About the service John Sturrock is a care home providing personal and nursing care to up to 40 people, some of whom were living with long term mental health conditions and some who were living with dementia. The provider was also caring for people with learning disabilities and autism, but this was not included in their registration. There were 40 people living in the home at the time of this inspection.
John Sturrock accommodates people in a purpose-build property. Each person had their own bedroom with en-suite facilities. There were indoor and outdoor communal areas.
People’s experience of using this service and what we found
People and relatives shared mostly positive feedback about the care provided. However, during this inspection, we were not assured the service provided was safe and we found widespread shortfalls in the way the service was managed. We found signs of a closed culture developing at the service.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care was not consistent with current best practice. The management of behaviour considered challenging to others did not follow a positive behaviour support approach and there was a lack of evidence that restrictive practices were used only as a last resort. Care planning documentation was not always written from the point of view of the person.
The provider failed to implement processes to effectively monitor the quality of the service and to identify the issues found during our inspection. Records were not always complete or contemporaneous.
Several events, including safeguarding incidents, had happened at the home. Most had been appropriately reported, but in the course of this inspection, we asked the provider to report another two safeguarding incidents that had not previously been identified as such.
Known risks to people’s care and the management of behaviour considered challenging was not managed well.
People’s medicines were not always administered safely.
The requirements of the Mental Capacity Act were not always being followed. We found some people who lacked capacity in relation to some areas of their care, had their liberty restricted as part of their care arrangements and this was not properly assessed and documented. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Care plans were not always individualised or reflective of the person's voice.
Management systems were not robust in ensuring consistent recording and analysis of accidents, incidents and complaints. We found gaps in staff’s training, assessment of competencies and supervision.
We made a recommendation in relation to staffing levels and staff deployment practices.
The registered manager was receptive to the inspection process and told us they had taken action in relation to the issues found at this inspection.
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 9 August 2019).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection enough improvement had not been made, the provider was still in breach of regulations and we found new breaches.
Why we inspected
The inspection was prompted in part due to concerns about a closed culture developing at the service due to the high number of safeguarding incidents, incidents involving the police and medicines errors. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for John Sturrock on our website at www.cqc.org.uk.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We found breaches in relation to safe care and treatment, consent to care and good governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.