St Andrews House is registered to provide accommodation and personal care for up to 24 older people who may be living with dementia. During the inspection 23 people were living at the home eight of whom were living with dementia. The home only admits people who are in the early stages of dementia. However, they would continue to care for people who developed higher dementia care needs, so long as their needs could be appropriately met. The home does not provide nursing care. This is provided by the community nursing team.
This unannounced inspection took place on 7 and 8 July 2015. The service was last inspected on 23 December 2013 when we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that people’s records did not contain up to date and accurate information. We found that some improvements had been made, but that one person’s care plan did not contain important health information. The registered manager ensured the care plan was amended to contain the information before the inspection was finished.
A registered manager was employed by 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.
The registered manager is due to retire in eighteen months and the assistant manager has been appointed to shadow them and to take over gradually during that time. In addition to the registered manager and assistant manager there was a team of senior carers who were able to offer on-going advice and support to other staff. Staff told us they felt well supported to do a good job and could seek help and advice from the registered manager at any time. People, their relatives and staff told us they felt the home was well managed. One member of staff told us they thought the registered manager was the best they had ever worked for.
There were audits and checks in place to monitor safety and quality of care. For example, medicines were audited monthly, and all accidents and incidents which occurred were recorded and analysed. Risk assessments contained good details on how risks were managed. Moving and transferring and pressure area assessments were in place and had been updated when risks had changed. Pressure relieving equipment was used when needed and no-one at the home had a pressure area concern. Risks presented by the environment were minimised. For example, radiators were covered, except where people requested they were not, temperature restrictors were fitted to taps and windows were restricted in their opening.
Medicines were stored safely and records were kept for medicines received and disposed of. People received their medicines safely and on time. There were clear instructions for staff regarding administration of medicines where there were particular prescribing instructions. For example, one person needed medicines administered at specific times and there was a clear note on their records when this should be given.
People told us they felt safe and said staff met their needs well, day and night. Relatives said they felt the home was very safe and said they had never seen any untoward behaviour by staff. People were protected by robust staff recruitment procedures to ensure the risks of employing unsuitable staff were minimised. People were protected from the risks of abuse as staff knew how to recognise and report any suspicion of abuse.
People’s needs were met in a timely manner as there were sufficient staff on duty. During the inspection requests for assistance were responded to promptly and call bells did not ring for a long time.
The registered manager provided staff with a variety of training including The Mental Capacity Act 2005 (MCA), dementia care and safeguarding adults. Staff received training in moving and handling and first aid from specialist outside training providers. People were happy with the skills of the staff. One person told us “two staff help me get into bed from my wheelchair, they use a board”.
Staff had a clear understanding of the Mental Capacity Act 2005 (the MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Throughout our inspection people were asked for their consent before staff provided personal care. Staff also offered choices about where the person wanted to sit and what they wanted to eat or drink. Staff also had an understanding of The Deprivation of Liberty Safeguards (DoLS) and that they could not restrain people without proper authorisation. No –one was being restrained at the time of the inspection.
Staff received supervision and an annual appraisal from the registered manager. The registered manager told us they used the sessions to ensure staff felt supported and as a check on their competence.
People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. There was appropriate friendly banter between staff and people living at the home. People told us “They’re (staff) very obliging… nothing’s too much bother” People received individualised personal care and support delivered in the way they wished and as identified in their care plans. Staff were able to tell us about people’s needs and how they ensured they were met. For example, staff told us about one person whose needs varied day to day. They told us that there were days when the person was very sleepy and liked to stay in bed and other days when they liked to chat and read the paper.
An activities coordinator works all day five days a week. Everyone spoke very highly of their attention to providing for their individual needs. There was an activities schedule displayed and people also had individual time with the activities coordinator. During the inspection a member of staff was playing board games with one person. People had access to a computer in the garden room for Skype-ing or emailing to keep in touch with relatives and friends. Recent activities had included crisp tasting and quizzes.
Regular meetings were held for people to express their views. One person told us that not much gets done at the meetings as people don’t speak up. We saw minutes of meetings where people had been asked for suggestion of where to go in the new car. People had suggested the cinema and shopping, and people had been taken out shopping.
At lunch time there was a choice of home-cooked food People were particularly complimentary about the food and one person told us “The food is wonderful…beyond belief”.
People were supported to maintain good health and had access to healthcare services where required. Records showed people had seen their GPs and health and social care professionals as needed. We received positive feedback from visiting professionals about the care being provided. One GP told us they had always thought the service was a “wonderful little residential home” and that all the people all seemed very happy. They said they thought the staff were skilled at meeting people’s needs.
The registered provider was keen to develop the service. There was limited lounge space available. People preferred to remain in the main lounge which doubled as a dining room. The registered manager and the registered provider had identified this as a problem and in their business plan for 2016 there were plans to extend the property to provide more living space.