Archived: St. John Home

Updated 30 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider continued to meet the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

We used information the registered provider sent us in the Provider Information Return. This is information we require registered providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also examined other information we held about the service. This included notifications of incidents that the registered provider had sent us since our last inspection. These are events that happened in the service that the registered providers are required to tell us about. We also invited feedback from the commissioning bodies who contributed to purchasing some of the care provided in the service. We did this so that they could tell us their views about how well the service was meeting people’s needs and wishes.

We visited the service on 19 September 2018 and the inspection was unannounced. The inspection team consisted of three inspectors.

During the inspection we spoke with seven people who lived in the service and with two relatives. We also spoke with a housekeeper, five care staff, three nurses, the administrator, the business manager and the manager. We observed care that was provided in communal areas and looked at the care records for five people who lived in the service. We also looked at documents and records that described how the service was managed including staffing, training and quality assurance.

After the inspection visit we spoke by telephone with two relatives.

Updated 30 November 2018

We inspected the service on 19 September 2018. The inspection was unannounced.

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

St John Home is registered to provide accommodation, nursing and personal care for 18 older people and younger adults. It can also accommodate people who require support to manage their mental health and people who have physical and/or sensory adaptive needs. There were 15 people living in the service at the time of our inspection visit all of whom were receiving nursing care.

The service was run by a charitable body who was the registered provider.

At the last comprehensive inspection on 16 August 2017 and 18 August 2017 the overall rating of the service was, ‘Requires Improvement’. We found three breaches of regulations. This was because people had not always been provided with safe care and treatment. In particular, there were shortfalls in the steps taken to reduce the risk of accidents and to ensure that people drank enough and dined safely. There were also oversights in the checks made to ensure the safe operation of bed rails and pressure relieving mattresses. In addition to this, suitable provision had not been made to obtain people’s consent to the care they received. Furthermore, the registered provider had not established robust systems and processes to monitor, assess and improve the service.

We told the registered provider to send us an action plan stating what improvements they intended to make and by when to address our concerns and to improve the key questions of 'Safe', 'Effective' and ‘Well Led' back to at least, 'Good'. After the inspection the registered provider told us that they had made the necessary improvements.

At the present inspection we found that sufficient progress had been made to meet each of the breaches of regulations. There were robust arrangements in place to ensure that people reliably received the nursing and personal care they needed. This included lessons being learned when things had gone wrong so that arrangements could be made to reduce the risk of people experiencing falls. It also included people being helped in the right way to drink enough and to eat safely. Furthermore, additional checks had been made to ensure that bed rails and pressure relieving mattresses were in a serviceable condition. Revised arrangements had been made to enable people to seek consent in line with national guidance. Additional quality checks had been introduced to enable the registered provider to better ensure that people received care that met their needs and expectations. However, in relation to this more progress was still needed as quality checks had not identified that additional steps needed to be taken for the service to comply with a change in best-practice guidance. We found that people had not always had information presented to them in an accessible way. This had reduced their ability to receive person-centred care that promoted their independence. This was because appropriate arrangements had not been made to implement the Accessible Information Standard 2016. We have made a recommendation in relation to this matter.

Our other findings were as follows: People were safeguarded from situations in which they may experience abuse including financial mistreatment. Medicines were managed safely. There were enough nurses and care staff on duty. Background checks had been completed before new nurses and care staff had been appointed. Suitable arrangements were in place to prevent and control infection.

People received nursing and personal care that was delivered in line with national guidance by nurses and care staff who had the knowledge and skills they needed. This included respecting people’s citizenship rights under the Equality Act 2010. People were supported to eat enough to have a balanced diet to promote their good health. Suitable steps had been taken to ensure that people received coordinated care when they used or moved between different services and people had been supported to access any healthcare services they needed. The accommodation was designed, adapted and decorated to meet people’s needs and expectations.

People were supported to have maximum choice and control of their lives. In addition, the registered provider had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.

People were treated with kindness and they had been given emotional support when needed. They had also been helped to express their views about things that were important to them. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received all the practical assistance they needed. People were given opportunities to pursue their hobbies and interests. Nurses and care staff recognised the importance of appropriately supporting people if they followed gay, lesbian, bisexual, transgender and intersex life-courses. Suitable arrangements were in place to resolve complaints to improve the quality of care. People were supported at the end of their life to have a comfortable, dignified and pain-free death.

There was no registered manager. However, there was a manager in post who had promoted an inclusive culture in the service. They were in the process of applying to be registered by us. People who lived in the service and members of staff were actively engaged in developing the service. Nurses and care staff had been supported to understand their responsibilities including speaking out if they had concerns about a person’s wellbeing. There were suitable arrangements in place to enable the duty of candour to be met. The registered provider had told us about any significant events that had occurred in the service. The quality ratings we had given the service were displayed in the right way. The registered provider was actively working in partnership with other agencies to support the development of joined-up care.