverpool University Hospital does not seem to be functioning as effectively as it could and is further impacting staff availability. Leadership should contact the practice manager/hospital and discuss alternatives. Healthwatch Liverpool are happy with permission to discuss with partners to see if there are alternative pathways.
• Attempt to source a dedicated transport for the care home as some staff and residents feel this is having an impact on residents’ activities.
• The inclusion of a ‘you said we did’ board is a good way of showing residents and families that staff are listening to suggestions and making changes in the home.

Positives and good practice

We found during our visit to St Joseph’s examples of positives and good practice which included but were not limited to: 

• The building and grounds of St Joseph’s are a real strength for the care home. The building is accessible and is designed and decorated in a way that makes it feel a very pleasant place to live and work. The surrounding grounds also looked well maintained and there was lots of greenery and nature nearby.
• St Joseph’s seemed exceptionally clean during our visit. We did not see anyone cleaning at the time, but the floors and surfaces were gleaming, and we did not see any clutter or debris. One resident commented positively about how clean the care home is.
• Staff seem to have built close relationships with residents and knew their interests and histories without needing to look through records. Staff came across as wanting the best for the residents and many residents seemed to consider staff as friends and family.

Response from Management

Management were in contact with us during the report writing process and seemed open and honest about things at St Joseph’s. They gave us the following responses to our recommendations.

Discussing staffing

We have had some difficulty with recruitment, particularly since Covid which is an ongoing concern across health & social care. Although we currently have staff vacancies, shifts are fully staffed within our mandate and includes relief/ bank staff, and part time staff who will pick up overtime. We are currently inducting three new staff members. Agency staff are used to fill some shifts but is mostly used for last minute cover such as sickness. 

I understand staff frustrations around recruitment; however, shifts are not run under what our mandate is. We have three shifts over a 24hr period, this includes six care staff plus a Team Leader of a morning, five care staff plus a Team Leader of an evening, and two care staff plus a Team Leader during the night. The morning and evening shift have a cross over of 3hours during the afternoon. 

The only thing I can think that relates to staff saying they would like extra staffing, is during this cross over period. This is something I can look at; however, thought it was important to say that we do not have shifts that are short staffed.

Discussing Activities

It is unfortunate that our minibus is no longer in use, however this is recent and has not prevented any community-based activities. We have two of our residents who are season ticket holders and attend home games at Goodison Park. The only activity in which the minibus has affected us, is that we were unable to do Blackpool this year. As part of next year's budget, we are looking at costings for new transport however, due to the needs of residents, this needs to be specially adapted with tail lift, and appropriate safety belts for securing wheelchairs. 

In the report, it captures a comment made by staff where they would like to offer more activities to residents without them having to pay. Residents will only pay for community-based activities that they wish to do i.e. like the football tickets. All in house activities are covered within our budget. 

Residents' meetings are held every other month and we also have quarterly beneficiary surveys which are completed by a member of our governance team. 

Discussing GP access

We have now been appointed a community matron who visits every other week, with regular contact in between. We can also request extra visits if needed. We now also have contact with the GP practice pharmacist who will carry out medication reviews and where we can discuss any issues relating to medication. 

In relation to using walk-in centres, the report states that this would require 2 staff when in fact, we only have one resident who requires 2:1 support when out in the community. 

The report states that getting appointments is difficult and waiting on the phone impacts staffing further. The appointments are usually made by the Team Leaders so would not impact the care staffing ratio.