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Andrin House Nursing Home Good

Reports


Inspection carried out on 10 December 2019

During a routine inspection

About the service

Andrin House Nursing Home is a residential care home providing personal and nursing care to people in one adapted building. The service can support up to 37 people. At the time of inspection there were 30 people using the service.

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

People received their medicines safely from trained staff. Guidance for staff to follow when administering medicines to be taken 'as and when required' was not on all care files. We found thickener (used to reduce the risk of choking if someone had difficulties swallowing) in a person's room which meant not all medicines were stored securely.

Recording of kitchen cleaning and temperature checks had lapsed but we did not find any negative impact had been caused to people. Staff had been trained in infection control and used appropriate personal protective equipment (PPE).

Quality assurance checks were effective in most areas of the service. However, audit processes had not identified the issues with the kitchen checks or gaps in some records related to people's care, for example, repositioning charts.

We have made a recommendation about the quality assurance checks in the service.

People were cared for safely. Staff understood safeguarding procedures. Safe recruitment practices were followed to ensure staff were suitable for their roles. Lessons were learned when things went wrong.

People’s care files contained clear information about their care and support needs. Staff knew people well and had a good understanding of their wishes and individual preferences. People’s personal histories, preferences and dislikes, diversity needs such as cultural or religious needs and links with family were all considered within the care plans. Staff received training to meet people’s needs.

Where required, people were supported with their eating and drinking to ensure their dietary requirements were met. People were supported to promptly access health care services when needed.

There was on ongoing redecoration programme. Improvements had been made to the décor and environment since the last inspection.

People received support from consistent, compassionate staff. Staff were caring in their approach and had positive relationships with people and their relatives. People were treated with respect. Staff maintained people’s dignity and promoted their independence. Consent was sought before care was delivered.

The registered manager was committed to driving improvements of the service and ensuring people received high quality care. The management team were aware of their legal responsibilities and worked in an open and transparent way. Feedback was sought from people, relatives and staff.

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.

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 requires improvement (published November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 1 October 2018

During a routine inspection

This inspection took place on 1 October 2018 and was unannounced. We returned announced on 2 October 2018.

Andrin House Nursing Home accommodates up to 37 people in an adapted building. At the time of the inspection 23 people were using the service. People using the service have an identified nursing need, which includes people living with dementia.

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

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection on 23 and 24 April and 2 May 2018, we asked the provider to take action to make improvements. To promote the safety and welfare of people and further promote their safety and well-being through robust staff recruitment processes and the ongoing supervision and appraisal of staff. To provide care and treatment that was personalised and met their needs. To meet their conditions of registration through the appointment of a registered manager. And to have effective governance arrangements to monitor the quality of the service.

The provider had taken action to make improvements following the Care Quality Commission (CQC) inspection of April and May 2018.

Andrin House Nursing Home had a registered manager. 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 provider had engaged the services of a consultancy firm to support them in bringing about the required changes to the governance of the service. The registered person reviewed internal audits as to the quality of the service that were carried out by the registered manager. However, audits in two areas, care planning and medicine, had not identified the shortfalls found through the CQC inspection. The registered person and registered manager, regularly met to review their progress in the changes made.

The registered person and registered manager, with the support of the consultancy firm were looking to prioritise further plans for improvement, based on risk, detailing the improvement, how it was to be made, the person with the overall responsibility and the timescale involved.

The provider had been transparent and had displayed the rating following the previous inspection within the service and on the website as required by legislation. The provider had met with staff following the previous CQC inspection and the minutes noted they had taken responsibility for the shortfalls found and discussed the areas for improvement.

People using the service, family members and staff had completed questionnaires to identify areas of improvement. The registered manager had analysed the results and had made tangible improvements in the day to day management of the service, which had had a positive impact on people using the service and the staff employed.

The registered manager had reviewed the policies and procedures for the service and had undertaken a range of audits to assure themselves of the quality of the service being provided. A system for supporting staff had been introduced, which included regular supervision, meetings and training. Information kept within staff files had been reviewed by the registered manager and updated wh

Inspection carried out on 23 April 2018

During a routine inspection

This inspection took place on 23 April 2018 and was unannounced. We returned on 24 April announced and 2 May 2018 unannounced.

Andrin House Nursing Home did not have a registered manager. 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 manager of Andrin House Nursing Home was on planned leave at the time our inspection. A manager of the registered person’s other service based in Leicester, facilitated the inspection.

Andrin House Nursing Home accommodates up to 37 people in an adapted building. At the time of the inspection 24 people were using the service. People using the service have an identified nursing need, which includes people living with dementia.

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

The overall rating for the service awarded at the previous inspection which took place on 1 and 14 June 2017 was requires improvement at which time we identified two breaches of the regulations. Following the last inspection we asked the provider to take action to make improvements to promote people’s safety and to improve systems and processes to monitor the quality of the service. The provider submitted an action plan outlining their plan for improvements.

The overall rating for this service 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 provider’s registration of the service, will be inspected again within six months.

