St John's Court

St Johns Court is a nursing home providing personal and nursing care for up to 42 people. The service provides support to younger and older adults who have a physical and/or sensory impairment. The service also supports people living with dementia. At the time of our inspection there were 30 people using the service. St Johns Court accommodates 42 people across four separate wings, each of which has separate adapted facilities. One of the wings, Buttercup, specialises in providing care to people with dementia.

People’s experience of using this service and what we found

St John’s Court had been through a period of management changes over the past year, which people and staff told us had caused instability within the home. People gave mixed reviews about the food offered, the provider had listened to people’s concerns, but these had not been fully addressed. Some people and staff continued to say there were not enough staff on duty to meet people’s needs. The provider monitored staffing levels, however had not fully addressed the concerns that had been raised.

Some people and staff felt there were not always enough staff on duty to meet people’s needs in timely way. We did not find evidence that people were not safe with the staffing levels. The provider told us they were reviewing dependency tools to better understand if staffing levels were right.

People's end of life care needs were met in line with their preferences in a respectful and dignified way, however, record keeping around this required updating to reflect people’s most up to date wishes.

People told us they felt safe. Relatives felt their family member was safe and cared for in the right way. Staff recognised different types of abuse and how to report it. The provider understood their safeguarding responsibilities and how to protect people from abuse. Potential risks to people's health and wellbeing had been identified and were managed safely. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risks associated with people’s care. People's medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People's care needs had been assessed and reviews took place with the person, and where appropriate, their relative. Staff had the training and support to be able to care for people in line with best practice. People were supported to have a healthy balanced diet and most people told us they were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.

People told us staff were kind and treated them well. Relatives felt the staff cared for their family member in a caring and supportive way. Staff treated people as individuals and respected the choices they made. Staff treated people with care and respect and maintained their dignity.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported to maintain contact with people who were important to them. People engaged in activities that were individualised to them. People had access to information about how to raise a complaint. Where complaints had been raised, these had been responded to in line with the provider’s policy.

The provider had systems and checks in place to identify and respond to shortfalls found within the service. The provider had changed aspects of their checks to ensure these were robust.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 May 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St John’s Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Johns Court is a nursing home providing personal and nursing care for up to 42 people. The service provides support to younger and older adults who have a physical and/or sensory impairment. The service also supports people living with dementia. At the time of our inspection there were 34 people using the service.

St Johns Court accommodates 42 people across four separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

People told us they felt safe and supported by the staff who worked in the home. Staff recognised different types of abuse and how to report it, however staff did not always feel listened to when reporting concerns. We found mitigation of known harm was not robust and some people were not always supported to remain safe.

Potential risks to people's health and wellbeing had not been consistently identified and managed to maintain people’s safety. We found areas of risk which had not been addressed sufficiently, such as management of falls, and environmental aspects. There were not always sufficient staff on duty to keep people safe and meet their needs. People's medicines were managed in a safe way, but storage of medicine required addressing. Areas of the home were visibly dirty and the management of Covid-19 was not always safe.

People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. New staff had not received an induction to ensure they were able to support people in a safe and effective way, while some training for existing staff’s had lapsed. People told us they did not always enjoy the food offered, the provider was reviewing how people could be involved in the menu choices. People who lived with dementia were not always supported to eat their meals and have their drinks as staff did not always have time. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.

People who lived with dementia were not always supported in a way which maintained their dignity. The dementia unit was not dementia friendly, with poor signage and lack of stimulation for people. The environment of the home was dirty and did not promote a respectful living environment. The provider could not be assured privacy was maintained for people’s information as offices were seen to be unlocked when unattended.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People told us they were supported and encouraged to attend the activities held within the home. People had access to information about how to raise a complaint. People's end of life care needs were met in line with their preferences in a respectful and dignified way.

People and relatives felt the management team had people's best interests at heart and felt the home and the way the service was run was good. However the staff team felt the previous management team did not listen or support them. Staff were positive about the new management team and felt they were already listening to them and making positive changes. The providers systems had not identified some concerns we identified on this inspection. Where the provider had identified areas for improvement these were not always acted upon in a timely way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was outstanding (23 October 2019)

Why we inspected

The inspection was prompted in part due to concerns received about people’s care, staffing levels and management oversight. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding's, people’s safety, staffing and the providers governance systems.

Please see the action we have told the provider to take at the end of this report.

