St Johns Wood Care Centre is a nursing home which provides nursing and/or personal care for up to 100 people and at the time of this inspection there were 73 people' using the service. This is predominantly older people but there is a specific unit within the home providing a physical disability service for up to fifteen people. Fourteen were using that part of the service at the time of this inspection. Each person has their own bedroom and there are communal lounges and dining areas on each of the five floors of the home.

This inspection took place on 25 and 26 July 2018 and was unannounced. This is the first inspection of the home since the provider, MMCG (2) Limited, took over as the provider of the service in July 2017. We found that the provider had implemented oversight systems for monitoring of the performance of the service. These processes had not, until recently, picked up on all changes and improvements that needed to be made. These matters were being addressed but progress had been slow to begin with but was now gathering pace.

A registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk assessments associated with people’s day to day, and personal, risks varied widely in terms of how they were completed and the information about how staff could implement measures to reduce the risks. Information was in some cases incomplete. No harm was reported to have resulted from this. However, this along with other general health and safety risk assessment inconsistencies, posed a potential risk of harm being caused if the necessary information and required risk reduction measures were not made clear for everyone.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make some decisions for themselves were protected. The service was making applications to have DoLs assessed, and re-assessed where DoLS approvals were approaching their expiry date. There was a lack of documentary evidence of how this was being followed up. However, we saw that the local authority that mostly places people at the service met with the registered manager recently to discuss what was needed from the local authority to resolve the outstanding applications. Mental capacity was assessed, however, this was not always completed fully in some cases as not all of the required documentation about who was consulted or what had been agreed had been completed.

The care plans we looked at were based on people’s personal needs and wishes and in some cases were good, but not so in other cases. Not all information that was known was recorded clearly to ensure consistency of approach by all staff. People’s personal, cultural, religious and lifestyle preferences were not given sufficient attention in care planning.

There was an organisational policy and procedure for protection of adults from abuse. The service also had the contact details of the London Borough of Camden which is the authority in which the service is located and other authorities who also placed people at the service. Staff said that they had training about protecting people from abuse and this training had been updated, which we verified on training records. We found there were a suitable number of staff on each floor during our visits. Staff were regularly present in communal areas to identify and respond to immediate assistance that people required.

People were supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home twice each week, but would also attend if need