The inspection was undertaken on 7 and 8 November 2016 and was unannounced.

The provider of St John’s Nursing Home is registered to provide accommodation and nursing care for up to 42 people who have nursing needs. At the time of this inspection 38 people lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, conservatory and dining room.

There was a registered manager in post who was supported by a deputy 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.

The management and staff team understood what was important to people who lived at the home and worked closely with each other and with families to ensure each person had the best life as possible. People played an active part in the running and development of the home. New ideas were made possible by a motivated management and staff team which enhanced people’s quality of life and provided therapeutic benefit to people.

People were supported to retain an active presence in the local community and to maintain their personal interests and hobbies. An activities team alongside care staff all worked together to organise a rich programme, whereby people were offered different things to do for fun and interest for those who wished to participated. People had opportunities to meet and develop relationships with students and volunteers to widen their social networks.

There was a warm, homely atmosphere and staff cared for people with kindness, patience and understanding. Staff had time to meet people’s needs and to spend time in conversations with people individually, without rushing. Staff were proud of their achievements in providing end of life care in a personalised way and often being ‘on call’ in their own time to meet people’s choices. Staff held high values about striving in their caring roles to help people to experience a good death free of pain and in comfort. Families and friends were offered after death care and a way of celebrating and sharing their memories of people’s lives each year with a tree which held people’s thoughts and balloons.

There was a sense this was people’s home and they were proud of their home. People were supported to actively use their skills and interests in the decoration of the different spaces within their home environment which included the garden spaces and creation of a pub.

Food and drink were provided to a high standard and people could choose what to eat and drink and when. People who lived at the home and their relatives could voice their views and opinions. The registered manager listened to what people had to say and took action to resolve any issues. The management team reviewed incidents and concerns to look for opportunities to improve policies and practices for the future. There were systems in place for handling and resolving complaints which focused upon opportunities for learning lessons.

People who lived at the home and all staff were actively encouraged to contribute to the evaluation of the care and support provided and the recommendations for improvement. The management team and staff worked together as a team with a passion to learn about and aim for best practice with people very much at the heart of the services they received in their home.

The management team and staff shared common values about the aims and objectives of the service people were provided. These were based around people being supported to live the best lives as possible. Regular quality audits and checks were completed so improvements were continually recognised and there was effective follow up action which made sure

St John’s Court is registered to provide nursing care and accommodation to up to 42 older people. At the time of our inspection 37 people were living there.

The inspection took place on 17 and 20 May 2016 and was unannounced.

At the time of our inspection a registered manager was in post. 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 told us they felt safe living at the home. Staff were aware of how to keep people safe and had undertaken training in this. People had their privacy and dignity maintained and staff were able to describe how they managed this. Throughout the inspection we saw staff to be kind and caring and treated people with consideration.

People and their family members felt sufficient staff were on duty to meet their care and support needs. Agency staff were not used to ensure consistency of care was provided. The registered manager was able to review staffing levels in line with people’s needs and increase staffing if needed. Systems to ensure safe recruitment processes and to check the registration of nursing staff were in place.

Staff were supported by the management and received training to ensure they had the skills and knowledge necessary to care for people. Staff were able to attended meetings where they were able to voice their opinions. People’s care needs were well known by the staff we spoke with including people’s likes and dislikes.

People were asked for their permission prior to receiving care and support so people were able to give their consent. Best interest decisions were in place where people were unable to make an informed decision on their own.

People’s healthcare needs were monitored and health professionals were consulted in order to maintain people’s well-being. People told us they liked the food available and confirmed a choice was available to them.

People were satisfied with the care provided and were supported in a way they wanted. People had care plans in place describing their needs and risks associated with their care. These were reviewed in line with people’s changing care needs.

Staff told us they enjoyed their work and liked the management team. People and their relatives were confident any complaints made would be listened to and responded to.

Systems were in place to monitor the service provided for people as a means to improve the quality of care and support people received. The registered manager had plans to further develop the service provided.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

People told us that they felt safe. Care records contained detailed risk assessments. Actions to minimise any risks identified were documented in people’s care plans. Risk assessments balanced risk with the rights of people to exercise choice. Care plans included information about possible urgent situations and how to deal with them. Staff had received basic life support training. There were Registered nurses on duty at all times.

The provider had relevant Mental Capacity Act (2005) policies including ‘Deprivation of Liberty’ safeguards that were applied in practice.

People told us that the home was always clean and tidy. Most areas in the home were well maintained. However a few areas, particularly the corridors, needed some attention. The provider had development plans in place for the refurbishment of the home.

Appropriate cleanliness and infection prevention and control policies and procedures were in place that were implemented and monitored in practice.

The provider demonstrated safe and effective medicines management.

Is the service effective?