For full information about CQC’s regulatory response to the more serious concerns see the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Johns Court provides accommodation and nursing care for up to 42 people. At the time of our inspection there were 39 people living at the home some of whom were living with dementia.

People’s experience of using this service and what we found

The management and staff team continue to provide an outstanding service whereby people were very much at the centre of their care. There was a very positive atmosphere where people’s differences were celebrated. People and their relatives were supported by all staff and the management team to be truly involved in their care. Staff continued to be compassionate and highly motivated in ensuring people were treated as individuals and had the best life they possibly could.

The provider's values were very much part of everyday life at the home. They were created with people’s uniqueness in mind and shared by people who lived at the home, all staff and the management team. These were based around people being supported to live the lives they chose. Myths were dispelled and there was a sense of positive risk taking as people enjoyed different experiences despite their physical and health needs.

Staff’s ‘can do’ attitude had not dwindled following the last inspection, instead staff continued to bring alive creative initiatives which enhanced people's quality of life. Promoting people’s independence was ‘the norm’ and very much linked to staff support in encouraging people to be proud of their achievements, however small these were.

People were supported to retain an active presence in the local community and to maintain their personal interests and hobbies. The rich programme of things for people to do for fun and interest, continued to be further developed with new ideas, bringing therapeutic benefit to meet people’s needs. People's own life experiences and talents continued to be celebrated by staff’s extensive support. Since the last inspection new ideas enabling people to recall life events and hopes were brought alive in a magazine created by people who were proud to share and had fun in doing so.

The management and staff team continued to have a passion to share their knowledge in different subject areas with people and their families as a way of empowering people. Developments had continued with staff creating and providing accessible booklets in different subject areas which people found helpful.

The registered manager was an excellent role model and together with their staff team they had a passion to learn about and aim for best practice with people very much at the heart of all their care. There was an honest and open approach to where further improvements were needed.

People who lived at the home and all staff were actively encouraged to contribute to the evaluation of the care provided and recommendations of where they could aim higher to drive through improvements. Regular quality audits and checks were completed so improvements were continually recognised. An extremely strong influence on ensuring people continually received high-quality care were the reflective practice opportunities provided to staff. These were very effective in following through actions and putting learning into practice.

People were protected from the risks of abuse because staff were trained in recognising and reporting any concerns of potential abuse. The provider had effective recruitment arrangements to ensure staff were suitable for their role before they commenced working at the home. The registered manager made sure there were enough suitably skilled, qualified and experienced staff to support people safely.

Risks to people's individual health and wellbeing were assessed and their care was planned to reduce the risks. Medicines were stored, administered and disposed of safely. Staff followed the providers policies in reducing the risk of cross infections and regular checks were undertaken to make sure people lived in a clean environment which had been adapted to meet people’s needs.

People's needs were assessed so these could be met effectively. Staff were trained in subjects aligned to the individual needs of people they provided care and support to. People were supported to eat and drink enough to maintain a balanced diet which met their needs and preferences.

People were supported to maintain their health and prompt action was taken to refer people to healthcare professionals when they became unwell or their health needs changed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding (published 15 October 2016). Since this rating was awarded the provider has altered its legal entity. At the last inspection the providers legal entity was Somerset Redstone Trust. At this inspection the legal entity is Amica Care Trust. We have used the previous rating of outstanding to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The provider of St John’s Nursing Home is registered to provide accommodation and nursing care for up to 42 people who have nursing needs. At the time of this inspection 38 people lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, conservatory and dining room.

There was a registered manager in post who was supported by a deputy 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.

The management and staff team understood what was important to people who lived at the home and worked closely with each other and with families to ensure each person had the best life as possible. People played an active part in the running and development of the home. New ideas were made possible by a motivated management and staff team which enhanced people’s quality of life and provided therapeutic benefit to people.

People were supported to retain an active presence in the local community and to maintain their personal interests and hobbies. An activities team alongside care staff all worked together to organise a rich programme, whereby people were offered different things to do for fun and interest for those who wished to participated. People had opportunities to meet and develop relationships with students and volunteers to widen their social networks.

There was a warm, homely atmosphere and staff cared for people with kindness, patience and understanding. Staff had time to meet people’s needs and to spend time in conversations with people individually, without rushing. Staff were proud of their achievements in providing end of life care in a personalised way and often being ‘on call’ in their own time to meet people’s choices. Staff held high values about striving in their caring roles to help people to experience a good death free of pain and in comfort. Families and friends were offered after death care and a way of celebrating and sharing their memories of people’s lives each year with a tree which held people’s thoughts and balloons.

