St Andrews Nursing Home

St Andrews Nursing Home is a nursing home providing accommodation for up to 45 older people and people living with a dementia. Although registered to provide nursing care the provider decided to suspend offering this type of care in November 2021. There were 27 people using the service when we visited.

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

People told us staff were caring and they felt safe. We observed staff deliver care and support in a kind and compassionate manner. It was clear staff understood people's needs and how to manage any presenting risks. Risk assessments were clear and readily identified how to mitigate these, staff were familiar with these documents and the actions they needed to take.

There were enough staff on duty and staff were recruited safely. The dependency calculation led to one member of staff, at times, would be present in the units. The providers were closely monitoring the situation and confirmed flexibility was available to increase staffing as needed.

The level of internet connectivity was patchy and deteriorated the further away from the centre of the home people and staff went. The provider had taken steps to address this but found a range of measures had not worked. They were in the process of looking at alternatives.

People were protected from abuse by staff who understood how to identify and report any concerns. Incident monitoring records were appropriately used to understand themes and reasons for the events. These were used to learn lessons and discussed across the team. Medicine management was effective. Staff adhered to COVID regulations and procedures.

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.

The systems the registered manager had in place allowed them to critically review the service and proactively looked at how improvements could be made. The registered manager and staff had worked diligently to ensure the new electronic record system was implemented effectively.

Staff told us that the registered manager was approachable and listened to their views. All felt the registered manager was running a good service. Staff were passionate about providing good care outcomes and took ownership for their practice. They had established good working relationships with all visiting professionals, and this had supported them to deliver effective care and support.

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

Rating at last inspection

The last rating for this service was good (published 10 May 2018).

We completed a targeted inspection in March 2021 to look specifically at infection control and were assured.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 report only covers our findings in relation to the Key Questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Andrews Nursing Home is a residential home providing accommodation with nursing and personal care mainly to older people and people living with a dementia. It can accommodate up to 45 people in one purpose-built building. There were 32 people using the service when we visited.

We found the following examples of good practice.

Systems were in place to allow safe visiting, including screening and testing visitors to reduce any potential infection risk, before they entered the building. The home had a purpose built visiting pod that included amplification to ensure people on either side of the screen could hear each other clearly.

Social distancing was encouraged, and changes had been made to communal areas to promote this.

There was a robust activities programme and people were engaged in a variety of solo and group activities. We saw people had been supported through the use of social media to keep in touch with relatives. On the day of our visit, we saw people in a "bubble" enjoying a game of dominoes.

Staff wore PPE correctly. Training in infection prevention and control measures and the appropriate use of PPE had taken place. The home had an infection control lead in place who liaised with other leads within the provider's national group to share learning and developments.

Systems were in place to admit people safely into the home and we saw risk assessments in place for testing and visiting as part of the provider's COVID-19 response.

A regular programme of COVID-19 testing was in place for people and the staff team.

Further information is in the detailed findings below.

St Andrew’s Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation for up to 45 people across two floors. At the time of our inspection there were 44 people using the service.

There was 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 lived in an environment where safety checks such as regular fire checks were carried out on a regular basis.

Staffing levels in the home were sufficient to meet people’s needs. We found staff were able to respond quickly if a person needed assistance.

People were supported as appropriate to receive their medicines safely from staff assessed as competent to do so. Arrangements were in place for the safe receipt, storage and disposal of medicines. We found some inconsistent practice in relation to topical medicines. These are creams applied to the skin. The registered manager agreed to improve consistency.

Since our last inspection no one using the service had experienced a serious accident or injury. Accidents and incidents were monitored each month and actions had been taken to prevent injuries occurring.

The service had appropriate systems in place to protect people from harm. Staff had received training in safeguarding and were able to tell us how they protected people and what actions they needed to take if they had any concerns about a person.

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

Food served in the home was appetising. Staff provided support and encouragement to people at meal times. We observed staff supporting people to eat and drink with patience and attentiveness. We found people enjoyed their mealtime experience.

Support was provided to staff to enable them to carry out their work in the home. This included induction, training supervision and appraisal.

Staff contacted other professionals and involved them in the service when people’s needs changed or when they had health issues which needed to be addressed. Advice from professionals was included in people’s care plans and passed between staff.