The provider had effective systems in place to monitor the quality of the service people received. This included audits, quality reviews, annual resident and staff satisfaction surveys and analysis of incidents and complaints. Lessons learnt from quality reviews were discussed and actions monitored.

Care records were well written, accurate and reflected the needs and wishes of the people who received a service. People told us they were fully involved in developing their care plan. Daily records demonstrated that staff delivered care in line with the care plan.

Is the service caring?

We talked with ten people who received a service. All the people we spoke with said the service good or very good. One person told us that, “It is a real home from home, the staff really care about you as an individual”. Another person told us, “I receive lovely, lovely, care in a lovely, lovely, home”. We observed staff talking with people in a calm, friendly respectful way.

Staff we spoke with demonstrated they understood the care needs of the people they were caring for. They were clear about their role and responsibilities. Staff had received training to meet the needs of the people who received a service. The provider had up to date relevant care policies and procedures which reflected current research and guidance.

Is the service responsive?

People had their needs assessed prior to receiving a service. Care plans reflected both the needs and wishes of people.

The provider had systems in place to ensure the views of people who received the service and staff were sought and acted upon. People were invited to resident and relative meetings where they were encouraged to make suggestions about improvements to the home.

People had access to a wide range of activities. A member of staff was employed to coordinate activities for residents. A monthly newsletter provided information and news to people who received a service.

People told us they were confident that any issue raised or complaint made would be thoroughly investigated and acted upon.

Is the service well-led?

Staff we spoke with told us they felt well supported by the registered manager and senior staff. Staff said they were able to raise issues with their manager at any time and were confident they would be acted upon. Staff had opportunities to raise and discuss issues at staff meetings and anonymously through the annual staff survey.

People told us that the registered manager was very responsive, approachable and was always available to talk to. One person told us, “We see the manager most days.They always ask me how I am and have time for a chat”.

Lessons learnt from audits, incidents complaints and comments were communicated effectively with staff. Actions to implement lessons learnt were monitored.

35 people lived at the home when we carried out this inspection.

The registered manager was on annual leave on the day we carried out this inspection. We spoke with the deputy manager and two nurses. We also spoke with care workers, people who used the service and some visitors.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. We observed that people appeared comfortable with the care provided.

We looked at the care records for three people and found that their needs had been assessed. The records showed that care and treatment had been planned and delivered in line with people’s individual needs. Staff told us that they were aware of each person’s needs and how to give care and support to meet those needs. We brought to the attention of the deputy manager some concerns about equipment used for people with sore skin and the records held about people.

People who used the service were provided with sufficient food and fluid to maintain their wellbeing.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

We saw that staff were supported in the work that they did.

We found that systems were in place should people wish to make a complaint about the service provided.

In this report the name of one of the registered managers was not in post and not managing the regulatory activities at this location at the time of the inspection.

When we inspected St John’s Court we saw that care workers were being courteous and respectful towards people who used the service ensuring that people’s dignity was upheld. Although we did not see an actual choice of meal provided at lunch time we were informed that usually a choice was available and that the kitchen would have prepared something if needed.

During our inspection people who used the service and visitors gave us positive comments such as “nothing but praise, marvellous” and “a new lease of life” since moving into St John’s Court”.

Care plans, risk assessment and other records were held on a computer system however these were not always up to date to give staff guidance and direction.

Information on safeguarding was available for people in the home including members of staff. Staff training records were available and although it was evident that some had not received training those on duty had an understanding of their responsibilities in the event of them becoming aware or suspect actual or potential abusive events.

We found communal bathrooms and toilets to be suitably clean with hand washing facilities provided. A total of three commodes were checked as part of the inspection visit. Two of these were found to be dirty and a potential infection control risk.

There were occasions when people had not received their medicine as prescribed. Records for care workers to fill in following the application of creams were rarely completed to evidence that these items were used as prescribed.

Safeguards to ensure that new employees are suitable to work with vulnerable people were in place but not always sufficiently robust.

On 07 and 09 January 2013 we carried out an inspection at St John’s Court Nursing Home. This inspection was to assess whether compliance actions we set following our previous inspection in July 2012 had been met. At the time of our inspection thirty nine people were using the service.

In July 2012 we found that the provider was not meeting the essential standards relating to care and welfare, cleanliness and infection control, management of medicines, requirements relating to workers and monitoring the quality of their service provision.

We found that improvements had been made in all of these areas. During this inspection we talked with people who used the service, five relatives, three members of the care staff, the deputy manager and the registered manager.

We found that steps had been taken to make sure that care and treatment was planned and delivered in a way that was intended to ensure people’s welfare.

We found that improvements had been made regarding the cleanliness of commodes to assist with infection control measures.

Improvements had taken place regarding the management of medicines to reduce the level of risk to people who used the service.

We found that improvements had been made regarding the recruitment of workers and that quality assurance system had been introduced to make sure that the provider was able to monitor the quality of the service provided.