The expectations 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 being 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 month, 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 service 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 no longer rated as inadequate for any of the five key questions it will no longer be in specialist measures.

The registered person and manager did not have systems and processes to assure themselves as to the quality of the service being provided. This lack of oversight as to the quality of the service and the services governance meant shortfalls and areas for development and improvement had not been identified. A number of external stakeholders had identified improvements were required in a number of areas, which had resulted in the developing of action plans to bring about improvement. We found some evidence to support that the action plans developed by the external stakeholders were being implemented. The leadership and management of th

Inspection carried out on 1 June 2017

During a routine inspection

This was an unannounced inspection that took place on 1 June 2017. We returned unannounced on 14 June 2017 to complete the inspection.

Andrin House provides accommodation, nursing and personal care to up to 37 older people. It is located in a residential area of Derby, close to the city centre. The premises are on two storeys with a passenger lift for access, a range of bedrooms, lounges, a dining area, and a secluded garden. At the time of our inspection there were 30 people using the service.

The service has not had a registered manager since 18 February 2016. 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 provider told us he was in the process of recruiting a manager for the service who would be registered with CQC. This is necessary as it is a condition of the provider’s registration that a registered manager is in place.

The atmosphere at the service was warm and friendly and people and relatives told us the care provided was good. They said they thought the service was well-managed and made many positive comments about the manager. However the provider did not have effective systems in place to ensure that people always received good quality safe care in a suitable environment.

Improvements were needed to the premises. For example, we found unrestricted windows, water in hand basins that was too hot, radiators without appropriate covers, and an unlocked store cupboard containing hazardous chemicals. Improvements were also needed to the way staff were supported and supervised and people’s views on the service collected and responded to.

Although people and relatives told us they thought people were safe at the service improvements were needed to the way risk was managed. One safeguarding incident had not been reported to the local authority and CQC and some people’s care plans and risk assessments were not fit for purpose. Some improvements were also needed to medicines management.

Staff mostly had the training they needed to provide effective care, although some staff had not completed recommended fire safety training. People and relatives said they thought the staff were well-trained. During our inspection visits we observed staff working with people in a skilled and competent manner.

People told us the care and nursing staff provided good quality care and we saw example of this during our inspection visits. Care plans were personalised to give staff an idea of the person themselves and their likes and dislikes. They contained details to help staff meet people’s needs in the way they wanted, for example, how many pillows they liked on their bed and the type of music they preferred. However, some people’s care records were incomplete so we could not be sure the care they received was responsive.

People and relatives said they were satisfied with the numbers of staff on duty. They told us staff were quick to come to people’s assistance when they needed it and we observed this in practice. There was a constant staff presence in the lounges and staff continually checked on people in other parts of the premises to ensure they were safe.

People made many positive comments about the food served. They told us they had plenty of choice and could have second helpings if they wanted. When lunch was served the food was fresh, nutritious, and well-presented. If people needed support with their food and drink staff provided this.

The service employed both nurses and care staff and people could see their GPs and other healthcare professionals when they needed to. Some people’s records showed that their heath had improved since coming to the service.

People and relatives told us they were involved in making decisions about people’s

Inspection carried out on 21 December 2015

During an inspection to make sure that the improvements required had been made

The inspection took place on 21 December 2015 and was unannounced.

We carried out an unannounced inspection of Andrin House in October and found two breaches in legal requirements. Those were in relation to Regulation 19 HSCA (Regulated Activities) Regulations 2014, fit and proper persons employed, and Regulation 17 HSCA (Regulated Activities) Regulations 2014, good governance.

Following the inspection the provider wrote to us to tell us what actions they would be taking to meet the breaches which had been identified.

We undertook this focused inspection on 21 December 2015 to check they had made improvements and to confirm that they now met the legal requirements in all the areas of concern that we identified. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Andrin House on our website at www.cqc.org.uk.

Andrin House is a care home with nursing for up to 37 people and specialises in care for older people. It is located in a residential area of Derby, close to the city centre.

There was no registered manager in post. An acting manager was covering this position. 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 focused inspection on 21 December 2015 we found the provider had made improvements to the recruitment process to ensure that all staff were suitable to work at the service. We saw that staff files contained evidence that appropriate checks were completed prior to staff commencing work at the service.

We saw that improvements had been made in relation to staffing levels and that there were sufficient staff on each shift to meet the needs of the people living at the service.

At our last inspection we found that the provider had not put in place suitable arrangements to monitor the quality of the service and there was no analysis of adverse incidents and events to prevent a reoccurrence. At the focused inspection on 21 December 2015 we saw that improvements had been made and there was evidence of actions being taken as a result of quality monitoring audits. This included complaints, feedback forms and meetings. We also saw there was evidence of actions being taken as a result of incidents and accidents and these results were analysed in order to attempt to prevent reoccurrence.

Inspection carried out on 14 October 2015

During a routine inspection

The inspection took place on 14 October 2015 and was unannounced.

