Archived: St. Johns Wood Care Centre

Updated 2 October 2020

The inspection

This was a targeted inspection to check whether the provider had met the requirements of the specific concern we had about person centred care, risk assessments and ensuring people’s nutrition and hydration needs were met. We also looked at infection control and management arrangements at the home. We will assess all of the key question at the next comprehensive inspection of the service.

Inspection team

The inspection team comprised of two inspectors and an Expert 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. They conducted telephone interviews with a selection of relatives of people that were using the 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 service did not have a manager registered with the Care Quality Commission as the person previously in this position had left a few weeks prior to this inspection taking place. A new manager had been appointed but had not yet made an application to register with CQC. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

We gave the service 48 hours’ notice of the inspection visit to ensure suitable arrangements could be made during our visit in relation to COVID-19 safety measures. We also wanted to ensure arrangements were in place for the inspection team to speak with relatives remotely. It was not possible to spend individual time with people living at the home although we did observe people interacting with staff and had brief passing conversations asking people how they were during our tour of the home.

What we did before the inspection:

We reviewed information we had received about the service since the last inspection. We sought feedback from two local authorities that commission most people’s placements at the home. We used this information to plan our inspection.

During the inspection:

We spoke with 11 relatives of people using the service by telephone about their relatives, and their own experience of the care provided. We observed care to help us understand the experience of people who could not talk with us. We spoke with a nurse, an activity co-ordinator, the deputy manager and the manager. We invited other staff, regardless of their role at the home to provide us with confidential feedback via email and we received one reply.

We reviewed a range of records. This included seven people’s care plan records as well as the records for monitoring people’s food and fluid intake if this needed to be monitored. We also looked at multiple risk assessment records, which covered a range of areas, including pressure ulcer care, diabetes care, general healthcare risks, including the response to the COVID 19 pandemic, and risk of falls. We also looked at a variety of records relating to the management of the service, including policies and procedures specific to infection control and COVID 19 pandemic response and safeguarding people from abuse as well as care planning records.

After the inspection:

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

Updated 2 October 2020

About the service

St Johns Wood Care Centre is a care home providing personal and nursing care to 69 people aged 65 and over at the time of the inspection. The home can support up to 100 people.

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

One floor specialised in caring for people with dementia, however, people living with dementia also lived on other floors of the home. Another floor specialised in caring for mostly younger adults with acquired brain injury or other conditions limiting their ability to live independently.

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

At the time of our inspection the service was in the process of improving care planning. however, care plans we reviewed were still complex and lacked clarity. 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, much needed to be done to fully assess all people and to understand the current and most accurate care and support needs.

People overall were protected from potential harm, although elements of risk for some people were not always clear and some were contradictory. For example, risk associated with medical or psychological conditions. Some people required monitoring to ensure that they drank enough each day although this was not always documented or evaluated fully.

Medicines management was safe and was given the necessary oversight by management of the home. The use of insulin was monitored appropriately, and this had improved since our previous inspection.

People were supported to have maximum choice and control of their lives. Staff usually supported people in the least restrictive way possible and in their best interests; the policies and systems in the home supported this practice. Consent, if not obtainable from some people using the service, was being sought from people who had power of attorney although some people’s reason for having best interest decisions made on their behalf needed clarification.

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 a number of caring interactions and staff treated people with respect.

The recently registered provider was able to demonstrate their awareness of issues that had been prevalent at the service for some time and informed us of their plans to make improvements.

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

This service was registered with us on 4 November 2019 and this is the first inspection. At the previous inspection in May 2019 there were multiple breaches and two warning notices were issued against the previous provider. At that time the service was rated as Inadequate.

Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was prompted in part due to the home being rated as inadequate as a result of an inspection the CQC in May 2019. The previous provider cancelled registration of the home in November 2019 and a new provider, Bondcare (London) Limited, took over operation of the home on 4 November 2019. A decision was made by CQC to inspect the service in order to check if the service was safely caring for people in light of the previous rating and a new provider having taken over the running of the home..

We have found evidence that the new provider had undertaken a review of the safety and wellbeing of people using the service. They had developed a detailed action plan to address the known and emerging issues about the day to day operation of the home.

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 a breach of Regulation 9 (Person Centred Care) in respect of care planning not suitably assessing or identifying some people's current care and support needs. We issued a warning notice in respect of Regulation 9 to be complied with by no later than 30 April 2020.

We also identified breaches to two other regulations as follows. Regulation 12 Safe care and treatment and Regulation 14 Meeting nutritional and hydration needs. Risk assessments were not fully completed, updated or followed up for some people using the service and some people's fluid intake was not being appropriately monitored or evaluated.

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.