St James House

We found the following examples of good practice.

Staff had received training on infection control and the safe use of personal protective equipment (PPE). During the inspection, we observed staff wearing PPE in accordance with government guidance. The provider had increased the number of hours worked by the domestic staff in the home to ensure high standards of cleanliness were maintained. The provider had policies and procedures in place to support staff in safe working practices. The provider was supporting people to maintain contact with their relatives in line with guidance in place at the time of the inspection. People living in the home were also able to receive visitors with appropriate procedures in place to reduce the risk of cross infection. The provider had also created spaces in the garden area of the home to support visiting should indoor visiting be restricted by government guidance. The service participated in the regular COVID-19 testing programme for both staff and people living in the home. Although the service was meeting the requirement to ensure visiting professionals were vaccinated against COVID-19, they had not always maintained a log of such checks. We have made a recommendation about this.

St James House is a residential care home which provides accommodation for up to 30 people who require support with personal care. Accommodation is provided in 30 single bedrooms over two floors. Four of the bedrooms have en suite facilities. The home is in a residential area in Darwen. There were 29 people living in the home at the time of our inspection.

People’s experience of using this service and what we found

Medicines were not always safely managed. As a result, some people had not received all their medicines as prescribed. The audit systems in place to monitor the administration of medicines had not been sufficiently robust.

People told us they felt safe in the home and that staff were always kind and caring. Staff had completed safeguarding training and knew the correct action to take to protect people from the risk of abuse. There were sufficient numbers of staff on duty to meet people’s needs. Staff had been safely recruited. They were aware of the action to take to reduce the risk of cross infection. The home was clean and the provider had plans to replace flooring in communal areas to reduce any malodour. Risks were safely managed and equipment was regularly serviced to ensure it was safe to use.

Staff received the training, support and supervision to ensure they were effective in their roles. People’s needs were assessed and regularly reviewed. Care plans provided detailed information for staff to follow to ensure they met people’s needs in the way they wanted. People enjoyed the food provided in the home. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us staff were respectful towards them and supported them to be as independent as possible. People were treated as individuals with diverse needs and interests. They were provided with information about advocacy services should they wish to receive independent support with making decisions about their care.

Care plans contained information on people’s health and communication needs as well as their family background, religious needs and social interests. Activities were available for people to participate in if they wished.

The management team and staff were clear about their roles and provided care which resulted in good outcomes for people. They worked in partnership with a variety of agencies to ensure people’s health and social needs were met

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 26 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. We have identified one breach of regulations at this inspection in relation to medicines management. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was last inspected in May 2017 when we carried out a focused inspection; this was due to a number of safeguarding concerns we had received. During that inspection we found a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always safely managed. Following the inspection, the provider sent us a plan which set out the action they were taking to meet the regulations. During this inspection we confirmed the required improvements had been made.

St James House provides accommodation for up to 30 people who require support with personal care. Accommodation is provided in 30 single bedrooms over two floors. Four of the bedrooms have en suite facilities. The home is located in a residential area in Darwen. There were 28 people living in the home at the time of our inspection.

People told us they felt safe in St James House. They told us staff were always kind and caring and were respectful of their dignity and privacy. Staff had received training in safeguarding adults and understood their responsibilities to protect people from the risk of harm.

People received their medicines as prescribed. Systems were in place to help ensure the safe handling of medicines. Regular audits of medication administration record (MAR) charts were carried out with action taken if any issues were identified.

People who used the service told us they always had their needs met by staff although they considered staff were often very busy. Staff told us they would like to be able to spend more time with people. They told us they understood the registered manager and provider were currently recruiting more staff as well as reviewing staffing levels in the home.

Risks in relation to the care people required had been assessed and reviewed. Risk management plans were in place to inform staff of the action they should take to keep people safe when providing care and support.

People were cared for in a safe and clean environment. On-going plans were in place to improve the décor and furniture in the home. Procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

Staff were provided with the induction, training and support required to help ensure they were able to deliver safe and effective care. The registered manager was in the process of improving the arrangements for monitoring and recording the training staff had completed.

People who used the service told us they were able to make choices about their daily life and the care they received. The registered manager was aware of their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected. The registered manager had submitted required DoLS authorisations to the local authority when people were assessed as being unable to consent to their care in St James House.

People told us the quality of food provided in the home was very good. Systems were in place to assess and monitor people’s health and nutritional needs.

Interactions between staff and the people who used the service were warm, friendly and relaxed. The staff we spoke with had a good understanding of the care and support that people required to meet their diverse needs. Staff told us they would always try and promote the independence of people who lived in the home. People spoken with confirmed staff would encourage them to do as much as they could for themselves.

Each person had a care plan that was tailored to meet their individual needs. All the people spoken with told us staff always provided them with the care they required.

There were regular opportunities for people to provide feedback on the care they received. Where possible, people were involved in the regular reviews of their care needs which were carried out by their keyworker.

