Archived: St Johns Wood Care Centre

Updated 31 July 2019

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 Care Act 2014.

Inspection team

The inspection team comprised of three inspectors, a pharmacist, a specialist advisor and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Johns Wood Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The previous registered manager of the service left their employment in February 2019. We were informed by the acting manager on the second day of this inspection that a new manager had been appointed and was expecting to commence in post in June 2019.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since our last inspection. We sought feedback from the local authority where the service is located and other authorities that also place larger numbers of people at the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with 22 people using the service and four relatives about their experience of the care provided. We spoke with 21 members of staff, including nurses, care workers, activity coordinators and the chef. We also spoke with the acting manager, deputy manager, clinical lead nurse, peripatetic manager, regional director, personnel manager and two quality compliance inspectors from the provider.

We reviewed a range of records. This included 10 people’s care records and 27 medicines records. We looked at the providers database for verifying disclosure and barring checks in relation to recruitment. We also looked at a variety of records relating to the management of the service, including a range of policies and procedures.

After the inspection

We sought further information after the inspection about immediate medicines concerns and other evidence documents, for example, staff training and supervision, quality assurance audits and policy and procedure documentation.

Updated 31 July 2019

About the service

St Johns Wood Care Centre is a care home providing personal and nursing care to 80 people aged 65 and over at the time of the inspection. The home can support up to 100 people.

The service provides nursing and personal care on five floors. People have their own ensuite bedrooms and share bathrooms and shower rooms, as well as lounges and dining rooms on the floor where they live.

One floor specialises in caring for people with dementia, however, people living with dementia also live on other floors of the home. Another floor specialises in caring for people with acquired brain injury.

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

People were not always protected from potential harm as risks were not managed effectively and staff were not always provided with up to date guidance about how to prevent harm. Medicines management was not given the necessary oversight by management of the home. The use of insulin was not monitored appropriately and had not identified emerging issues about incorrect insulin doses. Although no one was identified as having suffered direct avoidable harm the potential that some may do so was not mitigated as thoroughly as it should be.

Care planning was complex and confusing, and the way information was gathered and updated was not readily accessible. The nursing and care staff we spoke with, in almost all conversations, knew people they cared for well. Updating the current assessment of need for each person using the service had begun prior to this inspection, however, this remained an unresolved issue that was identified at the previous inspection that had not been fully addressed.

People were not always supported to have maximum choice and control of their lives. Although staff usually supported people in the least restrictive way possible and in their best interests; the policies and systems in the home did not effectively support this practice. Consent, if not obtainable from some people using the service, was not obtained from those with the authority to consent on people’s behalf in some cases.

Most people and relatives we spoke with felt able to raise things they wanted to with management or other staff at the home. People usually felt that staff were caring. We observed some caring interactions, although we also observed some occasions where the way staff interacted and spoke with people was not as caring and respectful as it should be especially during mealtimes.

The provider’s oversight and management processes, although in recent months highlighting some issues to be addressed, had not resulted in timely action to achieve the improvement necessary.

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 (report published 16 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not been made and the provider was still in breach of regulations.

The home is now rated as inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about fire safety and infection control. A decision was made by CQC to inspect earlier than had originally been scheduled to examine these concerns. We also checked progress regarding the previous breaches of regulations 9 (Person centred care) and 12 (Safe care and treatment).

We have found evidence that the provider has deteriorated in the day to day management of the service and needs to make improvement. Please see the Safe, Effective, Caring, 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.

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

Enforcement

We have identified ongoing breaches in relation to Regulation 9 (Person Centred Care) and Regulation 12 (Safe care and treatment). Risk assessment processes and care planning were each identified as ongoing breaches. Safe management of medicines was additionally identified as requiring action to ensure the safety of people using the service at this inspection. We issued a warning notice in respect of Regulation 12 to be complied with by no later than 12 July 2019 and Regulation 9 to be complied with by no later than 9 August 2019.

We also identified breaches to other regulations as follows. Regulation 10 (Dignity and respect) as some engagement with people was not respectful. Regulation 11 (Consent) as consent to care and treatment was not obtained for some people. Regulation 17 (Good governance) as there were widespread and significant shortfalls in service leadership and the culture created did not assure the delivery of high-quality care. Regulation 18 (Staffing) as staff were not being supported though supervision.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.