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Archived: St Johns Nursing Home Good

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Reports


Inspection carried out on 16 November 2016

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 13 October 2016.

The home is registered to provide accommodation and personal care for adults. A maximum of 43 people can live at the home. There were 38 people living at home on the day of the inspection. The accommodation is split over three areas. The Limes unit provides care for adults with an enduring mental health condition. The Pines unit provides care for older people, specialising in those with a diagnosis of dementia. There are also three flats to promote independent living for adults with a mental health condition.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 23 November 2015, the provider needed to make improvements in managing people’s medicines, ensuring that identified areas for improvement where completed and register a manager with the CQC. We found that improvements had been made and there was now a registered manager.

People told us that they were relaxed and felt safe in the home and the staff helped to keep them safe by being there. People were assured by the care staff and care staff told us about how they kept people safe. During our inspection we saw staff were available to respond to people and offered support, guidance or care when needed. People received their medicines from nursing staff as required and records were completed. People told us the staff were available and they did not have to wait for assistance or care.

People told us care staff knew them and their care needs well. All staff told us the their training supported them to care and understand the needs of people who lived at the home. All staff had supervision which they said supported and helped them in providing care to people who lived at the home. People’s rights and freedoms were respected by staff who listened and responded to people’s decisions. People were supported to eat and drink enough to keep them healthy and enjoyed their meals. We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us that care staff made sure they retained their independent living skills and were encouraged to be involved in their day to day care choices. People were familiar with all staff and had developed relationships of trust. Care staff were respectful when speaking with people and were considerate when talking about people with other staff members. All staff knew it was important to maintain a person’s privacy and dignity when proving personal care or when people were in the communal areas of the home.

Where people had not been able to be involved in the planning of their care due to their capacity to make decisions, relatives and care staff were involved and asked for their opinions and input. All staff offered encouragement and supported people to read or join in group activities and outings. People we spoke with told us they were confident to approach the manager if they were not happy with their care. The registered manager had reviewed and responded to all concerns raised.

People felt involved in their home and had opportunities to make suggestions that were listened to and actioned. Management and staff had implemented recent improvements and these were regularly reviewed to ensure people’s care and support needs continued to be met. The management team were approachable and visible within the home which people liked.

Inspection carried out on 23 and 27 November 2015.

During a routine inspection

St Johns Nursing Home is registered to provide care and accommodation to up to 43 people who need nursing care. At the time of our inspection 34 people lived at the home. The accommodation is split over two units. The Limes unit on the first floor provides care for people with an enduring mental health condition can accommodate up to 14 people and was full. The Pines unit on the ground and lower ground provides care for 26 older people who are living with dementia and had seven vacancies. In addition are three individual flats for people with a mental health condition to promote their independence.

The inspection took place on the 23 and 27 November 2015 and was unannounced.

At the time of our inspection a manager was in post however they had not yet registered with the Care Quality Commission although they were in the process of applying. 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.

The manager was aware of the need to recruit staff to reduce the dependence on agency staff who did not always know people. People did not always receive the correct medicine at the correct time due to the length of time the medicine round took.

People who lived at the home and their relatives told us they felt safe at the home. They were however aware of the use of agency staff and how this could affect the care of their family member. Risks to people’s safety and welfare were assessed however staff were not always aware of recent changes to people’s care.

People were cared for by staff who were kind and considerate. Staff had an awareness and understanding about the need to obtain people’s consent before care and support was provided and of people’s right to refuse care. The manager was aware of their responsibility to ensure people were not restricted unlawful and had submitted application for authorisation to the local authority where this was required.

Staff felt supported by the manager and they had received training and support to help them provide care and support to people. Staff were aware of how to recognise abuse and of the systems in place to support them report any concerns they had. Staff had an awareness of how to maintain people’s privacy and dignity.

People who lived at the home and their relatives were involved in the planning and reviewing of the care and support provided for people. People were able to participate in hobbies and other interests.

Relatives had confidence in the new manager and knew how to raise any complaints which they felt would be listened to and action taken.

People who lived at the home as well as their family members and staff were encouraged to be involved in the running of the home. Quality monitoring systems were in place however these were not always evaluated to check the action needed had taken place.     

Inspection carried out on 26 June 2014

During an inspection in response to concerns

We carried out an inspection at St John�s Nursing home over a period of one day. The inspection was conducted by two members of staff from the Care Quality Commission. This inspection took place on the ground floor unit only due to some concerns which had been brought to our attention. At the time of our inspection 19 people were using the service provided on this unit.

During the inspection we spoke with the registered manager as well as four support workers and some other members of staff. We spoke with two relatives who were visiting the home.

We observed the care and support that people who used the service received to meet their different needs. Due to the communication difficulties experienced by the people who used the service our discussions were limited. We looked at a sample of care records to establish the identified care needs of some people who used the service.

We found no evidence to support the allegations made although the provider may wish to note some of the comments made within the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

This is a summary of what we found.

