St John's Home

St John’s Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 50 people. The service provides support to older people. At the time of our inspection there were 30 people using the service.

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

Some environmental risks were not always mitigated. The registered manager addressed these concerns following our inspection. People's needs were assessed, and clear risk assessments were in place to guide staff. However, risk assessments for high-risk medications were not in place. Staff received safeguarding training and knew what to do if they thought someone was at risk. Medicines were managed safely. There were safe systems of recruitment in place.

Feedback about the service, staff and management was positive. Staff worked in effective partnership with external professionals. The management team had oversight of the service and demonstrated commitment to the continued development of the service. Actions were taken to develop and improve identified areas.

People 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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 March 2021) and there were breeches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 10 February 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St John’s Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St John’s Home is a residential care home providing personal care for up to 50 people aged 65 and over. At the time of the inspection the service was supporting 28 people.

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

The management of risk and systems and processes to ensure effective oversight of the service required improvement. We found gaps in records and not all known risks had strategies in place or completed. Not all audits had been completed or actions put into place. Systems in place to identify when support and care was not delivered were not sufficient. For example, repositioning tasks were not consistently completed.

Staff had access to detailed care plans which identified people’s like, dislikes, history and relationships important to them. The registered manager understood the assessible information standard to ensure people could understand information. People were supported by enough staff who knew them well and responded to their needs.

People were supported appropriately with their medicines. Staff received training on medicine administration.

People, relatives and staff were able to complain and understood the process. Staff were supported to raise and issues or suggestions to improve the service.

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 10 January 2020)

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We received concerns in relation to infection control, personal protective equipment and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St John’s Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to risks, oversight and record keeping at this inspection.

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 for 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.

We found the following examples of good practice.

¿ The provider ensured there was sufficient stock of Personal Protective Equipment (PPE) in place including masks, gloves, aprons and hand sanitiser. Infection control polices had been updated to reflect the current national guidance and staff were wearing this appropriately.

¿ There were numerous personal protective equipment (PPE) stations in the service. This meant staff had easy access to plentiful supplies of masks, gloves, aprons and hand sanitiser to use when they were in close contact with people. There were posters and information about COVID-19 on display throughout the service.

¿ The provider ensured staff were skilled in infection prevention and control. This included training about infection control specifically relating to 'Donning and Doffing' which is how to put on and remove PPE safely.

¿ Admissions processes had changed since the onset of the pandemic to reduce the risk of infection. People were admitted on the same day as they received a negative COVID-19 test result, including over the weekend. Government guidance was followed to ensure people’s safety.

¿ There was a testing programme in place for staff and people living in the service. This was to ensure if any staff or people had contracted COVID-19 and were asymptomatic, this was identified and acted upon in a timely way.

¿ The provider had set up a visiting room to facilitate visits between people and their relatives. This included an outside access point to the room. PPE and handwashing facilities was available to visitors. These measures meant people and their relatives could safely spend time together. Staff facilitated these visits in line with national guidance.

¿ Infection prevention and control audits took place on a regular basis. The provider had recruited additional domestic staff to enhance the infection and prevention standards in the home .

Further information is in the detailed findings below.

St John’s Home is a care home providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The home can support up to 48 people.

People were accommodated across two floors and a separate wing, each of which had separate adapted facilities.

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

There was a registered manager who had been the manager of the service since April 2014.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. People were supported to access relevant health and social care professionals.

People’s medicines were managed in a safe way. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care which mitigated these known risks.

People received care from staff who knew them well. Staff had a good understanding of people's needs, choices and preferences. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. Staff gained people's consent before providing personal care.

People were involved in the planning of their care which was person centred and updated regularly. People were supported to express themselves and their views were respected and acted upon. There was a complaints system in place and people were confident complaints would be responded to appropriately.

Staff were recruited using safe recruitment practices. Staff received training to enable them to meet people’s needs and were supported to carry out their roles.

The management team continually monitored the quality of the service, identifying issues and making changes to improve care.

People 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.

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 (19th June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

At the last inspection in May 2015, the service was rated ‘Good’. At this inspection we found that the service remained Good.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

There were sufficient numbers of experienced staff working in the home to meet people’s care and support needs. Staff had been subject to robust recruitment procedures prior to working in the home and received training in key areas that enabled them to understand and meet people’s care needs. People were protected from the risk of harm because staff were confident in recognising and reporting to maintain people’s safety. People could be assured that they would receive their prescribed medicines safely.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had detailed individual plans of care in place that were reflective of their care needs to guide staff in delivering their care and support. People’s needs were monitored closely and their plans of care reviewed to ensure they received appropriate care and support. People and their representatives had been involved in developing their plans of care which meant that people received consistent and personalised support.

People’s health and well-being was monitored by staff and they were supported to access relevant health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to help maintain their health and well-being.

Staff took time to get to know people and ensured that people’s care was tailored to their individual needs. People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored by the audits regularly carried out by the registered manager and by the provider.