This inspection was carried out on 5 December 2017 and was unannounced.

St Johns House Residential Care 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 home provides care and support for up to 23 older people, some of whom have dementia and physical disabilities. On the day of our visit there were 18 people using the service.

At the last inspection, the service was rated overall Good, with Requires Improvement in safe. At this inspection we found the service was overall Good, with Requires Improvement in responsive.

The service had 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.

Staff had knowledge and followed service policies and procedures to protect people from potential harm and abuse. Staffing numbers were appropriate to meet people’s needs in good time. Staff undertook appropriate recruitment checks which meant they were suitable to work with vulnerable people. Medicine management records were accurately maintained to ensure people had their medicines as prescribed. Staff followed safe infection control procedures. Incidents that occurred were regularly reviewed by the registered manager to ensure that causes were identified and dealt with as necessary.

People’s care records lacked information on the support people required and the guidance for staff on how to meet people’s individual needs. We made a recommendation about this.

Staff were trained appropriately for their role. Systems were in place to monitor the attended training courses which ensured that the registered manager was notified when staff were due for a refresher course. Some people told us the food provided was not always meeting their preferences. Staff supported people to meet their dietary and nutritional needs as necessary. The service provided important information about people to other agencies quickly when required. People had access to healthcare services as necessary. The provider was working to improve the premises for people living with dementia. People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible.

People told us that staff were kind and respectful towards their care needs. People’s religious needs were known and supported by the staff team. People had a say in how they wanted to be cared for and staff encouraged people to make decisions regarding their care and support needs. Staff maintained people’s dignity and respected their right to see their family when they wished to. The service encouraged people’s independence which meant they carried out activities by themselves where possible.

Staff followed guidance on how to use moving and handling techniques. This meant that people were provided with appropriate support to move around when they wished to. People and their relatives were aware of the complaints procedure and felt confident to raise their concerns if necessary.

Activities provided at the service had not always suited people’s care and support needs. We made a recommendation about this.

Staff felt well supported by the management team and approached the registered manager for advice when they needed it. People said the registered manager was responsive and attentive to their care needs. Staff were aware of and followed their responsibilities in relation to safe information sharing. Regular audits were carried out to monitor the quality provision at the service. The registered manager had shared information and updates w

One inspector made an unannounced visit to the service and gathered information to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff and from looking at records. We requested information from the provider. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were protected from the risk of abuse. All staff had been trained in how to recognise abuse and how to raise concerns. They were aware of the whistleblowing procedure and we saw posters and leaflets on display informing people how to report abuse.

People told us they felt safe at the service. Comments received included "I feel safe and I feel well." and "we don't have any bullies here." One person said one of the good features of the service was "the way that we are treated".

At a meeting for people who lived at the service they were reminded to "tell someone" if anyone was unkind to them.

Is the service effective?

Care plans described people's individual needs and care was provided in accordance with them. Records, our observations and discussions with people confirmed that this support was provided by trained and knowledgeable staff,

Is the service caring?

People were supported by kind and attentive staff. People living at the service said they felt the care was good especially as they never felt "rushed" by staff. One person said the care "makes me feel that I am getting better." Another person described the staff as "angels." and said that the staff attitude was good, explaining that "we are not talked down to."

Is the service responsive to people’s needs?

People said they were helped when they needed to be. One person said whenever they used the bell in their room to call for help "no matter what time, they are there straight away." We noted during our visit that call bells were responded to promptly.

Is the service well-led?

The service was well-led. The manager was registered and had been in post for several years. The provider visited the service to check the quality of the service provided. Service development was discussed to identify areas of improvement. Staff were well supported and trained to provide a good service.

We spoke with ten people who lived at St Johns House and with visitors, staff and managers.

People told us they were satisfied with the care they received. We were told that the staff were caring and helpful. Comments we received about St Johns House included "I like it here because it is comfortable and clean". A visitor said they liked the service because it was "small and personal".

We saw people enjoying activities during our visit and several people told us they had enjoyed a recent visit to Littlehampton. People said they felt safe at the service and although they had none, they felt able to raise concerns and complaints with staff.

Staff were recruited safely and appropriate checks were made to ensure they were suitable and experienced for their roles.

We spoke with several people who used the service who commented on their satisfaction. People said that they were provided with choices about their care and asked for their consent before doing something and their privacy was respected.

People we saw said they were "happy living here" and "liked the staff and food". People also told us that they "liked the activities provided for them". We found that the service had systems in place which assessed people's needs and care plans were written clearly. Well written risk assessments were in place for people and relatives were given the opportunity to plan for people's needs..

Staff listened to the people who used the service and provided for them according to their wishes on a daily basis. Staff observed people's dignity and respected their wishes. There were sufficient trained and experienced staff working at the home. We spoke with staff who said that "they liked the people they worked with".

We noted that some procedures regarding mandatory safeguarding required reviewing.

People told us how much they enjoyed living at the home, their quality of life was good and they followed their interests by continuing with hobbies and activities that they enjoyed before they moved to the home.

In their daily lives people feel able to do what they want to do, and have the food that they like. A range of stimulating activities is available for people to engage in.

People living in the home experience a continuity of care, the staff team remain consistent with relatively few changes to personnel.

People find that staff are approachable and kind, they are skilled and competent at providing the care that people require. Staff receive the training and development needed.

Staff know the standards expected in the home, they feel supported and have their practices appraised.

People like living in a well maintained home that is safe and homely, they like having their treasued possessions around them that gives a sense of belonging.

St Johns House provides care for up to 23 people. At the time of our inspection there were 21 people at the home, some of whom were living with dementia.

The inspection took place on 30 July and 3 August 2015. Our first visit was unannounced and we told the manager when our second visit would take place. Our last inspection was on 29 April 2014, when we found the home was meeting the regulations inspected.

The home has a registered manager as required. 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 one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The visitors’ book was not maintained as an accurate record and this could have presented risks to visitors’ safety in an emergency. You can see what action we have told the provider to take at the back of the full version of this report.

People and their relatives felt the home was safe and they were looked after well. Staff were knowledgeable about safeguarding people from abuse and knew the action to take if they felt they were at risk.

People received their prescribed medicines when they needed them and they were supported to maintain good health. Risks associated with people’s health and care needs were assessed and plans put in place to manage them.

There were enough staff to look after people well. Staff liked their work and they were trained and supported to do their jobs well.

People enjoyed their meals and they were given two choices of food to suit their tastes and needs. People were supported with their meals when they needed help.

The manager and staff understood their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

The staff were caring, kind and respectful to people. People were relaxed and comfortable with staff and enjoyed their company.

People and their relatives contributed to assessments and care plans.

The provider had systems to check that the quality of care people received met their standards and plans were put in place to make improvements when necessary. Staff had confidence in the management of the home and their views were listened to. Records were well maintained.