There was a sense this was people’s home and they were proud of their home. People were supported to actively use their skills and interests in the decoration of the different spaces within their home environment which included the garden spaces and creation of a pub.

Food and drink were provided to a high standard and people could choose what to eat and drink and when. People who lived at the home and their relatives could voice their views and opinions. The registered manager listened to what people had to say and took action to resolve any issues. The management team reviewed incidents and concerns to look for opportunities to improve policies and practices for the future. There were systems in place for handling and resolving complaints which focused upon opportunities for learning lessons.

People who lived at the home and all staff were actively encouraged to contribute to the evaluation of the care and support provided and the recommendations for improvement. The management team and staff worked together as a team with a passion to learn about and aim for best practice with people very much at the heart of the services they received in their home.

The management team and staff shared common values about the aims and objectives of the service people were provided. These were based around people being supported to live the best lives as possible. Regular quality audits and checks were completed so improvements were continually recognised and there was effective follow up action which made sure people received a high quality service.

People were supported to make safe choices in relation to taking risks in their day to day lives which helped people to maintain their own levels of independence. This was because staff made sure people had the equipment and aids they required to meet their needs. Staff had been trained and understood how to support people in a way which protected them from harm and abuse.

There was a stable team of staff and agency staff were not used due to the willingness of the management and staff team to fill any gaps in the staff rota if these should occur. There were sufficient staff with the right skills which included nurses to safely support people who lived at the home. The management team monitored staffing levels and made sure the right numbers of staff were made available so people’s needs were met and helped them remain as safe as possible. The management team had completed checks on staff prior to them starting to work to make sure they were suitable to work with people in their homes.

Staff received regular training which provided them with the knowledge and skills to meet people’s needs in an effective, responsive and personalised way. The management team supported staff to gain additional knowledge within their various champion roles to promote a greater awareness and understanding of the diverse needs of people who they provided care and support to. Staff had used their knowledge in practice on many occasions to support people in gaining the additional equipment, aids and specialist advice which had a significant impact on enhancing people’s wellbeing.

Staff had developed strong relationships with local healthcare services so people received any specialist support required. People were involved in saying what their preferences were for to meet their health needs and receive any medicines they were prescribed, and were happy with the support staff provided. There were arrangements in place to make sure staff were trained and competent in medicine administration. This meant people were supported to take their medicines at the right time and in the right way to meet their differing health and wellbeing needs.

People who lived at the home and their relatives were closely involved in planning and reviewing the care and support they received. Staff listened to people and had a detailed understanding of their needs and preferences. Staff understood the issues involved in supporting people who had lost capacity to make some decisions and made sure their caring practices were the least restrictive as possible when meeting people’s needs.

The management team and staff shared common values about the aims and objectives of the service people were provided. These were based around people being supported to live the best lives as possible. Regular quality audits and checks were completed so improvements were continually recognised and there was effective follow up action which made sure people received a high quality service.

The inspection took place on 17 and 20 May 2016 and was unannounced.

At the time of our inspection a registered manager was 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.

People told us they felt safe living at the home. Staff were aware of how to keep people safe and had undertaken training in this. People had their privacy and dignity maintained and staff were able to describe how they managed this. Throughout the inspection we saw staff to be kind and caring and treated people with consideration.

People and their family members felt sufficient staff were on duty to meet their care and support needs. Agency staff were not used to ensure consistency of care was provided. The registered manager was able to review staffing levels in line with people’s needs and increase staffing if needed. Systems to ensure safe recruitment processes and to check the registration of nursing staff were in place.

Staff were supported by the management and received training to ensure they had the skills and knowledge necessary to care for people. Staff were able to attended meetings where they were able to voice their opinions. People’s care needs were well known by the staff we spoke with including people’s likes and dislikes.

People were asked for their permission prior to receiving care and support so people were able to give their consent. Best interest decisions were in place where people were unable to make an informed decision on their own.

People’s healthcare needs were monitored and health professionals were consulted in order to maintain people’s well-being. People told us they liked the food available and confirmed a choice was available to them.

People were satisfied with the care provided and were supported in a way they wanted. People had care plans in place describing their needs and risks associated with their care. These were reviewed in line with people’s changing care needs.

Staff told us they enjoyed their work and liked the management team. People and their relatives were confident any complaints made would be listened to and responded to.

