St James House

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.

This service supported people with learning disabilities and/or autism and mental health needs. The service is registered to provide care for six people and had full occupancy at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People’s experience of using this service:

People using the service told us that they were happy with the support that they were receiving. People said that they felt safe living at the service and liked the staff who worked with them. Risks to people from physical and mental health conditions were assessed and there were mitigations in place to protect people. There were some concerns relating to medicines documentation, however these were addressed at the time of the inspection and had not impacted on people receiving their medicines as prescribed.

The staff at the service were caring and provided people with emotional support where this was needed. There were enough staff to keep people safe, support people to participate in activities and access the community. Staff knew how to protect people’s dignity and people had privacy when they wanted to be alone in their own room.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; people were provided with opportunities to develop their skills, people were supported to participate in daily living activities, access the community and increase their independence.

Staff provided people with appropriate levels of support to shop and cook for themselves where possible. People were encouraged to exercise and had access to healthcare services where this was needed. People participated in a wide range of meaningful activities in line with their needs and preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There was information for people on how to complain if they chose to do so and complaints were investigated and acted upon. People told us that they felt listened too and involved in planning their own care. People had keyworkers who led on their support and gave people the opportunity to feedback on their support and any concerns.

People knew the registered manager and deputy managers well and spoke to them regularly. This meant that people were able to discuss concerns with the management team directly if they wanted to do so. There were house meetings for people where they could raise issues and they were invited to feedback through surveys.

The service continued to meet the characteristics of Good in all areas; more information is in the full report.

Rating at last inspection:

At the last inspection (published on 11 November 2016) the service was rated Good.

Why we inspected:

This was a scheduled inspection based on the pervious rating.

Follow up:

We will visit the service again in the future to check if there are changes to the quality of the service.

St James House is a care home without nursing caring for up to six people with learning disabilities and other complex needs. Care and support is provided to adults with learning disabilities, autism, schizoaffective disorder and challenging behaviours. At the time we visited there were four people living at the home and two people in hospital.

St James house describe itself as a rehabilitation home. Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination.

There was a new manager at the home. The new manager joined the organisation in August 2016 and they had submitted their application as the registered manager with CQC. 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 and associated Regulations about how the service is run.

At our previous inspection on 20 October 2015, we found breaches of Regulation 9, Regulation 12, Regulation 13, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan by 15 December 2015. The provider submitted an action plan on 05 February 2016 which showed how they planned to improve the service by 28 February 2016. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

During this inspection, we found that care plans identified clear guidelines for supporting people with behaviour that other people may find challenging. The guidelines included clear descriptions of the behaviour, descriptions of possible and probable causes and strategies for supporting each person to become less anxious and calmer. We found that these guidelines were consistent.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Our observation on the day showed that people had a variety of activities. Activities were diverse enough to meet people’s needs and the home was responsive to people’s activity needs.

People had access to nutritious food that met their needs. We observed that people freely made their cold and hot drinks when they wanted them. The provider had fitted a new accessible kitchen that promoted people’s independence in the home.

The provider and registered manager had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training at start of their employment.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People knew how to make a complaint and these were managed in accordance with the provider’s policy.

Staff were clear about their roles and responsibilities. The staffing structure ensured that staff knew who they were accountable to. Staff meetings were held frequently. Staff told us they felt free to raise any concerns and make suggestions at any time to the registered manager and knew they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.