St Johns House

People’s experience of using this service: People using this service benefited from a service, which had maintained and built on the outstanding work that they did with people. People told us the service was, “Fabulous”, “The best there is” and “Like living in paradise.”

The provider demonstrated how they had achieved outstanding practice, development and improvement at the service. The leadership team sought creative ways to provide a personalised service and had achieved excellent results through exploring best practice and professional support and implementing it to enhance people's lives.

The staff team were highly motivated and were actively involved in and contributed to the continuous improvements in care and support. The provider and registered manager were dedicated to providing individualised care that met the highest of standards and promoted people's independence and quality of life.

The registered manager demonstrated a strong and supportive leadership style, seeking feedback in order to further improve the care and support provided. The registered manager and staff team used innovative, but safe practices to develop people's independence and create a vibrant, happy and thriving community.

Communication within the service was excellent at all levels and encouraged mutual respect between staff and people who used the service. People received exceptionally effective care. Staff collaborated with people and relatives to find out people’s interests and needs so they could provide person-centred, tailored packages of care that had a positive impact on outcomes for people who used the service.

The provider had attained regional and national recognition through accredited schemes, which acknowledge quality practice such as The Living Wage Foundation and Customer First. The management team encouraged and consulted with staff at all levels to improve the quality of service and all staff were encouraged to develop positive relationships with people living at the service and with each other. Staff took key roles to research best practice and promote better outcomes for people. For example, the activity co-ordinators had worked with a national company to develop and deliver person-centred activities which people found stimulating and enjoyable.

There was a truly holistic approach to assessing, planning and delivering care and support. Each person who used the service had a personal plan linked to their preferences and needs. Their wishes and choices were recognised and valued and people received excellent support to achieve a full and satisfying way of life. People were at the heart of the service, which was organised to suit their individual needs and aspirations.

Staff were caring, kind and compassionate with people, recognising them as individuals and treating them with respect and dignity. There was a strong emphasis on eating and drinking well. Meals were an enjoyable occasion, tables were attractively set and people could either sit in social groups they felt comfortable with or take their meals privately in their own rooms according to preference. Themed days, including special meals and celebration meals, featured regularly on the menu.

The atmosphere within the service was exceedingly friendly and open. A positive and innovative way of managing risk was discussed and developed with people who used the service. 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.

More information is in the full report.

Rating at last inspection: Outstanding (report published 9 June 2016).

Why we inspected: This inspection was a scheduled inspection based on the previous rating. The service has improved its rating of outstanding in two key questions, and now has achieved outstanding in four.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

St Johns House provides residential care for up to 36 older people.

There was a registered manager in place. 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.

At this inspection we found a vibrant, happy and thriving community. There were strong and mutually respectful relationships that existed between the people living at the service and the staff team. When asked, people’s feedback about the service was consistently high and people told us the care they received was, “Magnificent,” “Marvellous,” and, “Fantastic.” The overall impression from feedback from a variety of sources was that everyone thought people living at St Johns House were receiving the best possible care from an excellent staff team.

Emphasis was given to supporting people to lead an independent and fulfilling life, which the registered manager described to us as, “Adding Life to Years,” and encapsulated the beliefs and ideals of everyone working in the service. People living at the service could be as involved in decisions as much as they liked. We heard for example that people actively participated in staff recruitment and with an election to get a rescue dog, chickens, and a garden swing seat.

When we visited we found there was a stimulating, active environment with plenty of fun and laughter. Confident, experienced leadership provided a tangible presence in the service and managers successfully promoted the family values and people’s wellbeing and happiness, which, they told us, lay at the heart of everything they did.

The service had attained regional and national recognition through accredited schemes which acknowledge quality practice such as Investors in People Silver award, The Living Wage Foundation and Customer First. The management team encouraged and consulted with staff at all levels to improve the quality of service and all staff were encouraged to develop positive relationships with people living at the service and with each other. Staff took key roles to research best practice and promote better outcomes for people. For example, the registered manager was the recognised change leader within the organisation for the outstanding service programme with Ladder to the Moon looking at ways to engage with people creatively.

The registered manager had completed training to enable them to deliver safeguarding training to staff to make sure that risks to people were well managed. They were confident about local safeguarding policies and understood when they needed to raise an issue with the local authority to ensure any safeguarding concerns were dealt with in a timely manner.

