St Andrews Care Home

We found the following examples of good practice.

People were living in a clean and hygienic environment. The registered manager ensured regular cleaning of high touch points areas and the environment was well ventilated.

Visitors at the home had been tested and it was required for them to wear appropriate Personal Protective Equipment (PPE) when entering the home.

The environment was purpose built, spacious with enough sitting areas to ensure people could socially distance when they were spending time outside their bedroom.

An isolation area was created in the home for people who tested positive for Covid-19 and people living with Dementia who may not understand the need to self-isolate. This ensured that in case of an outbreak this could be contained better and reduced the risk of spread across the home.

There were enough staff allocated to work in the same units as far as possible and regular testing in line with current guidance meant if staff had to move to another area, they could do this following a negative rapid test. People and staff in the home were fully vaccinated.

Staff wore their PPE according to current guidance and they were trained in safely putting on, taking off and dispose of these safely.

St Andrews Care Home is a residential care home providing personal and nursing care to 33 people at the time of the inspection. The service can support up to 70 people.

People’s experience of using this service and what we found

People felt safe with the care they received, and staff were knowledgeable about when to report concerns to safeguard people. Risk assessments highlighted people's individual needs, and professionals were referred to when staff needed input for people. Where things went wrong, this was shared with staff and lessons were learnt and changes implemented.

Medicines were given to people when they needed them, where discrepancies were identified these were actioned appropriately.

Infection prevention control measures were in place and staff were wearing appropriate personal protective equipment (PPE).

People felt they were able to express how they wanted to be supported and staff were skilled and knowledgeable about their role. Staff and relatives felt there had been an increase in the use of agency staff over the last year due to COVID-19. However, this had been resolved in the recent weeks. The provider ensured that staff went through a recruitment process and all relevant employment checks were completed.

People were supported with their dietary needs and this was closely monitored by the management. People were supported to make decisions about their preference for end of life care. Care plans reflected peoples wishes and how they would like to be supported and what was important to them at this time.

People and relatives felt staff were kind and people were happy living at St Andrews Care Home. One person said, “I have been well looked after, they are friendly and have a joke with me. When I first came it was like one big happy family.” People had the opportunity to shape the support they received through resident meetings and giving feedback. We observed people being treated with dignity and respect.

There were enough staff to support people at the time of the inspection. The service has recently undergone a change in management, the overall feedback was positive.

The registered manager had systems in place to manage complaints. People and relative said they felt listened to when they raise any concerns.

The registered manager had implemented a lot of changes since the last inspection which had been acknowledged by the staff team. Systems had started to be used in a robust way and there were clear outcomes from the quality assurance systems in place. However, at the time of the inspection the home was working on 50% occupancy. The registered manager understood the need to ensure the quality of care continued as they start to increase the occupancy of the service, and to ensure the systems and culture of the service is sustained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 22 February 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 22 February 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Andrews Care Home is a purpose-built residential care home providing personal care to 57 people at the time of the inspection. The service can support up to 70 people.

People’s experience of using this service and what we found

People were exposed to the risk of harm due to a lack of robust risk management by the management of the service. People’s care plans and risk assessments were not up to date and lacked guidance for staff. Where care plans identified action was to be taken by staff to minimise the risk of harm to people, these were not always completed.

People had experienced unexplained injuries and bruising, these were not consistently investigated. Potential safeguarding concerns had not been referred to the local authority.

Incidents and accidents reported by staff were not reviewed or analysed by management or the provider. There was a lack of assurance that lessons were learnt, and action taken to minimise the risk of these types of events happening again.

We were not assured the provider was doing all that was needed to ensure COVID-19 outbreaks would be prevented at St Andrews Care Home. The service was not consistently following Government guidance, about how to operate safely during the COVID-19 pandemic, in areas such as the wearing of personal protective equipment (PPE) and actions required when people were isolating.

The provider had failed to act to rectify shortfalls found at previous inspections. This is the third consecutive inspection where the service has been rated requires improvement, and is now inadequate, in the Well Led domain with a breach of the regulations.

