CQC report explained · a residential care home
What the CQC found at St John's House
Rated Outstanding: inspectors found the home performing exceptionally well.
- Safe?
- Good
- Inspectors found effective safeguarding, risk management, staffing checks, medicines systems and infection control. Staff sometimes faced unexpected absences, and call bell response times varied, but observations showed people's needs were responded to promptly.
- Effective?
- Good
- People's needs were assessed broadly and care was supported by trained staff, suitable food and access to health professionals. Some mandatory staff training was outstanding at the time of inspection, with action taken to improve this.
- Caring?
- Good
- People said staff were kind, respectful and patient. Inspectors saw staff protect privacy, involve people in decisions and encourage independence.
- Responsive?
- Outstanding
- Care was highly individualised and adapted to people's histories, preferences, communication needs and wellbeing. End of life care and support for relationships, activities and community involvement were particular strengths.
- Well-led?
- Outstanding
- Inspectors found an open, inclusive culture and strong involvement of people, relatives and staff. Quality checks were meaningful, actions were followed through and the home worked with research and community partners to improve care.
What inspectors found, May 2023
Rated Outstanding; inspectors found exceptionally personalised care and strong leadership, with some mandatory staff training still outstanding.
This was an unannounced inspection. Inspectors visited the home, spoke with people, relatives, staff and professionals, observed care, and reviewed care records, medicines records, recruitment checks, audits and maintenance records.
The home was rated Outstanding overall. Safe, Effective and Caring were rated Good. Responsive and Well-led were rated Outstanding. Inspectors found people were safe, treated with kindness, involved in decisions and supported to live in ways that mattered to them.
The report highlights especially personalised support, thoughtful end of life care, a wide range of activities and strong links with local organisations. Inspectors also found a strong system for checking quality and learning from incidents.
The previous overall rating was Good, published in December 2017. Responsive improved from Good to Outstanding, and Well-led improved from Requires Improvement to Outstanding. The other three ratings stayed Good.
Personalised care
Staff took time to understand people's histories, values, interests and beliefs. Care plans were designed around individual needs and could support people through difficult periods.
“The service used individualised and especially innovative methods of care and support to not only ensure people's needs were met but that their wellbeing and quality of life was enhanced.” from the report
End of life support
Inspectors found end of life care was planned sensitively and reflected people's wishes. Families were also supported during this time.
“People received exceptional end of life care that had been sensitively planned with them and those important to them.” from the report
Kind and respectful care
People and relatives described staff as kind, patient and attentive. Inspectors saw staff maintain privacy and dignity during personal care.
“Throughout our inspection, we observed staff maintaining people's dignity, providing care with discretion, and encouraging independence.” from the report
Strong leadership
The home had clear accountability, regular quality checks and an open approach to learning from incidents. People, relatives and staff said they felt listened to.
“A robust and well-embedded governance and quality assurance system was in place that had been effective at ensuring people consistently received a high-quality, personalised service.” from the report
Activities and community links
The home offered varied activities and had built links with cinemas, theatres, charities and other local organisations. These activities were intended to support people's physical, social, spiritual and intellectual wellbeing.
“The home had a varied and wide-reaching activities programme that people spoke positively about.” from the report
Mandatory training outstanding
needs fixingSome mandatory staff training had not been completed at the time of inspection. The provider gave inspectors assurances about action being taken, and inspectors said this had not negatively affected care.
“Whilst staff had some training outstanding which the provider deemed mandatory, people told us this did not negatively impact on the care they received.” from the report
Call bell response times varied
minorPeople said the time taken to answer call bells was not always the same. Inspectors found that this had not affected people negatively and observed staff responding promptly to needs.
“Whilst people who used the service told us the time it took staff to respond to their call bells varied, it did not impact negatively on them.” from the report
- 01Which mandatory staff training was outstanding during the inspection, and has it now been completed?
- 02How do you monitor call bell response times, especially when there are unexpected staff absences?
- 03How are my relative's life history, preferences, communication needs and dementia-related needs recorded and reviewed?
- 04How do you involve families in planning and reviewing end of life care?
- 05How do you use people's feedback to improve the food menu and activities programme?
This was an unannounced inspection covering all five CQC questions, with a site visit on 25 April 2023 and further inspection activity ending on 10 May 2023. This explanation was written from the published report of 27 May 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, December 2017
Rated Good overall; inspectors found kind, personalised care, but quality checks were not yet reliable.
The inspection was unannounced on 30 October 2017. Inspectors returned on 2 November to discuss their findings and gather more information. They spoke with people living in the home, relatives, staff and health professionals. They also observed care, meals, activities and medicines, and checked care records, staff files, rotas and audits.
The home was rated Good for safe, effective, caring and responsive care. Inspectors found enough staff, detailed risk assessments, suitable training, good support with food and health needs, and kind staff who respected people's privacy and choices.
The home was rated Requires Improvement for being well-led. Quality checks had not always identified or followed up problems. These included incomplete daily pulse records and a high level of medicine administration errors, although inspectors found no impact on people's safety. The home was newly registered, so this was its first comprehensive CQC inspection and there was no previous rating to compare.
Kind and respectful staff
People and relatives described staff as caring. Inspectors observed staff being gentle, attentive and respectful of privacy and dignity.
“People were treated with kindness and dignity by staff who took time to speak and listen to people.” from the report
Personalised care
Care plans contained detailed information about people's health, routines, preferences and communication needs. Staff knew people well and responded to changes.
“People received personalised care and support, which was responsive to their changing needs and met people's social, and leisure needs in an individualised way.” from the report
Good health and nutrition support
People had regular contact with health professionals and received support with food, drinks and dietary needs.
“People were supported to maintain good health and had access to a range of healthcare services and professionals.” from the report
Open management culture
Staff said the manager was visible and approachable. People, relatives and staff were given opportunities to provide feedback and suggest improvements.
“There was an honest and open culture within the staff team.” from the report
Quality checks did not always work
needs fixingAudits did not always identify problems or set clear timescales for completing improvements. This meant managers could not always be sure that care records were up to date.
“The monitoring of quality and safety of the service, were yet to be embedded and sustained.” from the report
Medicine administration errors
needs fixingMedication audits showed many administration errors each month. Inspectors found that the audit tool did not clearly show what action was being taken to stop these errors happening again.
“Medication audits indicated a high level of errors each month” from the report
A missing daily health record
needs fixingOne person needed daily pulse checks, but there were no recorded checks during October or on the inspection day. The manager introduced a new recording form after inspectors raised this.
“there was no evidence that any pulse recordings had been taken for the month of October” from the report
Call-bell arrangements
needs fixingSome people said call bells were not answered quickly. Inspectors found the urgent and routine call sounds were initially the same, but this was changed during the inspection and a new audit was introduced.
“On the first day of our visit we found that the emergency sound and the routine sound for assistance were the same.” from the report
- 01What changes have been made to quality audits, and how do you check that actions are completed by a clear date?
- 02How many medicine administration errors have occurred recently, and what is being done to reduce them?
- 03Can you show us recent call-bell response audits and explain how urgent calls are identified?
- 04Have all current care staff completed emergency first aid training?
- 05How do you make sure daily health checks, such as pulse recordings, are completed and reviewed?
This was the first comprehensive inspection, covering the home and care provided across all five CQC questions. This explanation was written from the published report of 30 December 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 St John's House
2 rated inspections over 5 years: the service has improved, from Good to Outstanding.
- May 2023Outstandingcurrent ratingup from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Outstanding
- December 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2016
Registered with the Care Quality Commission on 21 November 2016.
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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13 live-in carers within about an hour of Norfolk
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Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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