Is the service safe?

We spoke with four support workers who worked at St Johns Nursing Home. They were confident that people who used the service were safe. We were assured by staff that they would report any incidents of abuse or neglect to ensure people�s safety. During our observations we did not see any signs of people who used the service feeling uneasy or unsafe with members of staff

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager informed us that they were aware of these and that they were in the progress of making further applications.

Is the service effective?

People's health and care needs were assessed. Care plans had been reviewed regularly and matched the care people required. The plans supported staff to deliver care and support that effectively met people's needs.

Is the service caring?

During our inspection we saw that staff treated people who used the service kindly. We saw staff interactions which were supportive and respectful towards people.

We observed staff supporting some people with their lunchtime meals using comforting words to make people feel at ease. Staff told us that at times the care delivered to people is �delayed� if sufficient staff were not available to meet individual needs.

One relative told us, �I am more than pleased with the care provided�.

Is the service responsive?

We saw that people who used the service were supported to be as independent as possible by the staff on duty. We saw staff respond to people who were unsettled such as offering to take people for a walk around the garden.

Is the service well led?

Staff we spoke with were generally positive about the management of the home. Some staff felt that they were not suitably prepared for when new people came to live at the home.

Inspection carried out on 11 September 2013

During an inspection looking at part of the service

29 people lived at the home at the time of our inspection. We found that the provider had made improvements to its infection control and audit systems since our last inspection in April 2013. As a result, people were protected from the risk of infection. This was because the provider had appropriate infection control measures in place and checked their effectiveness regularly.

Inspection carried out on 29 April 2013

During a routine inspection

36 people were living at the home when we inspected. We spoke with four people in the Limes unit and two people who were visiting relatives in the Pines unit. We spoke with the acting manager as the registered manager had recently resigned. We also spoke with the area manager and two members of staff.

Most people we spoke with told us they were happy with the home and staff. One person told us they thought the staff were rude but could not give us an example. Other people in the same unit were positive about the home. One person said: �The staff are very nice, very helpful.� Another person said: �I like it here.� A person who was visiting told us: �They look after X to my almost total satisfaction.�

We saw that people�s needs were reviewed regularly. We also saw that people's care records gave guidance to staff on how to meet people's needs.

People were not fully protected from the risk of cross infection.

People were protected from the risks associated with the unsafe use and management of medicines.

We found that there were sufficient numbers of suitably qualified staff available to meet the needs of people living at the home when we inspected.

We found that the provider had a system in place to monitor the quality of its service. However the system for monitoring the quality of cleaning within the home was not working effectively.

We saw that accurate records were kept of the care and treatment that people received.

Inspection carried out on 16 July 2012

During a routine inspection

Generally people living at the service were unable to give us views of the service provided due to either their frailty or general well being.

One person in the unit for people with enduring mental health needs told us that staff respected their privacy and called them by their first name.

We saw a number of examples during the day of staff knocking before they entered a person�s room, and examples of staff protecting people privacy and dignity while providing personal care. We also saw a number of examples of meaningful interaction between staff and people who lived in both units at the home. This included time spent during activities and well as mealtimes and during medication rounds.

A number of issues connected with cleanliness and the storage of equipment meant that people were not protected from the risk of infection.

Arrangements that were in place for the management of medicines did not ensure that people always received their medicines at the right time and guidance for staff on the administration of medicines �as required� was not clear.

The provider�s system for assessing and monitoring the quality of service provision did not identify issues with cleaning and storage of equipment and medicines and people�s records did not always reflect the care that staff had given.

Inspection carried out on 2 February 2012

During an inspection looking at part of the service

Generally people living at the service were unable to give us views of the service provided due to either their frailty or general well being. We spoke with one professional visiting the home who expressed no concerns about the care provided. We also spoke with one relative who told us that staff are �spot on� when somebody is not well or their usual self. The relative told us that they rated the staff highly and told us of the �dedication� of the staff. There were records in place showing the involvement of medical professionals as well as other health care professionals such as opticians and dentists. People appeared well cared for in that they were suitably dressed taking into account gender and weather conditions.

Care plans and risk assessments were in place for everybody living at the home. A recent audit of care plans carried out by the management team showed that improvement was needed. The date given for nursing staff to carry out these improvements had passed at the time of our visit.

Further improvement was needed on the care plans that we viewed. The shortfalls we saw had the potential of placing people at risk of their health care needs not being met.

The vast majority of Medication Administration Record (MAR) charts were completed correctly showing that people had received their medication as prescribed. We did however find that people�s medication was not always managed safely including the ordering, administration, recording and disposing of medicines.

We viewed the file of two relatively recently appointed members of staff. We saw that the service had taken up relevant checks to ensure their suitability for working with vulnerable adults prior to them starting work. These included Criminal Records Bureau (CRB) disclosures and references showing that people were of good character.

Reports under our old system of regulation (including those from before CQC was created)