Management had failed to use the care planning, risk assessment and monitoring systems in place effectively to ensure that people were safe. Action had not been taken where identified by the care planning alert system. Concerns relating to the health, safety and well-being of people were not responded to in a timely manner.

The provider had failed to ensure the service was consistently well-managed with effective oversight and governance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 8 February 2020) and there was a breach in regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to wound management, pressure care, incidents and management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Andrews Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the assessment of risks to people’s health and well-being, safeguarding people from harm and management oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St Andrews Care Home is a purpose-built residential care home providing personal care to 56 people at the time of the inspection. The service can support up to 70 people. The home has four units.

People’s experience of using this service and what we found

People told us the care they received met their needs. Most staff were kind, friendly and attentive to people’s needs. However, we did find that this was not consistent across all units. On one unit we found some staff were more task led in some cases and not putting the person first. People told us there were not enough staff to meet their needs. Staff felt there was enough of them to meet people’s needs. People had their needs met in a timely manner in most cases on the day of inspection. Staff were trained and felt supported.

People felt safe and staff were aware of how to promote people’s safety in many cases. Regular checks were in place to ensure staff worked in accordance with training and health and safety guidance adhered to. However, we saw that staff did not all work in accordance with their training. Medicines were managed safely.

There were governance systems in place and these were used effectively in most cases. However, we did identify some issues that had not been found through the quality assurance systems and incidences where staff were not working in a way which was expected. We were not confident that these issues would have been identified had an inspection not been carried out.

The environment was going through a refurbishment plan. The areas completed looked welcoming and homely. There was plenty of communal space for people to enjoy. People who were participating enjoyed the activities that were provided, however due to the ongoing recruitment of an activity’s organiser, we were told that people in their rooms did not receive much in the way of stimulation.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People gave mixed views about if they were involved in the planning of their care. This meant that care may not have been delivered in a person-centred way. However, staff knew people’s needs and preferences when asked. People had end of life care plans in place. Complaints were responded to appropriately. Feedback was sought through meetings and surveys. There were mixed views about the effectiveness of the meetings for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 08 January 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made. However, there continued to be a breach of regulation 17 and the overall rating has remained the same.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Andrews Care Home provides care and support to up to 70 people some of who live with dementia. At the time of our inspection there were 58 people being supported by the service.

At our last inspection on 24 February 2016 we rated the service good. At this unannounced inspection on 03, 11, 17 and 19 October 2018 we found evidence from our inspection that demonstrated risks to people’s safety and wellbeing. This was in relation to keeping people safe from harm, managing people’s medicines safely and monitoring the quality of care provided. The overall rating of the service has changed since our last inspection to ‘Requires Improvement.’

The service had a registered manager in post. 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.

People felt safe at the service. Staff had received relevant training on how to safeguard people but not all staff understood their responsibilities to report concerns. Medicines were stored appropriately but people on one unit did not receive these as the prescriber intended. Lessons from previous incidents were not consistently reviewed to improve the quality of care.

Risks to people’s safety and well-being were identified and managed to keep them safe from harm. Assessments were in place that gave guidance to staff on how individual risks to people could be reduced. Relevant pre-employment checks had been completed for all staff and safe recruitment practices followed. People were supported by sufficient numbers of staff. People lived in a clean and well-maintained environment.

Staff had attended relevant training to their role and spoke positively about the training they were provided, however training had not always been effectively delivered. Staff felt supported, although not all staff had regular supervisions and appraisals.

People’s consent was obtained, and staff were aware of how to support those people who may not be able to provide their consent. However, these decisions were not all documented as required. This was an area under review by the registered manager. People’s nutritional needs were met and the deputy manager was reviewing how people were provided with additional nutritional snacks.

People told us that staff were friendly and respected and promoted their privacy and dignity. Staff knew people well and were knowledgeable about people’s individual needs. People felt staff knew what was important to them and how people chose to spend their day.

People’s individual needs were assessed and people or where appropriate, their relatives were involved in the planning of how their support would be delivered. Care and support plans were regularly reviewed to ensure that they met people's current needs. However, people’s care records were not always updated to reflect their preferences or choices.

