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Inspection carried out on 18 February 2020

During a routine inspection

About the service

St. James Court is a residential care home providing accommodation and personal care to 50 people at the time of the inspection. The service can support up to 58 older people, including those living with dementia.

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

There were systems in place to recognise and respond to any allegations of abuse. Safe recruitment procedures made sure staff were of suitable character and background. There were enough staff employed to help keep people safe. However, the regional manager agreed to deploy staff more effectively during busier times of the day. Medicines were stored safely and securely. There were effective systems in place to ensure people received their medicines as prescribed.

Staff were provided with an effective induction and relevant training to make sure they had the right skills and knowledge for their role. Staff were supported in their jobs through supervisions and an annual appraisal.

People enjoyed the food served at St. James Court and were supported to eat and drink to maintain a balanced diet. People were supported to maintain good health and have access to health and social care services as required. The service would benefit from further development to better meet the needs of people living with dementia. The registered manager and regional manager told us this work was in progress.

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.

Positive and supportive relationships had been developed between people, their relatives and staff. People told us they were treated with dignity and respect and we saw this throughout the day of the inspection. There were activities available to people living at St. James Court.

The registered manager and staff were approachable and responsive to any issues raised. There were effective systems in place to monitor and improve the quality of the service provided. The service had policies and procedures which reflected current legislation and good practice guidance.

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 good (published 19 April 2017).

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.

Inspection carried out on 28 February 2017

During a routine inspection

St James Court is a care home which is registered to provide accommodation and nursing care for up to 58 people. Included within the home is a unit for people living with dementia called ‘Forget Me Not Lane.’ The home is purpose built and was registered in 2012.

The inspection took place on 28 February 2017 and was unannounced which meant we did not notify anyone at the service that we would be attending.

Our last inspection at St. James Court took place on 26 May 2015. We undertook this focused inspection to check improvements had been made following an unannounced comprehensive inspection of this home on 6 and 7 October 2014 where breaches of legal requirements were found and the overall rating for the service was ‘requires improvement.

Following the inspection on 26 May 2015 we found St. James Court was compliant with the regulations but the overall rating for the service remained as ‘requires improvement’. We did not improve the rating because to do so required consistent good practice over time.

The service had a registered manager in post at the time of our inspection. 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 we spoke with told us they felt safe living at St. James Court and they liked the staff.

We found systems were in place to make sure people received their medicines safely. The monitoring and auditing of some medicines did need improvement.

There were sufficient staff to meet people’s needs safely and effectively. The staff recruitment procedures in operation promoted people’s safety. The monitoring and auditing of some recruitment records did need improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role.

People and relatives said the staff were ‘lovely and caring.’

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected.

We found staff were responsive to meet people’s health and social needs. Support plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

We saw people participated in a range of daily activities which were meaningful and helped promote independence.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

Staff told us they felt they had a very good team. Staff said the registered manager was approachable and very supportive and communication was good within the service.

There were a number of processes in place to monitor the quality and safety of the service. The systems in place to assess and monitor the quality of service provided were not fully effective to ensure care provided was monitored, and that risks were managed safely.

Inspection carried out on 26 May 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this home on 6 and 7 October 2014 where breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches of Regulation 13 and Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. 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. James Court on our website at www.cqc.org.uk.

St James Court is a care home which is registered to provide accommodation and nursing care for up to 58 people, who may have dementia care needs. The home is purpose built and was registered in 2012.

On the day of this inspection, a manager was in place at the home and had submitted their application to become ‘registered 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.

We found the home had improved their policies, procedures and practice regarding the safe management and administration of medicines. Medicines at the home were appropriately stored, with temperature control mechanisms in place. Medication Administration Records (MAR) demonstrated the home administered medicines as instructed by the prescribing healthcare professional. Audits of medicines ensured any areas for improvement were identified and acted upon.

Most staff had received a supervision. However, only 21 of the 50 staff employed to work at the home had received formal, written one to one supervision. We made a recommendation about formal, written one to one staff supervisions for all staff employed to work at the home. We will follow up this recommendation at the next inspection. The home manager was in the process of conducting staff annual appraisals for all staff at the home. These were being conducted in line with a pre-appraisal self-assessment that the manager had asked all staff to complete prior to their annual appraisal taking place.

Inspection carried out on 06 and 07 October 2014

During a routine inspection

This inspection took place on 06 and 07 October 2014 and was unannounced.

Our last inspection at St James Court took place on 17 and 24 June 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.

St James Court is a care home which is registered to provide accommodation and nursing care for up to 58 people, some of whom may be living with dementia. The home is purpose built over two floors. The ground floor comprises of a 20 bed unit providing support to older people and an eight bed unit providing support to older people living with dementia. The first floor consists of a 30 bed unit providing support to older people who need nursing care. At the time of this inspection 45 people in total were living at St James Court.

The registered manager had not been working for a few weeks prior to this inspection and resigned from her post the day before this inspection took place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. We found that arrangements had been made to cover the registered manager’s absence. The deputy manager was acting as manager with support from a registered manager from another home within the same company and the regional manager of the home. The regional manager confirmed that arrangements were in place to recruit a new registered manager.

We found that the procedures for the administration of medication were not safe and the requirements for this regulation were not being met. Whilst written procedures were in place for the safe administration of medicines, we saw that these were not always adhered to. Two people had been left with their medicines and staff did not observe administration. This posed a risk to people’s health and safety.

Whilst levels of staff, in line with the assessed needs of people, had been maintained, there were differing opinions amongst people as to whether there were enough staff to meet their needs. People living at the home spoken with said that they felt safe. Staff had been provided with training in safeguarding people so that they knew how to identify and report abuse. Risk assessments had been undertaken to identify and minimise risks so that people were protected.

The provider was not meeting the requirements of the regulation to ensure that staff were provided with appraisal and adequate levels of supervision for development and support. This meant their performance was not formally monitored and areas for improvement may not be identified.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

People had access to a range of health care professionals to maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so that health was promoted and choices could be respected.

All of the people spoken with and their relatives said that they were well cared for by staff that knew them well. People living at the home, and their relatives said that they could speak with staff if they had any worries or concerns and they would be listened to.

Whilst a programme of activities was provided, some people told us that trips out of the home did not take place on a regular basis. We feedback to the deputy manager that consideration should be given to providing further trips out of the home for people that would choose this.

The environment for people living with dementia had not been adapted or provided with equipment designed to stimulate and support people. This meant the environment did not fully promote or support people’s quality of life. We recommend that consideration should be given to adapting this environment in line with current good practice so that people are supported.

Whilst regular meetings were held for senior staff and management at the home to share information, we found that full staff meetings had not taken place on a regular basis. In addition, we found that regular meetings with people living at the service and/or their relatives or representative had not taken place. Relatives meetings had taken place in January and July 2014. This meant people and/or their relatives or representatives did not have sufficient opportunities to be kept informed about information relevant to them.

The provider had ensured there were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. Whilst people and their relatives had been asked their opinion via surveys, the results of these had not been audited to identify any areas for improvement.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report

Inspection carried out on 17, 24 June 2013

During a routine inspection

People�s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us they had the choice to do things they wanted and when they wanted to.

People experienced care, treatment and support that met their needs and protected their rights. One person said about the home that it was �very nice, I am very settled.� Family members of people living at the home told us that they were kept informed about their relatives� care.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.