This inspection took place on 06 and 07 October 2014 and was unannounced.
Our last inspection at St James Court took place on 17 and 24 June 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.
St James Court is a care home which is registered to provide accommodation and nursing care for up to 58 people, some of whom may be living with dementia. The home is purpose built over two floors. The ground floor comprises of a 20 bed unit providing support to older people and an eight bed unit providing support to older people living with dementia. The first floor consists of a 30 bed unit providing support to older people who need nursing care. At the time of this inspection 45 people in total were living at St James Court.
The registered manager had not been working for a few weeks prior to this inspection and resigned from her post the day before this inspection took place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. We found that arrangements had been made to cover the registered manager’s absence. The deputy manager was acting as manager with support from a registered manager from another home within the same company and the regional manager of the home. The regional manager confirmed that arrangements were in place to recruit a new registered manager.
We found that the procedures for the administration of medication were not safe and the requirements for this regulation were not being met. Whilst written procedures were in place for the safe administration of medicines, we saw that these were not always adhered to. Two people had been left with their medicines and staff did not observe administration. This posed a risk to people’s health and safety.
Whilst levels of staff, in line with the assessed needs of people, had been maintained, there were differing opinions amongst people as to whether there were enough staff to meet their needs. People living at the home spoken with said that they felt safe. Staff had been provided with training in safeguarding people so that they knew how to identify and report abuse. Risk assessments had been undertaken to identify and minimise risks so that people were protected.
The provider was not meeting the requirements of the regulation to ensure that staff were provided with appraisal and adequate levels of supervision for development and support. This meant their performance was not formally monitored and areas for improvement may not be identified.
Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.
People had access to a range of health care professionals to maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so that health was promoted and choices could be respected.
All of the people spoken with and their relatives said that they were well cared for by staff that knew them well. People living at the home, and their relatives said that they could speak with staff if they had any worries or concerns and they would be listened to.
Whilst a programme of activities was provided, some people told us that trips out of the home did not take place on a regular basis. We feedback to the deputy manager that consideration should be given to providing further trips out of the home for people that would choose this.
The environment for people living with dementia had not been adapted or provided with equipment designed to stimulate and support people. This meant the environment did not fully promote or support people’s quality of life. We recommend that consideration should be given to adapting this environment in line with current good practice so that people are supported.
Whilst regular meetings were held for senior staff and management at the home to share information, we found that full staff meetings had not taken place on a regular basis. In addition, we found that regular meetings with people living at the service and/or their relatives or representative had not taken place. Relatives meetings had taken place in January and July 2014. This meant people and/or their relatives or representatives did not have sufficient opportunities to be kept informed about information relevant to them.
The provider had ensured there were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. Whilst people and their relatives had been asked their opinion via surveys, the results of these had not been audited to identify any areas for improvement.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report