26 March 2015
During a routine inspection
The inspection visit was carried out on 26 March 2015 and was unannounced. The previous inspection was carried out in December 2013, and there were no concerns.
The St. John Home is owned by The Priory of England & the Islands of St John. Accommodation is over two floors with a stair lift to the first floor. The home provides accommodation, residential and nursing care for up to 18 older people.
The service is run by a registered manager, who was present on the day of the inspection visit. 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.
Staff recruitment procedures were unsatisfactory as two new staff had not had checks carried out for Disclosure and Barring Service (DBS) checks, and a full employment history was not evident for some staff.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). No applications had been made to the DoLS department for depriving people of their liberty for their own safety.
Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager, or with outside agencies if they needed to do so.
There were sufficient numbers of staff to meet people’s needs, and to give them time, and not to rush them. This included nurses throughout the twenty-four hours. People said that they felt safe and secure in the home, and the staff looked after them “Very well”. Records of on-going staff training, supervision and appraisals confirmed that staff were working to appropriate standards and were supported by their line managers. Refresher training was provided to keep staff up to date.
The service had systems in place for on-going monitoring of the environment and facilities. This included maintenance checks, and health and safety checks. The premises were suitably maintained, and there were on-going plans for further improvements, including altering an existing bathroom to a wet shower room. Risk assessments were implemented for each person living in the home, highlighting specific concerns which could affect their welfare and safety. These included risk of falls, use of equipment, risk of developing pressure sores and checks for environmental hazards. These included a Personal Evacuation Emergency Plan (PEEP) in the event of fire or other emergency.
The registered manager had processes in place to follow up accidents or incidents and identify if any additional action could be taken to minimise assessed risks.
Medicines management was carried out effectively. Medicines were administered by trained nurses.
Staff were informed of their responsibilities under the Mental Capacity Act 2005, and encouraged and enabled people to make their own decisions in accordance with their capacity. Some people wished for their family representatives to discuss their care planning on their behalf, and this was arranged as agreed. Care plans contained suitable information to help staff to provide effective care, following people’s individual needs and preferences. People were encouraged to retain their independence wherever possible, and to make their own choices. This included daily choices such as what to wear, what to eat, and where to go.
People said that the food was “Very good” and “Excellent!”. The catering staff provided them with varied menus which enabled people to have a nutritious diet. A choice of meals was always available, and people could request snacks and drink at any time. All of the food was home cooked, and included home-made cakes every afternoon. A recent visit from the local council’s Environmental Health Officer had awarded the kitchen with the highest award of five stars for food hygiene. Most people chose to eat lunch together in the dining-room. This provided a focal point during the day for socialising, and preventing people from feeling isolated.
Nursing staff carried out on-going checks for people’s health needs, and contacted other health professionals for support and advice. A GP visited the home routinely once per week, and more often as required. Relatives told us that they were always kept informed by staff of any changes in the person’s health or welfare, and said, “The care is amazing here.” Another person told us that “The staff all have a lovely attitude. Nothing is too much trouble for them. They have always got time for you”.
Staff had a caring and friendly manner, and treated people with affection as well as with respect. They answered people’s call bells promptly. They were well informed about people’s previous lifestyles and the subjects that interested them. An activities co-ordinator managed events and day to day activities. The ‘Friends of St John’ also supported staff with providing entertainment, and visited people on a regular basis.
People were confident that they could raise any concerns with the staff or registered manager, and that these would be properly dealt with. The registered manager had a visible presence in the home, and it was evident that people and their relatives knew her well. She told people at the time of admission that she had an open door policy, and encouraged people to voice any concerns or complaints so that they could be addressed. The complaints log demonstrated there were reliable processes to follow up complaints appropriately.
People were encouraged to express their views every day, so that any concerns could be followed up immediately. The registered manager greeted each person every day when she was on duty, giving people confidence in her, and an opportunity to chat about anything. People were also invited to attend residents and relatives’ meetings, and the minutes of these were circulated to each person after the event. This enabled people to see what action had been taken in relation to items that had been discussed.
People were invited to completed six-monthly questionnaires which provided further information about people’s views. These could be completed anonymously if people wished. They were given out shortly before resident and relatives’ meetings, so that feedback from the questionnaires could be discussed at the meetings.
Staff said that they felt involved in the running of the home, and were clearly motivated to provide high standards of care. Staff meetings were well attended, and staff ideas were taken on board and used for on-going improvements to the service.
Records were neatly and accurately maintained, and were up to date and signed and dated. There were systems in place for the on-going monitoring of the service through daily, weekly and monthly checks and audits.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.