People were encouraged to provide feedback on the service they received and knew how to make a complaint. Quality assurance systems were in place, but not always effectively managed such as audits of medicines and peoples records. Audits carried out by the registered manager and provider did not identify some of the areas for improvement found at this inspection. People’s views and opinions were sought about the running of the home and care provided. Staff were encouraged to attend and take part in team meetings which were held regularly. Notifications of significant events were made when the registered manager was made aware of the incident by staff.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 24 February 2016 and was unannounced. The inspection team consisted of three inspectors due to the size of the home. The service is registered for 70 people and on the day of our inspection there were 67 people living at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People and their relatives told us that their family members were well cared for and they were happy with the standards of care and support their relatives received. There were no odours in the home and people looked well groomed. Bedrooms were personalised and it was obvious people could have their personal items around them and had a choice of where to spend their time and what activities or hobbies they wished to participate in.

People told us they felt safe living at St Andrews. Staff had received training in how to safeguard people from potential abuse and knew how to report concerns. Safe and effective recruitment practices were in place and this helped to ensure that staff were suitable to work in a care home environment. In most cases there were sufficient numbers of staff available to meet people’s agreed care needs when required. However on the day of our inspection we observed that on one unit in particular the staffing levels were not adequate to meet people’s needs in a timely way.

Staff were trained to assist people with taking their medicines regularly and safely. Potential risks to people’s health and well-being were assessed and where risks had been identified, remedial actions to reduce risks were put in place and these were reviewed regularly to help keep people safe.

People and their relatives and healthcare professionals were very positive about the standards of care in the home. They were complimentary about the staff and their experience, skills and abilities to support people appropriately. Staff were well supported and received training relevant to their roles and responsibilities. They had regular supervision with their line manager to discuss and review their performance and any development needs.

People had developed positive and caring relationships with the staff who supported them. Care and support was provided in a way that took account of their individual needs and preferences and the management team and staff knew people very well.

Staff were observed to obtain people’s consent before providing care and support to them. People, and where possible, their relatives were involved in the planning, delivery and review of the care and support provided. Information held about people’s medical and personal histories was securely maintained throughout the service and was only accessed by people who had a right to access it and where the people concerned had consented to the sharing of their personal information.

People told us that their support was provided in a way that promoted their dignity and respected and maintained their privacy. People were supported to take part in activities that interested them, both at home and in the local community. People felt that staff listened to them and responded to any concerns they had in a positive way. They knew how to complain if they needed to, however none of the people we spoke to during our inspection had ever had to make a complaint.

People and their relatives were positive and complimentary about the way the service operated including the management team and staff approach. There were effective arrangements in place to monitor risks and the quality of services provided. Systems and processes were used in a way that encouraged continual improvements to the quality of the service.

Is the service caring?

We spoke with eleven people who used the service and they all told us that the staff were caring and that they were well looked after. We heard staff speaking with people in a kind and gentle manner and we saw that they made good eye contact with the person and we saw that staff offered comfort to people who were upset.

A regular visitor to the home told us that the people who used the service were, 'Treated very well.' They also said that, 'The care here is better and the staff are lovely."

A person who used the service said, "It's very good here, we get very spoiled and they are very helpful."

Is the service responsive?

A health professional who worked closely with the staff told us that they felt the care provided was appropriate to meet people's needs. They said that the communication with staff was clear and that they were responsive to instruction.

The activity provision at St Andrews has been designed to meet individual's needs and preferences. People told us that their call bells were answered promptly and that the staff will get to them what needed.

Is the service safe?

People told us that they felt safe at all times. We found that medicines were stored safely for the protection of people who used the service and that people were receiving their medicines as prescribed by their doctor.

We found that regular audits of records were undertaken to ensure that care plans and risk assessments were up to date. Staff training and development needs were reviewed frequently so that people were cared for by appropriately skilled and experienced staff.

We noted that there were detailed risk assessments in place including fire safety, infection control and first aid in order to minimise the risk of injury to people using the service and staff.

