CQC report explained · a residential care home
What the CQC found at St John's Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Some environmental risks were not fully controlled, and written guidance for falls involving blood-thinning medicines was not clear enough. Medicines, staffing, recruitment, infection control and safeguarding systems were otherwise generally satisfactory.
- Effective?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward into the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward into the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward into the overall rating.
- Well-led?
- Good
- Managers had better oversight through audits, identified areas for improvement and took action. People, relatives and staff gave mainly positive feedback about the management and atmosphere.
What inspectors found, April 2023
St John's Home was rated Good overall, but inspectors found some safety risks and rated Safe as Requires Improvement.
Inspectors made an unannounced focused visit on 20 and 21 March 2023. They spoke with people, relatives, staff and healthcare professionals. They looked around the home and checked care records, medicines records, recruitment files, training records, incidents and quality checks.
The home had improved since the previous inspection. Risks relating to nutrition, hydration, skin checks and injuries were being recorded and reviewed more reliably. Staff were safely recruited, medicines were generally managed safely, and people told inspectors they felt safe.
Some safety problems remained. Wardrobes were not secured to walls, the laundry room door was not secured, and written guidance was missing for falls involving blood-thinning medicines. The registered manager acted on these issues after the inspection. There were also some inconsistencies in recording medicine bottle opening dates.
Safe was rated Requires Improvement and Well-led was rated Good. The overall rating became Good because the other key question ratings were carried forward from the previous inspection. The home was no longer in breach of regulations found at the earlier inspection.
Improved risk records
Records showed better monitoring of weight, skin condition, food and drink, injuries and incidents than at the previous inspection.
“At this inspection records demonstrated that injuries were recorded, and an appropriate body map completed.” from the report
Safe recruitment and staffing
Recruitment checks were completed before staff started, and inspectors found enough staff to meet people's needs during the visit.
“There were sufficient staff to meet people's needs. On the days of the inspection, we observed staff were visible and accessible to people.” from the report
Positive management
The management team used audits and staff feedback to monitor the home and make improvements.
“At this inspection systems were in place to provide oversight of the quality of the home.” from the report
Good partnership working
Staff worked with healthcare professionals and shared information about people's health and care needs.
“Staff worked closely with health care professionals, regularly sharing information relevant to people's health and social care needs.” from the report
Kind and positive atmosphere
People and relatives described the care, staff and atmosphere positively. Feedback included that staff were friendly and knew people's preferences.
“People and their relatives spoke positively about the warm atmosphere and care they received.” from the report
Environmental risks
needs fixingWardrobes were not secured to walls and the laundry room door was not secured. The manager addressed these issues after inspectors raised them.
“We identified wardrobes were not secured to the walls to prevent them from falling. We also found the laundry room door was not secured.” from the report
Falls and blood-thinning medicines
needs fixingStaff did not have enough written guidance about what to do if someone fell while taking blood-thinning medicine. Inspectors said this could increase the risk of harm, although staff knew the risks and the manager improved the guidance afterwards.
“Not having this guidance can risk staff not taking appropriate action as the person would be at higher risk of bleeding after their fall.” from the report
Medicine bottle records
minorOpening dates were not always recorded consistently on medicine bottles. Checks showed the medicines had not passed their expiry date.
“However, there were some inconsistencies with recording open dates on medicine bottles, checks confirmed these items had not passed their expiry date.” from the report
- 01What changes were made to secure the wardrobes and laundry room door after the inspection, and how are these now checked?
- 02What written procedure do staff now follow if someone falls while taking blood-thinning medicine?
- 03How do you check that medicine bottle opening dates are recorded correctly every time?
- 04How are monthly weights, daily skin checks, food and fluid records reviewed when someone is at risk?
- 05What areas from the previous inspection are still being monitored through audits or action plans?
This was an unannounced focused inspection of Safe and Well-led; the other key question ratings were carried forward from the previous inspection. This explanation was written from the published report of 13 April 2023 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, March 2021
Rated Requires Improvement; inspectors found gaps in risk management, records and oversight, although staffing and medicines support were satisfactory.
This was an unannounced focused inspection on 10 February 2021. It followed concerns about infection control, protective equipment and staffing. The inspection looked only at Safe and Well-led. The inspector could not speak to residents because of COVID-19, but spoke to relatives and staff and checked care, medicines, recruitment and management records.
The home had enough staff on the day, and medicines were administered and recorded appropriately. Staff knew residents well, and relatives said they were kept informed and knew how to complain.
However, records did not always show that people had enough food and drink, were repositioned, weighed or checked at night. Some risks and injuries were not properly recorded or followed up. Cleaning records were incomplete, and management audits did not identify or address all these problems.
The overall rating fell from Good at the previous inspection to Requires Improvement. The home breached regulations about safe care and treatment and good governance. CQC requested an action plan, will monitor progress and plans to inspect again.
Medicines
Medicines were administered safely, with appropriate records and reasons recorded when medicines were not given. Staff had suitable training.
“People were supported appropriately with their medicines. Staff received training on medicine administration.” from the report
Staffing
Inspectors found enough staff on the day of the visit, and rotas showed enough staff were scheduled.
“We found adequate staffing levels on the day of inspection, and rotas confirmed there were enough staff on shift.” from the report
Personalised information
Care plans contained useful information about residents, including their preferences, history and important relationships.
“Care plans included detailed information about people, their likes, dislikes, history and significant relationships.” from the report
Communication
Relatives said they were kept up to date, knew how to complain and felt staff knew their relative well.
“Relatives told us they were kept up to date with relevant information regarding their loved one.” from the report
Risk records and checks
seriousRecords did not always show that residents had enough food or drink, were repositioned on time, were weighed as planned or checked regularly at night. These gaps increased the risk of dehydration, malnutrition and pressure damage.
“The provider had failed to ensure all risks were assessed or managed and strategies to mitigate risks had been completed.” from the report
Management oversight
seriousSome audits had not been completed, and completed audits did not always set out or track the action needed. Systems did not reliably identify when care had not been delivered.
“The provider did not have sufficient systems in place to identify when support and care was not delivered.” from the report
Cleaning records
needs fixingInspectors were not assured that cleaning was being fully monitored. Records did not cover all equipment, weekends or high-touch areas.
“We found gaps within cleaning records, no evidence of equipment or weekend cleaning schedules and limited documentation of high touch areas being cleaned.” from the report
Recruitment checks
seriousSome staff files did not contain all required risk assessments or references. One staff member had started before a completed criminal record check was available.
“We found staff files that evidenced not all staff had adequate references and staff member had started work before a completed Disclosure and Barring Service [DBS] check was completed.” from the report
- 01What evidence can you show that food and fluid charts now record what was offered, taken and needed?
- 02How do you check that repositioning, night checks, weights and pressure mattress checks are completed on time?
- 03What has changed in the management audit system since the inspection, and how are actions checked until they are complete?
- 04How are cleaning schedules and high-touch cleaning now recorded, including at weekends?
- 05Have all staff recruitment files been brought up to date, including references, risk assessments and DBS checks?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were not inspected and were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 16 March 2021 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 John's Home
5 rated inspections over 8 years: the service has held its Good rating throughout.
- April 2023Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- December 2020Inspected but not ratedSafe: Inspected but not rated
- January 2020Goodstayed GoodSafe: GoodWell-led: Good
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2014
Registered with the Care Quality Commission on 2 April 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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