Archived: St John's Home

St Johns Care Home is registered to provide accommodation for up to 38 older people who require personal care. At the time of the inspection there were 32 people living at the service.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

People were not always protected from risks associated with their care and the environment. In that areas of the home that should have been secured were left unsecured and unattended and people’s thickeners were not stored safely.

People received their medicines as prescribed. Staff administering medicines checked each person’s identity and explained what was happening before giving people their medicine. However medicine records and records relating to people’s care were not always completed accurately.

People and staff told us there were not sufficient staff deployed in the home. However during our inspection we could find no evidence to suggest that people’s care needs were not being met as a result of insufficient staffing.

The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role. There was a whistleblowing policy in place that was available to staff around the home. Staff knew how to raise concerns.

People told us they were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities.

People’s care plans contained risk assessments which included risks associated with moving and handling, falls prevention and pressure damage. Where risks were identified plans were in place to identify how risks would be managed. Regular audits were conducted to monitor the quality of service.

Staff understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

People were supported to maintain good health. People had sufficient to eat and drink and were complimentary about the meals in the service. The service had an activities coordinator and people were offered a wide range of meaningful activities.

The service sought people’s views and opinions and acted upon them. People told us they were confident they would be listened to and action would be taken if they raised a concern. We saw complaints were dealt with in a compassionate and timely fashion.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery.

A single inspector carried out this inspection. The focus of the inspection was to answer one of our five key questions in relation to this outcome; is the service well led?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the well led?

Since our last inspection the provider had employed a new management team for the home. The new team had implemented an extensive improvement plan to ensure the monitoring of quality and safety of services provided to people was taking place.

We considered the five questions we always ask: Is the service caring? Is the service safe? Is the service responsive? Is the service effective? Is the service well led? This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People were treated with dignity and respect. We observed care workers interacting with people in a respectful and friendly manner. People we spoke with and their relatives told us they were treated with dignity and respect. One person said 'there aren't words for these girls, how much I appreciate their friendship and professionalism'.

People who used the service and their relatives felt cared for. One relative told us 'They [their relative] liked the place and finds the staff friendly and helpful'.

We were told that care workers were well trained and caring. One relative told us that they thought the home was 'astute at recruiting kind staff with an empathetic attitude.'

Is the service safe?

People told us they felt safe. One person told us, 'it's a first class place, I feel safe'. One relative of a person who lived at the home said 'oh yes absolutely' that their relative was safe. This showed us that people felt safe.

Care and treatment was planned and delivered in a way that was intended to ensure the persons safety. Care plans identified risks and we saw that risk assessments were in place; for example; nutritional, falls and tissue viability.

We found that the system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others was not effectively implemented and managed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

People who used the service, their representatives and staff were asked for their views about the service and the care they received and they were acted on. One relative told us 'any concerns are acted on'.

Care workers told us they felt listened to. Care workers had opportunities to raise issues and concerns through supervision and staff meetings. Staff meetings were held monthly to support them in their roles and enable them to voice issues and concerns. We saw the minutes of regular staff meetings held.

Is the service effective?

We looked at the care plans for five people who used the service. We spoke with people and relatives about the care delivered. All the people and relatives we spoke with were highly complimentary of care staff and the care they received. For example; one person said they 'find things excellent, it is a first class place', one relative said 'it's way beyond other care homes'.

All care workers we spoke with told us they felt supported to carry out their roles effectively. One senior member care worker said they "very much feel supported' and a care worker said in relation to staff support 'it's very good".

Is the service well led?

The organisation was going through a period of change. We saw and heard evidence to suggest the organisation had kept people who use the service their relatives and staff involved and informed through this period.

Care workers told us that they had been kept informed about the changes and had opportunities for to raise concerns and issues through staff meetings. One care worker said that at staff meetings 'you say what you want to say'.

The manager was not available to meet with during our inspection.

We found that the system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others was not effectively implemented and managed. We were told that there were leads in place to oversee outcome areas against care quality commission standards. These were then audited on a quarterly basis, six standards being covered per quarter. We were shown a copy of a blank 'Audit Assessment Recording' template. We asked to see the latest audits; however the provider was unable to make these available to us. Therefore, we were not assured that the auditing system in place was being effectively implemented and operated. This meant there was a risk that the provider was not effectively monitoring, auditing, and managing risks to people who use, work or visit in the service.

People wanting to live in the home had a thorough initial assessment of their needs and risks to their health and welfare. We spoke with seven staff members and found they were caring, respectful and committed. We saw that subsequent risk assessments and care plans did not always accurately reflect people's needs or include important information. Care workers did not always have accurate and sufficient information to know how to support people appropriately to ensure their safety and welfare. Care delivery was not always monitored effectively to ensure that changes to care were made when needed or that people's needs were being fully met.

The home had effective staff and volunteer selection arrangements in place. We found that all the recruitment checks, as required by the home, had been undertaken prior to staff and volunteers undertaking their duties at the home.

The home had arrangements in place to protect people from the risk of abuse. Staff understood the local safeguarding arrangements and knew how to respond to any concerns relating to abuse. We saw where restrictions on people's freedom were required to ensure they were kept safe applications to the local authority were made appropriately.

We found that staff had received appropriate induction, training and regular supervision to ensure that they had the skills to undertake their care tasks competently.

People we spoke with told us they knew how to complain and raise a concern. We saw that all complaints had been investigated and responded to within the timescales set within the complaints policy. Appropriate actions had always been taken.

We found there were a wide range of activities on offer for the people who used the service, and a range of choices regarding meals, worship and, where possible, being able to go out into the local community on their own.

The service was fully staffed and staff were qualified and trained to an appropriate level. Safeguarding policies and procedures were in place, and staff were encouraged to report any instances of abuse. People who used the service met regularly with the management of the service and were able to feedback comments, complaints and compliments.