St John's Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure its values and expectations were consistently embedded across the service. Concerns identified during the inspection, including shortfalls in care records, oversight and staff knowledge, demonstrated that expected standards were not always achieved in practice. This meant people did not always experience a consistent standard of care.

However, staff described a caring culture and a commitment to supporting people in a person-centred way. Staff told us they felt supported by the registered manager and able to raise concerns when needed.

Relatives also spoke positively about the culture of the service. One relative told us, “I would recommend it. When I walk into the home, it feels like a home.”

The provider did not have leaders with the skills, knowledge and oversight needed to ensure safe, effective and high-quality care. Leaders did not always recognise or respond to concerns appropriately, which increased the risk that issues affecting people were not identified or addressed in a timely way.

The registered manager and leadership team were committed to improving the service and took action to improve standards based on inspector feedback. However, the registered manager was not always able to demonstrate a sufficient understanding of regulatory requirements, risk-based practice or their responsibilities under relevant legislation. Concerns identified during the inspection were not always recognised as risks until they had been repeatedly explained and discussed. This limited leaders' ability to identify issues independently and take timely action.

The registered manager did not always demonstrate a clear understanding of people's needs, staff development requirements or the systems needed to ensure safe and person-centred care. This was reflected in the concerns identified in care planning, oversight, risk management and the application of the Mental Capacity Act 2005. As a result, leaders could not always provide assurance that people received consistent care or that risks were being appropriately managed.

The provider promoted a culture where people, relatives and staff felt able to raise concerns, provide feedback and share their views. Systems were in place to support people to speak up and feedback was encouraged.

People told us they felt comfortable approaching staff and raising concerns when needed. Relatives described being listened to and said concerns were generally responded to appropriately. A relative told us, "They always listen and are always supportive." Mechanisms were available for gathering feedback, including direct discussions with staff and the registered manager.

Staff told us they felt able to speak openly and raise issues relating to people's care and the running of the service. They participated in staff meetings which gave them an opportunity to speak up. They said they were able to approach the registered manager for support and felt their views were listened to.

The provider generally promoted equality, diversity and inclusion within the workforce. Staff spoke positively about working alongside colleagues from different backgrounds and said diversity was valued within the service.

Staff described an inclusive culture and told us they learned from each other's experiences, cultures and perspectives. Equality, diversity and inclusion were promoted through day-to-day practice and staff were supported to treat people with respect and understanding.

The provider did not always have effective governance systems to identify, monitor and address risks to people's health, safety and wellbeing. Oversight arrangements were not sufficiently robust to ensure concerns were identified and acted upon at an early stage.

Systems of accountability were in place, and the provider audits had identified repeated shortfalls. However, they were not always effective in ensuring policies, procedures and regulatory requirements were consistently understood and applied in practice. The registered manager’s existing monitoring arrangements for care planning, risk management, consent processes, staff knowledge and record keeping had not recognised the concerns we found. This limited their ability to identify concerns, assess their impact on people and drive improvement.

The registered manager demonstrated limited understanding of several areas of regulatory practice. This affected their ability to recognise potential risks and take proactive action to reduce them. As a result, people could not always be assured care was being overseen effectively.

Despite our findings, relatives often described the registered manager as approachable and responsive when issues were raised. A relative told us, "There have been some incidents that the care home could or should have done better but when I call to discuss they own it and try to put things right."

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

External professionals spoke positively about the service and described staff as caring, approachable and hardworking. The main area identified for improvement was the timeliness of communication, particularly responses to emails.

The provider did not always promote a culture of continuous learning, improvement and innovation. Opportunities to use learning to improve people's experiences, outcomes and quality of life were not always fully developed.

Staff told us learning and professional development were encouraged and opportunities were available to complete training and develop their skills. However, there was limited evidence to demonstrate how learning had been used to drive measurable improvements for people. The provider could not consistently show how feedback or training had improved outcomes or experiences.

Systems for capturing and embedding learning were not always effective. This meant opportunities to identify successful practice, test new ways of working and share learning across the service could be missed. The provider had not always demonstrated how they actively promoted innovation or developed creative approaches to improve equality of experience and quality of life for people.

Although we found these concerns, relatives often described a service that was willing to make changes when issues were raised.