Archived: St Andrews Lodge

Updated 30 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 21 February 2017 and was announced. The provider was given 24 hours’ notice because the location is small and we needed to be sure that the registered manager and other staff were available to speak to us on the day of the inspection. The inspection team consisted of two inspectors.

Before the inspection we reviewed information we held about the service including previous inspection reports, any notifications, (a notification is information about important events which the service is required to send to us by law) and any complaints that we had received. This enabled us to ensure we were addressing relevant areas at the inspection. A Provider Information Return PIR asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. We did not ask the provider to submit a (PIR) prior to this inspection because the inspection was undertaken at short notice.

We spoke to four people who use the service. We interviewed the registered manager. We looked at a range of documents including policies and procedures, care records for five people and other documents such as, incident and accident records, medication records and quality assurance information. We reviewed staff information including recruitment, supervision and training information as well as team meeting minutes.

The last inspection of 25 October 2016 identified three continued breaches and one new breach of the regulations. We issued four warning notices requiring the provider to become compliant with the regulations by 31 January 2017. At this inspection we checked what progress had been made.

Updated 30 September 2017

We inspected St Andrews Lodge on 21 February 2017. St Andrews Lodge is a small care home without nursing, for up to seven people with mental health needs. At the time of the inspection there were five people living at the home. People required support to manage their mental health and other medical needs. The building was a large detached house arranged over two floors, with a large garden at the back of the property. The home is situated in a residential area of Burgess Hill and local shops and services are within walking distance.

The home had a registered manager who was also one of the registered providers. 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.

At the last inspection in October 2016 we identified continued breaches of the regulations in three areas and one new breach of regulations. We took enforcement action against the provider. We issued four warning notices in relation to good governance, the safe care and treatment of service users, standards of hygiene at the premises and staffing. We undertook a comprehensive inspection on 21 February 2017 to check whether the required actions had been taken to address the breaches we previously identified. This report covers our findings in relation to these requirements.

The overall rating for St Andrews Lodge is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the providers’ registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The registered manager had failed to make and sustain all the improvements needed to address the requirements detailed in the warning notices. Whilst some improvements had been made, there remained continued breaches of the regulations.

Risks to people were not consistently identified and managed to protect people. Staff did not always have clear guidance in how to support people and measures to reduce risks were not always effective. Environmental risks were not consistently assessed and managed. This was identified as a continued breach.

Standards of hygiene had improved and the registered manager had implemented systems to ensure that regular infection control procedures were maintained in most areas of the home. However some areas remained in poor decorative state and hygiene remained an issue in these areas of the home. This was identified as a continued breach.

The registered manager was aware of areas requiring improvement identified at the previous inspection, and that they were required to comply with the regulations by 31 January 2017. However they had not addressed all aspects of the warning notices and therefore breaches of the regulations remained. The continued failure to improve through a lack of effective systems and poor planning demonstrates inadequate management and leadership.

There continued to be a lack of effective systems in place to manage risks, for example a fire risk assessment had not been completed for the home. Policies and procedures had not been updated, this meant that staff did not have the guidance they needed to provide a safe and effective service. Records were not always up to date, complete and accurate. The registered manager had made some improvements and introduced systems and processes to improve standards of care and to provide better oversight. However not all systems were imbedded and improvements were not yet sustained. The continued failure to improve standards means that there remained a breach.

People’s care plans were not well personalised, for example there was little detail about individual’s personal history, their preferences, views, interests and aspirations. This meant that the care plans lacked a sense of the person and were task focussed. Staff had little information to guide them in providing care that was personalised or responsive to the needs of the person. We identified this as a breach.

Failure to maintain adequate standards of hygiene and maintenance in some areas of the home had a negative impact on the dignity of people. There was a significant impact for one person whose needs were not always effectively supported. This was identified as an area of practice that needed to improve.

Staff had received some training and support and people told us they were confident that staff had the skills to support them. One person said, “I’m sure the staff know what they are doing.” However people’s needs were not met consistently because staff did not always have the training and support they needed . This was identified as an area of practice that needed to improve.

People told us they felt safe living at St Andrew’s Lodge, one person said, “I think I am much safer here then living on my own.” People’s medicines were managed safely by staff who had been trained and assessed as competent. Staff understood their responsibilities with regard to protecting people from abuse and knew how to report concerns. There was a safe recruitment process in place to ensure that staff were suitable to work with people.

People told us they enjoyed the food at St Andrews Lodge and that they had enough to eat and drink. One person enjoyed cooking and usually made the main meal for people. One person told us “I like the food its very, very good.”

People were supported to access the health care services they needed and they told us they were supported to make and attend appointments. Staff were working within the principles of the Mental Capacity Act 2005 (MCA) and understood the importance of seeking consent from people before providing support.

People spoke highly of the staff, one person said “The staff are always kind,” another told us, “I can’t think of anything that they could do better.” They told us that staff knew them well and understood their needs. People were supported to retain their independence. One person told us about trips to the local swimming pool, they said, “I think I have grown in confidence and I could go on my own now if I wanted too.” People were encouraged to express their views. One person told us that they had all been consulted about the colour scheme for recent refurbishment in some areas of the home.

People were supported to follow their interests and they told us they enjoyed the activities that were provided at the home. People knew how to complain and said they would feel comfortable to do so. People spoke highly of the staff, one person said of the registered manager, “They are very, very nice and kind. They know me very well. I get all the help I need.” Some management systems were in place to support planning and people were asked for their views on the service and planned developments.

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