CQC report explained · a residential care home
What the CQC found at John Cabot House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough suitable staff on duty to meet people's needs safely. Medicines were stored securely, given at the right times and recorded accurately.
- Effective?
- Good
- Staff had training about acquired brain injury and supporting behaviours that may challenge others. Staff were supervised and people were supported with food, drink, consent and mental capacity decisions.
- Caring?
- Good
- People told inspectors staff were kind and caring. Inspectors saw respectful, patient and positive interactions, with attention to privacy, dignity and independence.
- Responsive?
- Good
- Care plans gave detailed guidance about people's needs, routines, interests and independence. People were supported with social and therapeutic activities both inside and outside the home.
- Well-led?
- Good
- The home had quality checks, incident reviews, staff meetings and provider oversight. Inspectors found these systems were identifying shortfalls and supporting improvements.
What inspectors found, October 2018
Rated Good; inspectors found safe, kind and personalised care, with improvements since the previous inspection.
The inspection was unannounced and took place on 22 August 2018. Inspectors spoke with people using the home, managers and staff. They reviewed care files, recruitment and support records, medicines information, training records, rotas, audits and other management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough trained staff, safe medicines systems, suitable support for people with acquired brain injuries and respectful care.
The previous inspection had found problems with lighting, staffing, staff training, kindness, activities and quality checks. At this inspection, inspectors found these issues had been addressed. People were being supported to take part in activities in the home and community, and the quality checks were described as effective.
Enough suitable staff
Inspectors found staffing levels were planned around people's needs. Staff were able to provide support in a calm and unrushed way.
“There was enough staff on duty to be able to meet each person's needs in a calm and unrushed way.” from the report
Relevant staff training
Staff had training about acquired brain injury and behaviours that may challenge others. Records confirmed they had the skills and knowledge needed to support people.
“The staff training records confirmed that staff had completed training to help them have the skills and knowledge to provide effective support.” from the report
Kind and respectful care
People described staff as kind and caring. Inspectors observed warm, positive and respectful interactions.
“At this inspection we observed all the staff on duty were caring, warm and positive in their approaches towards people.” from the report
Personalised activities and support
People were supported with activities they chose, both in the home and in the community. Care plans included personal interests, routines and ways to build independence.
“There was clear written evidence that people took part in a range of social and therapeutic activities.” from the report
Effective quality checks
The provider and home had systems for checking safety and quality. These checks identified issues and recorded the actions needed.
“There were clear and embedded systems in place to check and monitor the quality of the service provided.” from the report
Inspectors raised no specific concerns in this report.
- 01How is my relative's acquired brain injury reflected in their daily support plan, and what training has the current staff team completed?
- 02How will you make sure my relative is offered regular activities outside the home, and how will these offers be recorded?
- 03How are medicines, including their purpose, side effects and preferred way of taking them, recorded and checked?
- 04If my relative cannot make a particular decision, how will you assess capacity and involve them in a best-interest decision?
- 05What recent issues have been found through your quality checks, and what action was taken to address them?
This was an unannounced inspection of the overall service and covered all five CQC questions; the report also checked whether problems found at the July 2017 inspection had been addressed. This explanation was written from the published report of 4 October 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2017
Requires Improvement; inspectors found unsafe delays, gaps in staff training and failures to always protect dignity, with a warning notice issued.
This was an unannounced inspection on 19 and 20 July 2017. Inspectors spoke with people, staff and health and social care professionals. They looked at care records, staff files, training records, rotas and management records.
The home was rated Requires Improvement in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that one person's flat had been without working lighting for several weeks, staffing had sometimes fallen below the home's own planned level, and staff lacked important training about acquired brain injury.
People were not always treated with dignity and respect. Records did not explain why planned activities had not happened, and concerns raised by people were not always recorded as complaints. There were also weaknesses in management checks and reporting incidents to CQC.
There were some positive findings. Medicines were managed safely, risks were assessed, care plans were detailed, and staff generally knew people well. The report says the lighting was partly restored during the inspection and the water leak was repaired by 31 July 2017.
Medicines
Inspectors found that medicines were managed safely and people received them as prescribed. The home had introduced a new system to improve medicine records.
“Records evidenced that people received their medicines as prescribed.” from the report
Risk planning
Risk assessments covered areas such as health conditions, choking, nutrition, anxiety and personal care. Staff understood the guidance and how to keep people safe.
“Staff had a good knowledge and understanding of individual risk assessments and measures to be taken to keep people safe.” from the report
Person-centred care
Care plans included detailed information about people's preferences, communication, routines and goals. They also supported people to develop daily living skills and independence.
“The service made use of a wide range of person centred planning tools to assess people's individual needs and plan to meet those needs.” from the report
Working with professionals
Staff worked with therapists and other professionals and put their care plans into practice. Inspectors were told this supported people's rehabilitation.
“Professionals we spoke with said staff worked positively with them and implemented the plans they developed.” from the report
Unsafe flat conditions
seriousOne person's flat had no working lighting for several weeks. Water was also leaking through the ceiling, and the kitchen could not be used until repairs were made.
“At the time of our inspection one person's apartment had no working lighting.” from the report
Staff training
seriousNone of the six staff whose records were checked had completed the planned in-depth training about acquired brain injury. Inspectors said some staff did not fully understand how it could affect behaviour.
“Staff had not received the training required to effectively meet people's needs.” from the report
Dignity and respect
seriousA person said a staff member spoke to them in a patronising way. Another person felt they had not been listened to about the lack of lighting.
“I'm not a child and don't need speaking to like one” from the report
Activities and records
needs fixingOne person had not been supported to leave the home in the 19 days before the inspection. Records did not show whether activities had been offered, declined or stopped because the person was unwell.
“Care records kept did not provide an explanation of why planned activities had not taken place” from the report
Management oversight
seriousThe home's quality systems had identified some risks but had not ensured they were dealt with within a reasonable time. A required notification about the lighting problem had not been sent to CQC.
“The provider's quality assurance systems had not ensured action had been taken to reduce or remove concerns identified, within a timescale that reflected the impact to the health, safety and welfare of people.” from the report
- 01Have all staff now completed the in-depth training about acquired brain injury, and how do you check they understand it?
- 02What staffing level is planned for each shift, and how do you respond when staffing falls below that level?
- 03Has the water leak and all lighting work been fully completed, and how are repairs now monitored?
- 04How do you record activities that are offered, declined or cancelled, including when staffing is the reason?
- 05How are concerns and complaints recorded, investigated and reported to families?
This was an unannounced inspection covering all five CQC questions; inspectors did not carry out a SOFI 2 observation because they considered it would be intrusive and interfere with usual activities. This explanation was written from the published report of 22 August 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of John Cabot House
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- October 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2016Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- June 2014
Registered with the Care Quality Commission on 30 June 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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