St Johns Nursing Home Limited

Updated 3 February 2023

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

This inspector was undertaken by two inspectors and one Specialist Nursing Adviser.

Service and service type

St Johns Nursing Home Limited 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 Johns Nursing Home Limited is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. However, the service’s new manager planned to register with CQC as the registered manager for St Johns Nursing Home Limited.

Notice of inspection

This inspection was unannounced.

What we did before the 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. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people, 5 care staff and two nurses. We also spoke with the new manager, the registered manager of one of the provider’s other services who was providing support and the Nominated Individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We checked 8 people’s care records and 5 staff files. We checked people’s medicines and medicines administration records and the provider’s quality assurance records. We also contacted 4 healthcare professionals for their views about the service.

Updated 3 February 2023

About the service

St Johns Nursing Home is a residential care home providing personal and nursing care to up to 54 people in one adapted building. The service provides support to people who need nursing support, including people living with dementia. At the time of our inspection there were 44 people using the service.

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

Staff administered medicines to people appropriately, but we found medicines administration records were not always adequately completed. The risk of people developing pressure sores was managed by a range of measures designed by healthcare professionals. However, records relating to these were not always completed. For example, there were gaps in people’s turning and hydration records. In the weeks prior to our inspection a new manager came in to post at the service. They had introduced auditing processes that identified these shortfalls. We will continue to monitor the service to ensure that the provider’s quality checks improve and maintain people’s safety. The service’s new manager had recruited new staff, including nurses and a clinical lead, to the team. This ensured there were enough staff available at all times to deliver safe and effective care. Staff received training and supervision.

People’s needs were assessed and reviewed. 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 received the support they required to eat and drink and accessed healthcare services whenever they needed.

Caring staff maintained people’s privacy and dignity. People were supported to maintain relationships with friends and relatives. People’s spiritual and cultural needs were met and they were supported to make decisions

People’s changing needs were identified and met. People were supported to participate in a range of activities. The provider planned to double its number of activity coordinators and increase the choice of activities available to people. The service had access to specialist support should people be identified as requiring end of life care.

The service did not have a registered manager in post. However, a new manager had recently joined the service and had immediately implemented a range of changes to drive improvements. Whilst we had identified some shortfalls at the service these largely predated the new manager's arrival. The new manager intended registering with the CQC to become the service’s registered manager. People and staff expressed confidence in the new manager who was working in partnership with others to meet people’s needs.

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 07 September 2022). 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 regulation related to governance but remained in breach of regulation related to safe care and treatment. We have found evidence that the provider needs to make improvements. The new manager had identified these and was in the process of making improvements. Please see the Safe 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.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, people’s weight, complaints and the management of the service. A decision was made for us to inspect and examine those risks.

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.

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

Enforcement and Recommendations

We have identified a continued breach in relation to people’s safe care and treatment.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.