A number of activities were organised within the home to help promote people’s sense of wellbeing. People were also supported to access the local community and to remain in contact with family and friends.

Staff told us they enjoyed working in the service and found the registered manager to be supportive and approachable. Regular staff meetings took place and were used as a forum to discuss how the service could be improved.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of the running of the home.

St James House provides accommodation for up to 30 people who require support with personal care. There were 24 people living at the service at the time of our inspection.

Since the last inspection the manager had successfully applied to register with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. They were not present on the day of the inspection due to being on maternity leave. The deputy manager was therefore responsible for the day to day running of the home with support from the provider who was based at the service each weekday.

During this inspection we identified a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always safely managed. You can see what action we told the provider to take at the back of the full version of the report.

We identified shortfalls in the management of medicines. Although most medicines were stored safely, two medicines that are controlled drugs (subject to tighter legal controls because of the risk of misuse) were not kept inside the controlled drugs (CD) cupboard as required by law. Discrepancies were identified in the records for one liquid CD which meant some stock could not be accounted for.

People had not always been given their medicines as prescribed. In addition staff who were not trained to administer medicines were responsible for applying medicated creams. People may be harmed if staff give any type of medicine without first being appropriately trained.

People who used the service gave us mixed feedback about staffing levels in the service. Seven of the eleven people we spoke with told us they did not feel there were always enough staff available, particularly at night. Staff we spoke with told us they always had sufficient time to meet people’s needs although none of these staff had worked at night. Our observations during the inspection showed all call bells were answered promptly. The provider told us they would arrange a meeting with people who used the service to discuss their concerns further.

Recruitment processes in the service had improved since the last inspection. When we looked at the staff personnel files for two people who had been recruited since the last inspection we noted all required pre-employment checks had been completed. The provider had also introduced additional safeguards into the recruitment checklist to record when references had been received and any action taken in response to adverse comments received in requested references.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. Staff were able to tell us of the correct action to take should they witness or suspect abuse.

Care records showed that risks to people's health and well-being had been identified, such as the risk of falls, pressure sores and poor nutrition. However we noted one person’s records did not make it clear that two hourly positional changes were required during the night in order to help manage the risk of pressure sores. We were told this person’s record would be amended as a matter of urgency to ensure they always received safe and appropriate care. However there were no current issues with regard to the person’s skin integrity.

During the inspection we noted that all areas of the home were clean although there were some malodours present at times. None of the people we spoke with raised any concerns regarding the cleanliness of the premises. The provider showed us the action plan they were in the process of completing following a recent inspection by the lead infection control nurse from the local clinical commissioning group (CCG).

Systems were in place to ensure the equipment in use in the service was safe and regularly serviced.

Staff told us they enjoyed working at St James House and that the provider and managers were approachable and supportive. They told us regular staff meetings afforded them the opportunity to put forward any suggestions as to how the service might be improved and that these were always listened to.

We saw that people had opportunities to comment on the care provided in St James House. Records we reviewed showed action had been taken in response to feedback received. There were systems in place for receiving, handling and responding appropriately to complaints. All the people we spoke with during the inspection told us they would be confident that any concerns they reported would be listened to and action taken by the manager to resolve the matter.

Improvements had been made to the quality assurance processes in place although some audits needed to be more robust. We noted the provider had commissioned an external consultant to help identify and drive forward required improvements in the service. We have recommended that the provider continues to embed quality assurance processes in order to ensure the quality of service provision.

This inspection was prompted in part by three allegations of institutional abuse which were substantiated following investigations by the local authority. We had also received anonymous information of concern regarding the management of medicines in the service.

St James House provides accommodation for up to 30 people who require support with personal care. There were 28 people living at the service at the time of our inspection.

The service did not have a registered manager in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new and experienced manager had been appointed since our last inspection; they had been in post since June 2016. They told us they were in the process of submitting an application to CQC to register as manager at St James House. The manager was supported by a deputy manager and the provider who visited the service on a daily basis.

During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. This was because recruitment processes were not sufficiently robust to ensure people who used the service were protected from unsuitable staff. Additional checks had not been completed for those applicants who had previously worked with vulnerable adults or children and the provider had not taken appropriate action to follow up references which included negative feedback. Governance arrangements in the service needed to be improved in order to ensure people’s records accurately reflected the care they required. Two people’s care records did not include detailed care plans. This meant they were at risk of receiving care which was inappropriate for their needs. In addition audit processes had not been sufficiently robust to identify the shortfalls we identified during this inspection.

You can see what action we have told the provider to take at the back of the full version of the report.

Staffing levels in the service had recently been increased following a number of substantiated safeguarding allegations. People told us this had made a positive impact on the care they received. However some people told us they did not always feel there were sufficient staff on duty to meet their needs in a timely manner. Our observations during the inspection showed staffing levels were appropriate to the needs of people living in St James House at that time.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. Staff were able to tell us of the correct action to take should they witness or suspect abuse.

