Archived: St Johns Wood Care Centre

St Johns Wood Care Centre is a 100 bed nursing home which provides nursing and/or personal care for up to 100 predominantly older people and young people with physical disabilities. Each person has their own bedroom and there are communal lounges and dining areas on each of the four floors of the home.

This inspection took place on 21, 23 and 29 December 2015 and was unannounced. At our last comprehensive inspection on 8 August 2014, which was a part of out wave 2 new inspection approach and prior to the current provider taking over, the service was meeting all of the regulations we looked at. As a result of this inspection we found five breaches of regulations, namely Regulation’s 9 (Person centred care), Regulation 12 ) (Safe care and treatment), Regulation 14 (Meeting nutritional and hydration needs) and Regulation 18 Staffing).

At the time of our inspection a registered manager was employed at the service. 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 service was previously operated by a provider that went into administration in February 2015. Administrators then took over the temporary operation of the service until a new provider was identified in September 2015. This provider was then registered with the Commission in early November 2015. As the result of safeguarding concerns that had arisen in October and November 2015 we took the decision to carry out an inspection of the service earlier than we normally would for a service that had re-registered under a new provider. This was to respond to any risks about the way in which the service was operating and to ensure people’s safety and well-being.

The staff of the service had access to the organisational policy and procedure for protection of adults from abuse. They also had the contact details of the London Borough of Camden which is the authority in which the service is located and other authorities who also placed people at the service. Staff said that they had training about protecting people from abuse and this training had been updated, which we verified on training records. However, some staff were not aware of what safeguarding and whistleblowing means.

We found there were the designated numbers of staff on each floor during our visits. Staff were regularly present in communal areas to identify and respond to immediate assistance that people required.

We saw that risks assessments concerning falls and those associated with people’s day to day risks were in some cases not fully completed or updated. Measures to minimise emerging risks, and in particular those associated with falls, were not speedily identified or implemented and this added to the potential unnecessary risks that some people faced.

We saw there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make some decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately and making the necessary applications for assessments when these were required.

People were supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. People and their relatives told us they felt that healthcare needs were dealt with well and we saw that staff supported people to address their medical needs.

The care plans we looked at were based on people’s personal needs and wishes in some cases, but were unclear in areas such as nutrition and hydration and contained conflicting information about people’s care needs. People’s personal, cultural, religious and lifestyle pretences were not given sufficient attention in care planning.

People’s views were respected in most cases but we also observed an incident of disrespectful behaviour by a member of staff. Although feedback from people using the service and relatives showed that the view was of a caring staff group we saw that there were conflicting approaches made with people in some cases. Not all staff were respecting people’s dignity or right to make free choices.

The service had undergone a long period of uncertainty about its future ownership and operation. We found that oversight of the service had suffered as a result and needed to be addressed.

As a result of this inspection we found five breaches of regulations, referred to above, we also made two recommendations covering the areas of  effective, and responsive. You can see what action we told the provider to take at the back of the full version of the report .