Archived: St John's Nursing Home

Updated 30 May 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This focused inspection was prompted by information we received from partner health and social care agencies regarding their serious concerns for risk to people’s health, safety and welfare.

The information shared with CQC also indicated potential concerns about the management of risk and leadership. This focused inspection examined areas of potential risk, including infection prevention and control, nutrition and hydration, continence management, medicines management and the use of pressure relieving equipment.

Inspection team:

The inspection was carried out by two inspectors and one assistant inspector.

Service and service type:

St John’s Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation and personal and nursing care for up to 37 older adults and people living with dementia.

St John’s Nursing Home had a manager registered with the Care Quality Commission. This means that they and the registered provider are legally responsible for how the home is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced.

What we did:

Prior to the inspection we reviewed information we had received about St John’s Nursing Home. We sought feedback from local authority commissioners and safeguarding adults team and other health care professionals who worked with the service.

During the inspection we gathered information by observing the care that people received. We reviewed the care records for 6 people. We looked at records in relation to the management of the home such as quality audits.

We spoke with the registered manager, three registered nurses and 4 members of care staff. We also spoke with a visiting local GP, local authority representatives and clinical commissioning group (CCG) representatives.

Updated 30 May 2019

About the service:

St John’s Nursing Home is a care home situated in the town of Boston, Lincolnshire. The home is registered to provide accommodation for up to 37 older people, some of whom live with dementia and complex physical health needs. There were 31 people living in the home at the time of our inspection.

People’s experience of using this service:

The registered provider had failed to ensure risks to people’s health, safety and welfare had been effectively identified, assessed or managed, which placed people at risk of harm. Specialist healthcare support had not always been sought in a timely manner. Some vulnerable people had received treatment in hospital as a result of poor care practices.

The registered provider had failed to ensure people were supported to eat and drink enough to maintain good health. Furthermore, they had failed to ensure people’s continence and skin integrity needs had been effectively assessed and managed. The registered provider had not followed the advice of healthcare professionals regarding essential care to meet people’s needs.

The registered provider had failed to implement effective infection prevention and control control practices which placed people at risk. Some people had developed infections that had not been recognised or appropriately managed by staff which subsequently required medical treatment.

The registered provider had failed to recruit and retain the required numbers of staff to provide consistent care for people. This meant there was a reliance on the use of agency staff who did not know people well or fully understand their care needs.

The registered provider had failed to ensure that staff had the right knowledge and skills to care for people safely and that they understood their responsibilities. This meant that people did not receive the essential care they required. Furthermore, they had failed to accurately assess the levels of staffing required to keep people safe and meet their needs.

The registered provider had failed to ensure people received the right medicines at the right times because arrangments for the ordering and monitoring of medicines did not support good practice.

The registered provider had failed to ensure effective governance and leadership systems were in place. This meant there was no clear oversight of the quality of care provided for people and opportunities for learning and improvements had been missed due to poor governance and leadership arrangements.

Why we inspected:

This was the first inspection of St John’s Nursing Home since the registered provider registered the location with CQC in November 2018.

We brought forward the inspection due to information we received from partner health and social care agencies regarding serious risks and concerns for the health, safety and welfare of people who lived St John’s Nursing Home. They had been carrying out regular checks of the care provided at the home over the course of the previous month. The inspection focused on two key questions; Is the service safe? and Is the service well-led?

Enforcement:

The services provided for people met the characteristics of an inadequate rating in the key questions: Is the service safe? and Is the service well-led?

We urgently removed the location from the provider’s registration to ensure regulated activities could not be carried on from there.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk