CQC report explained · a residential care home
What the CQC found at St James House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Known fire and other safety risks were not always managed safely. Night-time checks were not consistently recorded and parts of the building were not clean, although staffing, recruitment and medicines management were found to be safe.
- Effective?
- Requires improvement
- Health and eating risks were not always monitored properly. Inspectors also found unclean and poorly maintained areas, while mental capacity assessments, DoLS applications and much staff training were in place.
- Caring?
- Requires improvement
- People did not always receive care that protected their dignity or involved them in decisions. Staff were kind and understood people's communication, but bedding, care plan access and house meetings were not consistently handled well.
- Responsive?
- Requires improvement
- Care plans lacked clear goals and activities did not regularly reflect people's interests or wishes. The home did respond to complaints and had some accessible information, but people's individual needs were not consistently assessed and supported.
- Well-led?
- Requires improvement
- Governance systems did not reliably identify or fix problems with safety, cleanliness, health needs and personalised care. A new manager had begun making changes, but there was no registered manager in place during the inspection.
What inspectors found, September 2022
Rated Requires Improvement; inspectors found serious gaps in risk management, cleanliness, person-centred care and oversight.
Inspectors visited unannounced on 27 and 28 May 2022. They spoke with all four people living there, a relative and six staff. They observed care, checked records and reviewed medicines, staff files and management information.
The home was not always safe. Inspectors found fire risks, missing night-time checks, poor cleanliness and weak monitoring of one person's fluid intake and eating risks. Some bedrooms, bathrooms and outdoor areas were not clean or well maintained.
Care was not consistently personal or dignified. People did not always help plan their care, have meaningful activities or work towards personal goals. One person was moved at short notice without the local authority being informed.
All five areas were rated Requires Improvement. This is worse than the previous Good rating, published on 13 July 2019. The provider was required to send an action plan, and CQC said it would monitor progress and return to inspect.
Staffing and recruitment
People said they had enough staff. Recruitment checks were completed, and staffing numbers and skills matched people's needs.
“The numbers and skills of staff matched the needs of people using the service.” from the report
Medicines
Medicines were stored and given safely. Staff understood the need to avoid excessive medicines to control behaviour, and managers carried out regular reviews and audits.
“Medicines were being stored and administered safely.” from the report
Safeguarding
Staff knew people well and understood how to protect them from abuse. Safeguarding information and incident tracking were in place.
“Staff were able to speak confidently about the action they would take to keep people safe.” from the report
Kind staff interactions
People told inspectors that staff treated them well. Inspectors saw staff adapt their approach calmly when one person became distressed.
“Staff took the time to understand people's individual communication styles and develop a rapport with them.” from the report
Fire and safety risks
seriousA basement door marked to stay locked was open, and the basement contained combustible materials despite known fire risks. Required night-time fire drills had not taken place, and some night checks were not recorded properly.
“There was a known fire risk at the service and incidents where fires had been set.” from the report
Health and eating risks
seriousFluid intake was not monitored for one person with a serious health condition. Another person's eating plan did not include all the steps needed to reduce choking risk.
“Staff confirmed that they had not been monitoring the person's fluid intake.” from the report
Cleanliness and repairs
needs fixingInspectors found unclean bedrooms and bathrooms, damaged furniture, littered outdoor areas and missing protectors on some sharp railings. Cleaning records were incomplete.
“People's bedrooms and bathrooms were not kept in a clean state during our inspection.” from the report
Person-centred support
needs fixingCare plans did not consistently contain goals or aspirations. Activities were mostly daily living tasks, and people were not regularly supported with their chosen interests or wishes to go out more.
“People's care plans did not include goals or have aspirations for people to work towards.” from the report
Involvement and dignity
needs fixingNot everyone had access to their care plan or was involved in house meetings. Inspectors also found bedding and a mattress in a poor condition, which did not protect one person's dignity.
“Not all people living at St James House had access to their care plans.” from the report
Leadership and oversight
seriousAudits had identified some issues but did not lead to timely action. A person had been moved out of the area at short notice without the local authority being informed.
