St Johns House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question outstanding. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture that focused on providing kind, person‑centred care and creating a homely environment for people. Staff, people using the service and visiting professionals consistently described the service as a calm, welcoming and caring place to live. People told us they felt safe, well supported and treated with respect, and professionals spoke positively about the culture within the home. The registered manager was visible and involved in the day‑to‑day running of the service, and staff described leaders as approachable and supportive. There were positive relationships with the provider, including regular visits and audits, which helped reinforce shared expectations about care quality. People’s rooms were personalised, the environment was well maintained and there was a clear emphasis on dignity, independence and wellbeing.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. The registered manager was well known to staff and people using the service and was actively involved in the daily operation of the home. Staff told us leaders were approachable and supportive, and professionals described positive and long‑standing working relationships with the management team. However, leaders did not consistently and robustly respond to incidents, provider rapid assurance and ensure a clear strategy was put in place to ensure people’s safety at all times.

People did not always feel they could speak up and that their voice would be heard.The provider had systems in place to support people, staff and relatives to raise concerns and share feedback. Staff told us leaders were approachable, and people and relatives said they would feel comfortable raising concerns if needed. Complaints were recorded, investigated and responded to, with evidence of learning where appropriate.

Professionals told us they felt confident to raise issues with the service and described open communication and good information sharing. There were resident and relative meetings, and feedback had been raised previously about staffing and response times. However, although concerns had been raised, these did not always lead to timely or sustained improvement. Some people told us they had raised concerns, but these had either not been acted upon or there was a delay in a response. This reduced the confidence of all people to speaking up and meant people did not always experience consistent outcome as a result of their feedback. Some staff told us they had raised concerns about staffing and the quality of some agency staff, but this had not been acted upon. One member of staff told us, “There aren’t enough staff. Agency staff can be more of a hinderance than a help. I often have to pull them up about moving and handling. I’ve told the managers, but I don’t know what has been done about it.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them however there were gaps in training and oversight of staff assurances. The provider demonstrated a commitment to treating staff fairly and respectfully. Staff told us they were supported through induction, training and supervision, and some staff described being supported to achieve qualifications and career progression. Leaders made reasonable adjustments, such as extending induction periods when needed, to ensure staff were supported in their roles. There was a diverse workforce, and interactions observed between staff and people using the service were kind, respectful and inclusive. However, there were gaps in training compliance, supervision and appraisal arrangements meant that systems to fully support and develop the workforce were not always effective or equitable. This reduced assurance all staff had consistent access to development and support. Whilst the provider responded to this feedback during the inspection, systems were not in place locally to ensure training and formal staff support was consistent.

The registered manager did not establish consistent and clear responsibilities, roles, systems of accountability and good governance. They did not act on the information about risk, performance and outcomes, or share this securely with others when appropriate.

The registered manager did not have effective governance, management and sustainability arrangements in place at the time of the inspection. Although a range of audits and checks were completed, including audits of care, medication and infection prevention and control, these did not consistently identify, or address risks observed during the inspection.

There were clear gaps between governance systems and the quality of care experienced by people. Key risks, including staffing practice, quality of care provided by agency staff, call bell monitoring, dignity concerns and the management of safeguarding allegations, were not always acted on promptly or effectively to drive improvement. This meant leaders did not have sufficient oversight to ensure consistent, safe and dignified care. Although leaders took steps after the inspection to address concerns and provided additional assurances, the findings reflected a lack of robust and sustainable systems at the time of inspection.

The provider worked well in partnership with health and social care professionals. Records showed timely referrals and coordinated working, and professionals described strong, positive relationships with the service. GPs and community health teams were involved regularly, and professionals told us communication was effective and concerns were addressed promptly.

Most people were supported to maintain links with the local community and to take part in outings, events and activities. The service had a positive reputation locally, and professionals and relatives spoke highly of the care provided. These partnerships helped support continuity of care and positive outcomes for people using the service.

The registered manager did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The registered manager demonstrated an ability to learn from incidents, complaints and feedback, accidents, incidents and safeguarding concerns were largely recorded, reviewed and, where appropriate, lessons were identified. However, this was inconsistent and the inspection team identified risks to people which had not been robustly acted upon which negatively impacted on the ability to learn and improve if there is a culture where elements are not shared openly and without delay.

Following the inspection, leaders reflected on the findings and took steps to strengthen arrangements around safeguarding, risk management and oversight. This showed a willingness to learn and improve. However, this learning was not embedded to prevent issues in the first place, and some improvements were reactive rather than planned and pre-emptive. This limited the overall effectiveness of learning and continuous improvement.