We saw staff knocking before entering people’s rooms, and closing bedroom and bathroom doors before delivering personal care. Staff protected people’s dignity and privacy.

Relatives spoke with us about the kind and caring nature of the staff. This was echoed by visiting professionals.

The registered manager and the staff listened to people who wished to speak up on behalf of themselves. They also listened to relatives as natural advocates for people using the service. An independent advocacy service was available to help people speak up.

Each person had care plans which were person centred and contained relevant guidance to staff to enable them to provide the right care for people. These were regularly reviewed and updated as necessary.

The service had strong links with key partners. Advice from other professionals had been incorporated into people’s care plans.

People were supported to participate in activities of their choice. The activities coordinator arranged for entertainers to visit the home and had also invited a resource to the home that could enable people to look through viewfinders and remember their past history.

Whilst the provider had a complaints process in place there had been no complaints since our last inspection. We observed the registered manager respond to issues raised by relatives. Relatives confirmed with us this was the case and they appreciated the prompt response from the registered manager.

People, their relatives and staff were complimentary about the registered manager. Relatives felt the registered manager was proactive in responding to them and staff felt well supported by them.

The provider and the registered manager had arrangements in place to monitor the quality of the service and make improvements where necessary. For example we saw they carried out regular audits to monitor the effectiveness of the service. Surveys were carried out to seek the views of people who used the service, their relatives and staff.

Records in the home were up to date and accurate.

St Andrews Nursing Home provides care and accommodation for up to 45 people with residential and nursing care needs. On the day of our inspection there were 43 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

St Andrews Nursing Home was last inspected by CQC on 29 July 2015 and was rated Good.

Accidents and incidents were appropriately recorded and analysed to identify any trends.

The registered provider had a safeguarding policy in place and the registered manager understood their responsibilities with regard to safeguarding. Staff had been trained in protecting vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at St Andrews Nursing Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care. However, one person who had been admitted to the home for end of life care did not have an end of life care plan in place.

Care records showed that people’s needs were assessed before they started using the service however some care records were incomplete and not regularly reviewed.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs and the service had links with the local community.

The registered provider had a complaints policy in place and people who used the service and family members were aware of how to make a complaint.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

The registered provider had a quality assurance process in place however care records were not regularly audited.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We asked the provider to send us a plan detailing how improvements would be made and we carried out our recent review to ensure standards had improved.

We did not speak with people who used the service during our visit regarding this outcome area but we did speak with nursing staff and senior managers to evaluate the improvements.

We found the service had made improvements and had systems in place for the safe handling and administration of medicines.

We arrived at the service at 11:45pm on Monday 9 December 2013 and left at 4:00am on Tuesday the 10 December 2013. We found during our visit staffing levels were not sufficient to meet people's needs. We asked the provider to take immediate action to ensure people's needs were met. The provider had been able to rectify staffing levels immediately which meant we have not taken any further action on this occasion, but we have informed the local safeguarding authority of our findings and we will continue to monitor the service.

We asked staff how they ensured they obtained consent from people. Comments included 'I ask what I can do first, how I can help', 'I look in care plans and liaise with relatives too, if someone doesn't want me there I leave and go back later' and 'I ask people what they would like.'

People were happy with the care provided. Comments included 'The staff are very good, they're well trained', 'They look after me well, they couldn't do better' and 'They're very professional, my (relative) has become a different person since they moved here.'

We checked medicines records and found some stock levels and records were inaccurate.

When we visited there were 31 people accommodated in the home. We when arrived during the afternoon, we looked at the number of staff supporting people at the home. We found there was one nurse and four care staff on duty. The manager showed us the staff rotas for the past two months and they showed similar staffing levels.

The provider had a clear policy on obtaining feedback from people using its services. This included information from sources such as residents and relatives meetings, complaints and survey questionnaires.

We looked closely at the condition of the home, how the provider maintained it and how unforeseen damage was dealt with. We found the building had been properly maintained and when unexpected damage occurred, immediate steps had been taken to ensure the safety of people who lived or worked there. We found the provider had also taken steps to ensure the safety of people who used the service by carrying out regular checks and making improvements based on their findings. We also saw people who used the service, their relatives and other professionals were welcomed to the home and their views were sought on the way the home was run. We found people's diversity was valued, respected and encouraged.