“The provider's governance systems had not been effective in identifying or putting right concerns identified at this inspection.” from the report
- 01What action has been completed to remove the fire risks in the basement, and when were night-time fire drills last carried out?
- 02How are fluid intake, restricted diets and eating or choking risks now recorded and checked?
- 03Which repairs and cleaning improvements have been completed, including bedrooms, bathrooms, outdoor areas and bedding?
- 04How are people now involved in their care plans, house meetings, goals and activity choices?
- 05Who is currently responsible for the home, and what progress has been made towards having a registered manager?
This was an unannounced inspection covering all five key questions, prompted partly by concerns about risk management and infection prevention and control; all previous ratings were reassessed. This explanation was written from the published report of 3 September 2022 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, July 2019
St James House is Rated Good; people received safe, kind and personalised care, but medicines records were not always completed correctly.
This was an unannounced scheduled inspection on 20 May 2019. One inspector spoke with five people living there, managers and support workers. They reviewed support plans, health records, medicines records, management documents and one recruitment file. Feedback was also sought from health and social care professionals and commissioners.
The home supported six people with learning disabilities and/or autism and mental health needs. Inspectors found enough trained staff, good support with health needs, food, activities and community access. People said they felt safe, liked the staff and were involved in decisions about their care.
There was a medicines recording problem. Some records that needed two staff signatures had not been completed consistently. The home dealt with this during the inspection by providing more training, improving checks and arranging an external medicines audit. Inspectors said this had not affected people receiving their medicines as prescribed.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. It had also been rated Good at the previous inspection, published on 11 November 2016.
Kind and respectful support
People described staff positively. Inspectors saw staff being friendly, patient and respectful of privacy and personal preferences.
“We observed that people were happy in the company of staff.” from the report
Choice and independence
People were supported to cook, shop, use public transport, take part in daily tasks and work towards personal goals.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible” from the report
Meaningful activities
People took part in activities that matched their interests, including exercise, swimming, shopping, courses and community activities.
“People participated in a wide range of meaningful activities in line with their needs and preferences.” from the report
Good risk support
Staff had plans to manage health risks, emotional distress and incidents. Staff used restraint only as a last resort and reviewed what they learned.
“Restraint was not used regularly and was only used as a last resort.” from the report
Open management
People and staff could approach managers directly. House meetings, surveys and keyworker discussions gave people ways to raise concerns.
“People were comfortable approaching the registered manager and regularly went in to the office to speak to them throughout the day.” from the report
Medicines records
needs fixingSome medicines records that needed two staff signatures were not completed consistently. The home provided further training, improved its audit system and arranged an external audit, and inspectors said people still received medicines as prescribed.
“When some medicines had been administered the medicine record should have been to be signed by two members of staff, this had not been done consistently.” from the report
Audit did not spot the issue
minorThe home's own medicines audit had not identified the recording problem before the inspection. The audit process was changed so that future concerns should be identified.
“The audit of medicines had not identified the concerns we identified on inspection.” from the report
- 01How do you now check that medicines records needing two staff signatures are completed every time?
- 02What did the external medicines audit find after the inspection, and how often are medicines records now checked?
- 03How will you support my relative to make choices and build independence in daily activities?
- 04How are my relative's communication needs recorded and shared with all staff?
- 05How are people and relatives involved in reviewing support plans and raising concerns?
This was an unannounced scheduled inspection covering all five CQC questions and the overall rating; the previous inspection had also rated the home Good. This explanation was written from the published report of 13 July 2019 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 St James House
4 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- September 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2015Requires improvementSafe: Requires improvementEffective: InadequateCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2014
Registered with the Care Quality Commission on 22 December 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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
39 live-in carers within about an hour of Kent
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 33 can care for a couple. 12 years' experience on average.
“Always on time and with a lovely smile for my mum. Theresa is kind and sensitive to my mum's needs.”
“Irene was a very kind and empathetic carer who knew just the right words to say to put a smile on my face.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.