Risks assessments were in place for a wide range of environmental and individual factors. This helped to ensure that risks were identified and action could be taken to reduce and minimise the likelihood of potential risks to people. Specialised cleaning equipment including laundry equipment had been purchased to minimise the risk of cross infection.

Robust recruitment systems were in place to recruit staff safely. All staff received induction training, which introduced them to the culture and values of the service. They also received training in addition to specific training for people’s individual needs. There was a health and wellbeing champion who met with the GP each week to discuss people’s health care, which ensured that people’s welfare remained under constant review.

Staffing levels were flexible to ensure people were well supported to make full use of the facilities and go out on trips. There were dedicated activity coordinators in addition to the housekeeping staff, kitchen and laundry staff, all of whom took an active part in every aspect of the service and were also encouraged to develop positive relationships with people living there. The service was maintained to a very good standard of comfort and cleanliness and when we looked around one person described the accommodation as, “Always spotless.” We saw a new extension had been built to house a new laundry, and there were plans to extend and refurbish the kitchen.

One member of staff had responsibility for the safe management of medicines to ensure people received the right medicines at the right time and that these were handled safely. Both the registered manager and the medicine champion regularly reviewed and audited medicines to ensure they met people’s current needs. They were proactive in involving heath care professionals whenever they felt that changes may be required.

The registered manager was clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People confirmed they were consulted about their preferences including their food and drink choices. The chef met with people on a regular basis to ensure preferences were reflected on the menu. Meals were an enjoyable occasion, tables were attractively set and people could either sit in social groups they felt comfortable with or take their meals privately in their own rooms according to preference. Themed days including special meals and celebration meals featured regularly on the menu. The service had its own minibus and people were also frequently offered the opportunity to eat out in local cafes and restaurants.

Mobile tablets had been recently introduced for care planning and to record daily records and handover records and we saw staff confidently using these. People had informed staff about the areas of their care they considered most important and care plans reflected their particular wishes.

People were encouraged to give feedback informally on a daily basis, through surveys and regular meetings and the service acted upon what people said.

Effective management systems were in place to safeguard people, promote their independence and wellbeing and drive continuous improvement.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). There was no one currently using the service who had a DOLS in place. The provider knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity training. This meant people would be safeguarded as required.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

People were protected from the risk of infection because staff followed good infection control practice and these practices were monitored regularly.

There were sufficient care workers to respond to people's health and welfare needs. A person who used the service told us, "The staff are very good, they know what they are doing. We have the right kind of staff."

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care. People told us they were included in making decisions about how their care and support was provided.

New staff had received relevant induction training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere. People told us staff were 'exceptional.' One person said 'the staff are wonderful; there is always something to occupy us, I have been learning the recorder and I sing in the choir.' And another person said 'the staff are wonderful, it's lovely here.'

Is the service responsive?

People's needs were met in accordance with their wishes. We saw evidence of the service ensuring people were able to continue with interests and hobbies; for example the residents choir and recorder group.

People we spoke with knew how to make a complaint if they were unhappy.

People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

People's care and support needs were planned and monitored, with arrangements in place to involve people in decision making. People said that staff were responsive and treated them well. Staff knew about people's needs and preferences. Comments included 'Oh they are very, very obliging, quite marvellous', 'They are fantastic, they would do anything for you' and 'I get very well looked after.'

People's dietary needs were assessed and special dietary requirements were provided for. People were provided with a variety of food and drink. Comments made to us about the food included 'I'm very satisfied with the food' and 'They are always asking you if you need another drink.'

Systems were in place to administer and store medication in a safe way. Comments made to us by people living at the home included 'They make sure you take what has been prescribed' and 'You can self-medicate if you want to.'

Staff recruitment procedures were in place to ensure that suitable staff worked at the service. People told us that staff were professional and kind. Comments made to us included 'Always cheerful' and 'The staff are so good to me.'

We observed the staff during their interactions with people who live at the home and saw they supported them in a respectful and dignified way. We also saw people were at ease and clearly relaxed in their surroundings.

We saw that there were a good range of activities that people could engage in, and that they could choose freely how to spend their time. We asked individuals if they felt anything could be improved upon at the home. Overall people were happy but some people said that meals at the home were not always good and could improve. People did confirm however that they were given information about how to complain, and opportunities to express and air their views. They also felt their concerns were listened to and acted upon and that the home was very well managed.