St John's Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to person centred care planning and delivery.

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.

Records did not consistently provide staff with the information they needed to deliver safe, person-centred care. People's needs had been assessed and these records contained detailed information about people’s personal histories, backgrounds and preferences. However, this information was not always reflected within care plans. Care plans were often generic and lacked clear guidance about how staff should support people's health needs, risks and individual preferences. This increased the risk of inconsistent care and meant staff could not always rely on care records to understand how people wished to be supported.

Several sections of care plans had not been completed, including information about people's preferences, life histories and end of life wishes. Some records included terminology such as, ‘challenging behaviour’, ‘attention seeking’ ‘self-toileted’ and ‘compliant’, which was not consistent with respectful or person-centred practice that valued people.

Despite these findings, relatives told us staff took time in practice, to get to know people and understand what was important to them. One relative told us, "The care plan was transferred from the other care home. It was then revisited and a new one created with our input.”

The provider did not always ensure care and treatment were planned and delivered in line with people's needs and preferences. Records did not always provide accurate or up to date information to support consistent care.

Systems were in place to assess people's needs and monitor aspects of their health using recognised tools for weight management and preventative skin damage. However, records were not always updated as frequently as required and some information was therefore inaccurate or incomplete. This increased the risk that changes in people's health or wellbeing may not be identified promptly and that staff may not always have access to current information about how to support people safely.

Care records did not always clearly reflect what was important to people or how their individual needs should be met. This limited the provider's ability to demonstrate that care was consistently planned and delivered in line with current needs and best practice.

However, staff sought advice from healthcare professionals when required and worked with external services to support people's wellbeing. Relatives were positive about staffs understanding people's needs. A relative told us, "The times we are there they are very attentive and caring."

The provider generally worked well with other teams and services to ensure people received coordinated care. Information was shared when people moved between services to help support continuity of care and reduce the need for people and relatives to repeat information.

Staff told us they communicated with each other and knew how to escalate concerns when required. Staff worked with healthcare professionals and other agencies to support people's health and wellbeing. Information was shared when people transferred between services and there was evidence of joint working to support people's care.

However, communication was not always consistent. Some staff felt information sharing within the service could be improved to help ensure all staff had the same understanding of people's needs. Relatives raised a recurring concern about some staff speaking in languages that people and relatives could not understand. This had the potential to cause confusion and create increased barriers to effective communication.

The provider did not always support people to manage their health and wellbeing in a way that promoted independence, choice and control. Opportunities to improve people's health outcomes were not always identified or acted upon.

People had access to a range of healthcare professionals and staff worked with external services to support people's health needs. Staff were proactive in encouraging people to eat and drink, particularly during periods of hot weather. Relatives told us people were supported to access healthcare services when needed. A relative told us, "Yes, [my family member] has access to healthcare and the podiatrist comes too."

However, mealtime support was not always provided in a timely way. One person fell asleep before eating their meal and another waited an extended period for support to eat, which resulted in their meal becoming cold. This created a risk that people may not always receive the support they needed to maintain their nutrition and wellbeing.

Confidential information was not always managed appropriately. Dietary information was displayed in an open area of the home where it could be seen by other people or their visitors. Although steps were being taken to address this, there was limited understanding of the impact this could have on people's privacy and dignity.

The provider did not always effectively monitor people's care and treatment to ensure positive outcomes were achieved and maintained. Quality assurance systems had not consistently identified or addressed concerns affecting people's experiences and wellbeing. Provider level audits had identified reoccurring issues. However, service level audits, while in place had failed to identify the concerns or act on them in a timely manner. This reduced the provider's ability to identify shortfalls, monitor improvements and ensure people received consistent care.

Records did not always support effective monitoring of outcomes. Daily notes focused largely on tasks completed and did not consistently capture meaningful information about people's wellbeing, experiences or progress towards anything they wished to achieve. As a result, opportunities to identify changes in people's needs and evaluate whether care was achieving positive outcome was missed.

Practice relating to the use of clothing protectors was reviewed during the inspection after concerns were identified about dignity and choice. Plans were made to better reflect people's preferences and ensure care was delivered in a more person-centred way. However, this was yet to be implemented.

The provider did not always ensure people's rights were protected when decisions about their care and treatment were being made. Systems for recording and evidencing consent were not always effective.

Staff generally understood the importance of seeking consent before providing care and people were supported to make day to day choices. However, mental capacity assessments were often generic and did not clearly demonstrate how people had been supported to understand decisions, how they had been involved in the process or how conclusions about mental capacity had been reached. This meant records did not always provide assurance that decisions were being made in line with the Mental Capacity Act 2005.

The registered manager was unable to explain why one person's relative had signed consent documentation when the person had been assessed as having the mental capacity to make their own decisions. The registered manager told us this was because the relative held a Lasting Power of Attorney. However, they did not demonstrate an understanding that these arrangements only take effect when a person lacks the mental capacity to make the relevant decision for themselves. This created a risk that people's rights may not always be fully respected or upheld.

While records did not always demonstrate this, relatives told us staff sought consent and demonstrated patience involving people in decisions prior to care being delivered. One relative told us, "[Staff] do ask [my family member] and sometimes they will decline support but then staff talk them around and they will agree, having given their consent."