Archived: St John's Nursing Home

At the last inspection on 27 September 2016 we found that the provider was not meeting the standards of care we expect. This was in relation to the staff being unaware of how to implement the Mental Capacity Act 2005 and the safe storage and administration of medicines. The registered manager had also failed to inform the Care Quality Commission (CQC) of accidents and incidents which had occurred in the home, which they are legally obliged to do.

We undertook this focused inspection on 28 March 2017 to check that they had followed their plan and to confirm they now met the legal requirements. During this inspection on the 28 March 2017 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St John’s Nursing Home on our website at www.cqc.org.uk.

St John’s Nursing Home provides care for people who require personal care. It provides accommodation for up to 37 people. At the time of the inspection there were 35 people living at the home.

There was a registered manager in post. 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.

On the day of our inspection we found that the registered provider had ensured that staff were more aware of how to implement the Mental Capacity Act 2005 and had received further training. Documentation was in place in the care plans we looked at to show people’s mental capacity had been tested, if necessary and other parties consulted. The storage of medicines had improved and staff were observed administrating medicines in a safe way. The notifications which the registered manager was required by law to send to us were now being received by CQC.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, with some having loss of memory.

There was a registered manager in post. 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.

We found three breaches in relation to the management of medicines, the Mental Capacity Act and the requirement to report incidents to CQC. You can see what action we have asked the provider to take at the end of main report.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS authorisations are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there were six people subject to such an authorisation. The provider had failed to ensure staff had been trained in the implementation of the Mental Capacity Act 2005 and therefore correct assessments had not always been completed.

We found that there were times of day when there was insufficient staff to meet the needs of people using the service. The provider had not taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, but care was not planned and delivered in a consistent way through the use of each care plan. People and relatives were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was not clear. Risks associated with people’s care needs were assessed, but plans were not always put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information.

There was poor storage and administration of medicines. Staff had not kept accurate protocols for the use of some medicines to ensure people could be given them safely. Actions from medicine audits had not been signed to say they had been completed.

People had a choice of meals, snacks and drinks. Meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. The meal time was chaotic and not organised, which meant people sometimes were disrupted whilst consuming their meal.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home. Quality checks had been completed to ensure services met people’s requirements, but actions had not been followed through to completion. The provider had failed to inform CQC of accidents and incidents which had occurred so we could make a judgement that appropriate action had taken place.

Relatives told us staff informed them of events which had occurred and they had given permission to staff to look after their family members'. One person said, "Staff consult me over the best way to help X walk without a risk of falls."

They told us they knew staff kept notes on their family members' needs. Half the relatives we spoke with had seen the care plans.The other half did not want to see them. They told us when other health and social care professionals needed to be involved in assessing people's care needs they were consulted by staff. One relative said, "I take part in the yearly reviews and relatives meetings."

Policies were in place to instruct staff on how to give medicines safely. Storage areas were tidy. The manager completed monthly audits to ensure the correct procedures were being adhered to by staff.

Relatives told us their family members' needs were being met.There were mixed views whether there were sufficient staff on duty at all times. Half the people told us staff were always around to give them time to talk. Other relatives told us they had observed staff being rushed at certain times of the day. The manager assessed people's needs and decided on the staffing levels.

The complaints process was on display. Relatives and staff told us they had confidence concerns would be investigated fully.