St James House

Updated 3 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two Inspectors carried out the inspection.

Service and service type

St James House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St James House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection the registered manager had recently left the service, and a new manager had started and was in the process of registering with CQC. This meant the provider was legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with all four people who lived at the service and one relative about their experience of the care provided. We spoke with six members of staff including the area manager, manager and care support staff.

We observed staff interactions with people and observed care and support in communal areas.

We reviewed a range of records. This included three people's care records and three medicines records. We

looked at four staff files in relation to recruitment, staff supervision and training. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 3 September 2022

About the service

St James House is a residential care home providing personal care and accommodation to four people at the time of the inspection. The service can support up to six people. The service is in Dartford town centre, in an old Georgian style residential building and the service was situated behind a secured gate.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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. People had Mental Capacity Act (MCA) assessments and had been supported to apply for a Deprivation of Liberty Safeguard (DoLS) for restrictions made to keep them safe.

Some risks to people had not been safely managed at the time of our inspection. Fire and safety risks needed addressing. Some parts of the building were not clean or well maintained.

Risks to one person living with a health condition that required monitoring of fluid levels had not been safely managed.

People did not always receive person centred support. Some people’s activities did not reflect their interests and there was a lack of goals and aspirations in people’s care plans.

Governance systems had not always been effective in highlighting and putting right issues identified at this inspection. Some aspects of the culture of the service were not positive, as one person had been moved from the service at short notice without involving partner agencies.

Right support:

The model of care and setting did not always maximise people’s choice, control and independence. People were not fully considered and involved in the planning of their care and some choices were at times restricted. St James House was located on site with another care home. The model of the service does not reflect the Right Support, Right Care, Right Culture guidance

Right care:

Care was not always person-centred and did not always promote people’s dignity. People did not always have access to meaningful and person-centred activities.

Right culture:

Some values and attitudes of leaders and care staff did not always ensure people using services led confident, inclusive and empowered lives.

Rating at last inspection

The last rating for this service was good (published 13 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about risk management and infection prevention and control. A decision was made for us to inspect and examine those risks. We also undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well led sections of this full report.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to safe management of risk, person centred care, premises and equipment, and good governance. The registered provider had failed to effectively monitor and improve the quality of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.