St Andrews Lodge

Updated 30 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 1 inspector on 6 November 2023 and 2 inspectors on 7 November 2023.

Service and service type

St Andrews Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Andrews Lodge is a care home without nursing care.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. The registered manager was also a director of the company providing the service.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority safeguarding and quality team, and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service, however they declined to speak with us at length. We used informal observation to evaluate people’s experiences and to help us assess how their needs were being met. We also observed how staff interacted with people.

We looked at records in relation to 4 people’s care.

We also spoke with the registered manager also a director of the company, 4 staff members and 3 agency staff. We looked at records relating to staffing, recruitment, training and development of staff, management of the service and systems for checking the quality and safety of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 30 January 2024

About the service

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.