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St Johns Nursing Home Requires improvement

We are carrying out checks at St Johns Nursing Home. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 October 2018

This inspection took place on 6, 8 and 10 September 2018 and was unannounced.

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

St Johns Nursing Home accommodates up to 38 people in one adapted building over two floors. There were 25 people at the service at the time of inspection. People living at the service were older persons with nursing care needs, some of whom were living with dementia.

At our last inspection in January 2018, we found widespread shortfalls within the safety and governance of the service. We identified seven breaches in six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The home received an overall rating of inadequate and was put in special measures.

We issued warning notices for more serious breaches of Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and requirement notices for the other regulations breached.

Following the last inspection, we met with the provider and imposed four conditions on their registration. This helped us monitor the progress of improvements made to help ensure the safety of people living at the service. The provider sent us regular action plans and audits to demonstrate how they had made and sustained required changes. We also stipulated that the provider required written permission from CQC before admitting new people to the home.

The service did not have registered manager in place at the time of our inspection. 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. Since the last inspection, the registered manager had left and no longer worked for the provider. The new manager had been in place since February 2018. At the time of inspection, their application to register as manager with CQC was in progress.

The manager had overseen significant improvements since the last inspection. The provider had met the requirements of the regulations which were breached at our last inspection.

There was a clear governance structure within the service, staff understood their roles and there was a calm and organised atmosphere in the home. The manager had implemented effective systems to oversee the quality and safety of the home. They had formulated and implemented plans to make improvements to areas which needed addressing and used audits and checks to assesses how effectively these changes had been embedded.

The provider had worked with different stakeholders to identify issues and put in place plans to make improvements. We received positive feedback from health and social care professional about how the service was managed.

People, relatives, staff and professionals told us that that the manager had instilled a positive culture at the service and that she was professional and approachable. The manager listened to complaints and feedback, using them to identify how improvements could be made.

However, we identified a breach in regulation around the provider’s recruitment processes. The provider did not always ensure that the required recruitment checks were carried out before staff started working at the service.

There were enough staff in place to meet people’s needs. The provider had recruited permanent nursing and care staff to decrease the reliance on agency workers. Staff were supported with appropriate training and ongoing support in their role.

Staff were compete

Inspection areas

Safe

Requires improvement

Updated 20 October 2018

The service was not always safe.

The provider did not always make the appropriate checks when recruiting staff.

There were sufficient numbers of staff in place to meet people’s needs.

Risks to people were assessed and mitigated.

There were safe systems in place to manage people’s medicines.

There were systems in place to protect people against the risk of infections spreading.

Processes were in place to protect people against the risk of abuse and harm.

Effective

Good

Updated 20 October 2018

The service was effective

Staff had access to training and ongoing support in their role.

There were policies and procedures to help ensure the provider gained appropriate consent to care.

The environment was suitable for people’s needs.

The manager made appropriate assessments to ensure people’s needs were met.

People followed a diet in line with their requirements and preferences.

People had access to healthcare services as required.

Caring

Good

Updated 20 October 2018

The service was caring.

People were treated with dignity and respect.

People were involved in making decisions about their care.

Staff were caring and attentive to people's needs.

Responsive

Good

Updated 20 October 2018

The service was responsive.

People received personalised care.

There were systems in place to ensure people's complaints were handled appropriately.

The service had an empathic and caring approach to providing end of life care.

Well-led

Requires improvement

Updated 20 October 2018

The service was not always well led.

The manager had overseen significant improvements in safety and quality, but still required time to embed safe practice around the provider’s recruitment procedures.

The provider worked effectively with stakeholders to improve safety and quality at the home.

There was a clear governance structure in place and people, relatives, staff and professionals told us the management were open, approachable and professional.

The manager carried out a series of audits, which had been effective in monitoring the quality and safety of the service.

The manager used feedback to make improvements to the service.

The manager had informed CQC about significant events at the home.