Systems were in place to monitor the service provided for people as a means to improve the quality of care and support people received. The registered manager had plans to further develop the service provided.

Is the service safe?

People told us that they felt safe. Care records contained detailed risk assessments. Actions to minimise any risks identified were documented in people's care plans. Risk assessments balanced risk with the rights of people to exercise choice. Care plans included information about possible urgent situations and how to deal with them. Staff had received basic life support training. There were Registered nurses on duty at all times.

The provider had relevant Mental Capacity Act (2005) policies including 'Deprivation of Liberty' safeguards that were applied in practice.

People told us that the home was always clean and tidy. Most areas in the home were well maintained. However a few areas, particularly the corridors, needed some attention. The provider had development plans in place for the refurbishment of the home.

Appropriate cleanliness and infection prevention and control policies and procedures were in place that were implemented and monitored in practice.

The provider demonstrated safe and effective medicines management.

Is the service effective?

The provider had effective systems in place to monitor the quality of the service people received. This included audits, quality reviews, annual resident and staff satisfaction surveys and analysis of incidents and complaints. Lessons learnt from quality reviews were discussed and actions monitored.

Care records were well written, accurate and reflected the needs and wishes of the people who received a service. People told us they were fully involved in developing their care plan. Daily records demonstrated that staff delivered care in line with the care plan.

Is the service caring?

We talked with ten people who received a service. All the people we spoke with said the service good or very good. One person told us that, 'It is a real home from home, the staff really care about you as an individual'. Another person told us, 'I receive lovely, lovely, care in a lovely, lovely, home'. We observed staff talking with people in a calm, friendly respectful way.

Staff we spoke with demonstrated they understood the care needs of the people they were caring for. They were clear about their role and responsibilities. Staff had received training to meet the needs of the people who received a service. The provider had up to date relevant care policies and procedures which reflected current research and guidance.

Is the service responsive?

People had their needs assessed prior to receiving a service. Care plans reflected both the needs and wishes of people.

The provider had systems in place to ensure the views of people who received the service and staff were sought and acted upon. People were invited to resident and relative meetings where they were encouraged to make suggestions about improvements to the home.

People had access to a wide range of activities. A member of staff was employed to coordinate activities for residents. A monthly newsletter provided information and news to people who received a service.

People told us they were confident that any issue raised or complaint made would be thoroughly investigated and acted upon.

Is the service well-led?

Staff we spoke with told us they felt well supported by the registered manager and senior staff. Staff said they were able to raise issues with their manager at any time and were confident they would be acted upon. Staff had opportunities to raise and discuss issues at staff meetings and anonymously through the annual staff survey.

People told us that the registered manager was very responsive, approachable and was always available to talk to. One person told us, 'We see the manager most days.They always ask me how I am and have time for a chat'.

Lessons learnt from audits, incidents complaints and comments were communicated effectively with staff. Actions to implement lessons learnt were monitored.

The registered manager was on annual leave on the day we carried out this inspection. We spoke with the deputy manager and two nurses. We also spoke with care workers, people who used the service and some visitors.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. We observed that people appeared comfortable with the care provided.

We looked at the care records for three people and found that their needs had been assessed. The records showed that care and treatment had been planned and delivered in line with people's individual needs. Staff told us that they were aware of each person's needs and how to give care and support to meet those needs. We brought to the attention of the deputy manager some concerns about equipment used for people with sore skin and the records held about people.

People who used the service were provided with sufficient food and fluid to maintain their wellbeing.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

We saw that staff were supported in the work that they did.

We found that systems were in place should people wish to make a complaint about the service provided.

In this report the name of one of the registered managers was not in post and not managing the regulatory activities at this location at the time of the inspection.

In July 2012 we found that the provider was not meeting the essential standards relating to care and welfare, cleanliness and infection control, management of medicines, requirements relating to workers and monitoring the quality of their service provision.

We found that improvements had been made in all of these areas. During this inspection we talked with people who used the service, five relatives, three members of the care staff, the deputy manager and the registered manager.

We found that steps had been taken to make sure that care and treatment was planned and delivered in a way that was intended to ensure people's welfare.

We found that improvements had been made regarding the cleanliness of commodes to assist with infection control measures.

Improvements had taken place regarding the management of medicines to reduce the level of risk to people who used the service.

We found that improvements had been made regarding the recruitment of workers and that quality assurance system had been introduced to make sure that the provider was able to monitor the quality of the service provided.