About the service St Johns Court is a nursing home providing personal and nursing care for up to 42 people. The service provides support to younger and older adults who have a physical and/or sensory impairment. The service also supports people living with dementia. At the time of our inspection there were 34 people using the service.
St Johns Court accommodates 42 people across four separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.
People’s experience of using this service and what we found
People told us they felt safe and supported by the staff who worked in the home. Staff recognised different types of abuse and how to report it, however staff did not always feel listened to when reporting concerns. We found mitigation of known harm was not robust and some people were not always supported to remain safe.
Potential risks to people's health and wellbeing had not been consistently identified and managed to maintain people’s safety. We found areas of risk which had not been addressed sufficiently, such as management of falls, and environmental aspects. There were not always sufficient staff on duty to keep people safe and meet their needs. People's medicines were managed in a safe way, but storage of medicine required addressing. Areas of the home were visibly dirty and the management of Covid-19 was not always safe.
People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. New staff had not received an induction to ensure they were able to support people in a safe and effective way, while some training for existing staff’s had lapsed. People told us they did not always enjoy the food offered, the provider was reviewing how people could be involved in the menu choices. People who lived with dementia were not always supported to eat their meals and have their drinks as staff did not always have time. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. 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 did support this practice.
People who lived with dementia were not always supported in a way which maintained their dignity. The dementia unit was not dementia friendly, with poor signage and lack of stimulation for people. The environment of the home was dirty and did not promote a respectful living environment. The provider could not be assured privacy was maintained for people’s information as offices were seen to be unlocked when unattended.
People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People told us they were supported and encouraged to attend the activities held within the home. People had access to information about how to raise a complaint. People's end of life care needs were met in line with their preferences in a respectful and dignified way.
People and relatives felt the management team had people's best interests at heart and felt the home and the way the service was run was good. However the staff team felt the previous management team did not listen or support them. Staff were positive about the new management team and felt they were already listening to them and making positive changes. The providers systems had not identified some concerns we identified on this inspection. Where the provider had identified areas for improvement these were not always acted upon in a timely way.
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 outstanding (23 October 2019)
Why we inspected
The inspection was prompted in part due to concerns received about people’s care, staffing levels and management oversight. A decision was made for us to inspect and examine those risks.
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. This included checking the provider was meeting COVID-19 vaccination requirements.
You can see what action we have asked the provider to take at the end of this full report.
The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safeguarding's, people’s safety, staffing and the providers governance systems.
Please see the action we have told the provider to take at the end of this report.
For full information about CQC’s regulatory response to the more serious concerns see the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider 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 continue to monitor information we receive about the service, which will help inform when we next inspect.