People who used the service told us they felt safe in St James House and that staff were always kind and caring. Interactions between staff and the people who used the service were warm, friendly and relaxed. The staff we spoke with had a good understanding of the care and support that people required. They told us, wherever possible, they would support people to maintain their independence.

Medicines were generally safely handled although the use of prescribed creams was poorly documented. The manager conducted regular checks to ensure staff were competent to administer medicines safely.

Care records showed that risks to people's health and well-being had been identified, such as the risk of falls, pressure sores and poor nutrition. However these risk assessments had not always been regularly reviewed and updated. This meant that people were at risk of receiving unsafe or inappropriate care.

People were cared for in a safe and clean environment. Procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the premises and the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

Staff received the induction, training and supervision necessary to enable them to carry out their roles effectively and to care for people safely. Staff told us they enjoyed working in St James House and felt they were well supported by the managers and provider. They also told us they were able to make suggestions about how the service could be improved.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was aware of their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected.

Systems were in place to help ensure people’s health and nutritional needs were met. Records we reviewed showed referrals had been made to specialist services such as dieticians when any concerns were identified. People who used the service told us the quality of the food was good.

We saw that a programme of regular activities was provided to help maintain the well-being of people who used the service. Some people we spoke with during the inspection told us they felt a broader range of activities could be offered to help reduce social isolation.

We saw that people had opportunities to comment on the care provided in St James House. Records we reviewed showed action had been taken in response to feedback received.

There were systems in place for receiving, handling and responding appropriately to complaints. All the people we spoke with during the inspection told us they would be confident that any concerns they reported would be listened to and action taken by the manager to resolve the matter.

This comprehensive inspection was carried out to check that the provider had met the requirements of the warning notice regarding the management of medicines and to check that all other required regulations were being met.

St James House provides accommodation for up to 30 people who require support with personal care. There were 22 people living at the service at the time of our inspection.

The service did not have a registered manager in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new and experienced manager had been appointed since our last inspection; they had been in post since November 2015. They had submitted an application to register with CQC as manager at St James House.

During this inspection we found significant improvements had been made to the way medicines were administered in the service. This meant the requirements of the warning notice had been met.

People who used the service told us they felt safe in St James House and that staff were always kind and caring. We found people were cared for by sufficient numbers of safely recruited, suitably skilled and experienced staff. Staff received the training and support necessary to enable them to carry out their roles effectively and care for people safely.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse.

All areas of the home were clean and we saw that procedures were in place to prevent and control the spread of infection. Risk assessments were in place for the safety of the premises and systems were in place to deal with any emergency that could affect the provision of care.

We saw that the equipment and services within the home were serviced and maintained in accordance with the manufacturers' instructions. This helped to ensure the safety and wellbeing of everybody living, working and visiting the home.

The staff we spoke with had a good understanding of the care and support that people required. We saw people looked well cared for and there was enough equipment available to promote people's safety, comfort and independence. Interactions between staff and the people who used the service were warm, friendly and relaxed.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The manager was aware of their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); to ensure that people's rights were upheld.

People's care records contained enough information to guide staff on the care and support required. We noted that the manager was in the process of introducing a new format for care plans to ensure that people’s wishes and preferences were fully documented. Care records showed that risks to people's health and well-being had been identified and regularly reviewed. We saw that plans were in place to help reduce or eliminate the identified risks. Records we reviewed showed that people had the opportunity to contribute to the development and review of their care plan.

People told us they enjoyed the meals provided in St James House. Systems were in place to help ensure people’s nutritional needs were monitored and referrals made to specialist services when any concerns were identified.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. There were systems in place for receiving, handling and responding appropriately to complaints. We saw that feedback received from people was encouraged and used to drive forward improvements in the service.

Following the inspection visit we were sent an action plan informing us how the provider intended to ensure people were protected against the risks of inappropriate care. We revisited the service to ensure the necessary actions had been taken.

We spoke with four people who used the service and reviewed four care files. All the people we spoke with told us they were satisfied with the care they received at St James House. One person told us, 'It's marvellous here. Staff are very good'. Another person commented, 'I'm happy here. Staff look after me'.

We found all the care files we looked at included care plans which had been updated to reflect people's changing needs.

We reviewed the care files of five people who used the service. We found evidence that there were procedures in place to obtain consent from people regarding the care and treatment they received at St James House.

We found two of the care files we looked at did not contain care plans. This meant there was a risk that people who lived at St James House might not receive safe and appropriate care to meet their needs.

We found the premises were safe and secure and had been maintained to a reasonable standard. All the people we spoke with told us they felt comfortable within the home.

We spoke with four members of staff who told us they felt well supported and confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified to carry out their role.

We found that suitable arrangements were in place to manage an effective complaints process for identifying, receiving and handling complaints for people in St James House.

We revisited the service and looked at the recruitment and selection procedure and the records of two staff who had been recently appointed. We found that the necessary arrangements were in place to ensure that people were protected from unsuitable staff.

We found that there were adequate systems in place to regularly assess and monitor the quality of the service people received.