St Andrews Lodge

St Andrews Lodge is a residential care home providing regulated activity accommodation and personal care to up to 8 people. The service provides support to people who have a mental health condition or a learning disability. At the time of our inspection there were 8 people using the service, 3 out of 8 people were receiving the regulated activity personal care.

People’s experience of the service and what we found:

People we spoke with were satisfied with the service.

The service was not well led. The provider did not have adequate oversight of the service and lacked a recognition and understanding of risk. Governance systems were not robust or used effectively and were failing to consistently assess, check and improve quality and safety of the service, and care delivered.

There were risks associated with fire safety, health and safety and incidents triggered by people’s mental state. Incidents were not being investigated properly, and there was a lack of effective learning from incidents, complaints, and safeguarding incidents to reduce risks to people from reoccurring.

Right Support: People did not receive the right support to maximise their choice, control, and independence and staff did not support them in the least restrictive way possible, and in their best interests. This meant people did not lead fulfilling and meaningful everyday lives that promoted their wellbeing. Limited information was available about people's aspirations and goals and how staff could support them to achieve these. People did not receive an interactive and stimulating service that ensured they led inclusive and empowered lives.

Right Care: There were no clear management systems followed in practice to support staff learning and development. Gaps in staff training, supervision and competency checks did not ensure people were cared for by staff with the necessary skills, knowledge, and ability to deliver the right care and support, and protect them and others from harm.

Right Culture: The culture of the service did not empower people to lead their best life. Care delivered was not person centred and did not always promote people’s dignity, independence and safety.

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 29 March 2019.

At this inspection we found the provider remained in breach of regulations and the service is rated inadequate.

Why we inspected

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

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question 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 Lodge website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to management and governance and risk management, and a new breach in staffing support and training.

Please see the action we have told the provider to take at the end of this report.

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

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.

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.

People’s experience of using this service:

Systems were in place to monitor the quality of the service provision; however, these were not always effective in ensuring issues were identified or improvements were made and sustained.

Improvements were required to the service's governance arrangements to assess and monitor the quality of the service and ensure that action was taken as required.

Systems were not effective to check that people received their medicines as prescribed and where people received medicines ‘as and when required’ there was not always guidance in place for staff on when these medicines should be administered.

People, their relatives and staff were positive about the care provided at St Andrews Lodge.

Staff knew people well and had developed meaningful relationships with them. People were given choice and supported to develop daily living skills.

Staff were kind and caring and people were treated with dignity and respect.

People received effective care from staff who understood how to recognise and report issues of concern and potential abuse. Staff were recruited safely, were visible in the service and responded to people quickly.

There was a complaints system in place and people felt able to raise concerns which were addressed.

People could access the community and take part in a range of activities which promoted their wellbeing.

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.

People's health was well managed and there were positive links with other services to ensure that individual needs were met.

People, their relatives and staff were positive about the deputy manager and felt they were approachable.

Rating at last inspection: Good (report published 29 September 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

There were 6 people living in the service when we inspected on 5 July 2016. This was an unannounced inspection.

There was a registered manager in post. 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.

There were some procedures and processes in place to ensure the safety of the people who used the service. However, people did not have personal evacuation plans to guide staff on how to support them in the event of a fire. Water temperatures had not been checked to protect people against the risk of legionella or to check that thermostatically controlled valves were working correctly.

People were provided with their medicines when they needed them and in a safe manner. The manager had identified and was working on improvements to systems for administering as and when required medicines. This was to ensure this was being managed safely

Staff were trained and supported to meet the needs of the people who used the service. There were sufficient numbers of staff to meet people’s needs and recruitment processes checked the suitability of staff to work in the service.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

People received care that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Staff were passionate about supporting and promoting the independence of those who lived at St Andrews Lodge.

Care and support was based on the assessed needs of each person and people were encouraged to pursue their hobbies and interests.

People’s nutritional needs were assessed and they were supported to eat and drink sufficiently.

There were processes in place that encouraged feedback from people who used the service and people were involved in making decisions about their care and support.

There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

Quality assurance audits were used to identify shortfalls and drive improvement in the service.

We found that the manager and staff offered an inclusive and consultative approach to people who have a range of complex mental health needs. We saw that staff worked tirelessly and passionately to guide, support and empower the people who used the services at St Andrews Lodge.

We found that people were protected from the risks of an unsafe environment because the service had effective methods to monitor the safety of the buildings and an effective maintenance programme in place.

We found that there were adequate levels of staffing providing the appropriate support to people. Staff were supported by an effective style of leadership which was responsive to the needs of the people who used the service. We also found

that there was an appropriate and effective system in place to monitor and review the service's performance.

The relative we spoke with told us that there had been a 'massive improvement in the past year' in the person they visited. They were very happy with the range of activities during the week. However, they felt that the drop in staffing levels at the weekend meant that people had less opportunity to go out then. The provider told us that they were reviewing staffing levels at the weekend.

As part of this unannounced inspection we checked on the standards that were not met at our last inspection in July 2011. The areas needing improvements were staff training and quality assurance. We found that the provider had made improvements since our last inspection. Additional staff training had been given and good systems for auditing standards had been introduced. As a result we found that these standards were now met.