Is the service effective?

We saw that, where people did not have the capacity to make their own decisions, family members and advocates had been involved and appropriate referrals had been made to safeguard the person. We found that the provider had systems in place to ensure people's consent was obtained before care or support was provided, and the provider acted in accordance with people's wishes. When the home was no longer able to meet the person's needs the appropriate professional health and social care staff were involved to ensure the person's welfare.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare.

Is the service well led?

A relative told us that the manager was always responsive to any concerns they raised.

We saw evidence to confirm that a provider's representative visited the service monthly and completed a report of their audit. The manager told us the report was made available to them immediately so actions could be carried out promptly.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service their relatives, the staff who supported them and from looking at records.

We found that the home was not meeting the outcomes we inspected.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We found that some of the staff we observed delivering care were kind and caring. We saw from our observations that while some staff delivered care in a person centred manner others did not. By person centred we mean that staff focused on the person rather than on the task they needed to complete. We saw that there was a lack of respect for the privacy and dignity of the person. We saw that some of the staff looked to their own needs without exploring the effects of this on the people.

Is the service responsive?

We saw that people's needs to be comforted and stimulated were not met. People were left unattended at lunch time. We saw throughout the day that staff assisted people in a manner that did not promote their personhood and dignity. We saw a senior staff member assist a person with their mobility by leading them by the hand in a childlike manner. The staff member set the pace, making the person move faster than they appeared comfortable with.

Staff consistently told us that they did not have time to spend with people other than to meet their immediate needs.

Is the service safe?

We were told that the systems in place to ensure the welfare of the people were not always followed by staff. This meant that the manager of the home was unaware of the risks that this may have been posed to some of the people.

Is the service effective?

We saw from our observations on the Windsor Unit that the home did not have effective processes in place to ensure the welfare of the people. On the day of our inspection we noted that people's lunchtime medicines were not administered until late afternoon.

Is the service well led?

We identified that the home had not met required standards on the care and welfare of people at our inspection in August 2013. The provider sent us an action plan as to how these requirements would be met in November 2013. This stated that the requirements would be met by November 2013. We inspected again on 29 January 2014 to see if the improvements had been made. We identified that the standards for the care and welfare of the people, meeting nutritional needs and the administration of medicines had not been met.

The area of the home this inspection was mainly focused on had one member of the management team based there. We saw that although they were there throughout the inspection they had no impact on the quality of care provided to the people.

During our inspection we identified areas of concern that were very apparent. The staff on duty and the management staff on the floor had not identified or acted on these areas of concern.

We found that the service had made improvements in relation to the cleanliness of the environment. We reviewed their management of medicines and although improvements had been made in regards to the issues found at our previous visit, there were other issues regarding obtaining of appropriate quantities of medicines.

The inspection identified that the service still needed to make improvements regarding the recording and monitoring of people's weight.

For the dementia themed inspection we pathway tracked five people's care, spoke with people, their relatives and staff. We also provided comment boxes to help obtain people's views. We found that staff had been given sufficient training to understand the experiences of people living with dementia, but the person centred approach was not always practised. Staff told us this was due to there not being time to provide it.

We saw from records that people had appropriate access to other professionals, including health and social care support. The service was proactive in assessing a persons' health and contacting the relevant medical professional.

Although the service had systems in place to assess and monitor the quality of the care provided to people living with dementia, we found that these were not well managed or effective.

We looked at the care records of 10 people who lived at the home. We noted that people had not always received the care that they had been identified as needing. We also noted that detailed assessments of the possible risks to people had not always been completed or fully updated.

We saw that in each care record there was a partially completed form that would be completed and passed to another service in the event of the person being transferred. This document detailed the personal information required by the receiving service.

On the day of our inspection the home looked clean and bright. However, on one unit there was a very unpleasant odour and we found other areas where the required standard of cleanliness was not met.

We found discrepancies between the medication held and the record of the medication administered for one person and that medication had been stored for periods at temperatures in excess of the maximum recommended.

We saw that there was an effective system to regularly assess and monitor the quality of service that people received.