We last inspected this service in August 2014 and found some breaches of legal requirements. These were in respect of assessing and monitoring the quality of the provision, respecting and involving people who use services and obtaining and acting in accordance with, the consent of people living in the service. During this inspection we found that some improvements had been made to meet these requirements. This included improvements in the process of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), and also the assessing and reviewing of people’s risks.

Andrin House is a care home with nursing for up to 37 people and specialises in care for older people. It is located in a residential area of Derby, close to the city centre.

Andrin House has 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.

We found that people’s safety was not fully supported as there were not always sufficient staff on duty. The provider did not have appropriate recruitment systems in place to check staff were suitable to work with people living at the service.

We found unsuitable arrangements in place to monitor the quality of the service and there was not always analysis of adverse incidents to prevent reoccurrence.

Where we have identified breaches of legal requirements and regulations associated with the Health and Social Care Act 2008, relating to good governance and fit and proper person’s employed, you can see what action we told the provider to take at the back of the full version of the report.

People we spoke with said they felt safe at Andrin House and they felt confident to speak to staff if they had any concerns. Staff were knowledgeable as to whom they should report information to should they believe someone was at risk of abuse.

We saw risk assessments in place in people’s plans of care to promote their safety. Staff were aware how to respond to emergencies.

We saw that people received their medication in a timely and safe manner, administered by staff who were trained in the administration of medication.

People were given choices with regard to food and drink preferences and appropriate support was given when needed.

The registered manager and senior staff understood the principles of the Mental Capacity Act 2005 (MCA), and supported people in line with these principles. This included staff seeking consent from people before delivering care.

Referrals were made to other healthcare professionals in a timely manner to meet their health needs.

We saw staff positively engaging with people living at the service and staff encouraged people to participate in activities.

Our observations showed that people were treated in a caring manner, and with dignity and respect.

Care plans were individual to the person and reflected their care and support needs. Care plans included information about people’s interests, likes and dislikes which provided staff with sufficient information to enable them to provide care effectively.

People knew how to make complaints and were confident these would be acted upon.

Staff did not always feel supported by the registered manager if they had any concerns about the running of the service.

Inspection carried out on 19 August 2014

During a routine inspection

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, and to provide a rating for the service under the Care Act 2014.

This inspection was unannounced which meant the manager and staff did not know we were coming. We last inspected this service in September 2013 and found some breaches of legal requirements. These were in respect of meeting people’s needs, management of medicines, the safety and suitability of the premises and the support provided to workers. During this inspection we saw that some improvements had been made but further action was still required. You can see what actions we have told the provider to take on the back of the full version of the report.

Andrin House is a care home with nursing for up to 37 people and specialises in care for older people. It is located in a residential area of Derby, close to the city centre.

The service had been without a registered manager but had recently appointed a new manager who had been in post for six weeks when we visited. The manager was going through our registration process to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Some people who used the service were unable to make decisions about their care, support and safety. The Mental Capacity Act (MCA) 2005 was introduced to protect people who lack the capacity to make decisions for themselves due to their illness or disability. Staff we spoke with were aware of the Act and their responsibilities however there was no clear process in place to ensure people were supported to make safe choices.

The provider had not recognised they were restricting a person’s liberty and had not made an application under the Mental Capacity Act Deprivation of Liberty Safeguards (DoLS) until they were prompted to do so by a health care professional.

Some people presented with behaviour that challenged others but there were no management plans in place to ensure people were supported by staff in a positive and consistent manner.

The provider did not have appropriate recruitment systems in place to check staff were suitable to work with vulnerable people.

Assessment of people’s risk was being undertaken however reviews did not reflect changes in people’s circumstances.

People told us the staff were kind to them. We observed mostly positive interactions with staff however there was limited one-to-one interaction between people and staff at mealtimes. The care records provided limited information for staff to provide care which met people’s preferences. Staff had not recognised the cultural needs of one person who used the service.

People were referred to healthcare professionals to support their health and wellbeing however we saw that some recommendations were not implemented.

There were no arrangements in place to monitor and improve the quality of the service.

Inspection carried out on 17 September 2013

During a routine inspection

As part of this inspection we spoke with seven people who used the service and one relative. We also spoke with four members of staff including the acting manager.

One the day we inspected the provider had 21 people using the service.

People we spoke with were happy with the care provided. Comments from people who used the service included: �I�ve never been happier�, �they keep a good eye on you� and �marvellous�.

People had care plans in place. Monthly reviews had been completed but not all care plans reflected the information contained in these reviews. This meant that staff may not have been aware that the person needs had changed. We found that not all risk assessments were being completed correctly.

We found that medication levels were not always recorded correctly and that relevant protocols were not in place.

The provider was not up to date with mandatory tests such as those of electrical items and gas safety. No audits of the building were completed to ensure it was adequately maintained.

Staff we spoke with told us that they felt supported. We found that not all staff were up to date with mandatory training. Supervision had not occurred in line with the provider�s identified frequency.

The provider had a complaints system in place. There had been no formal complaints within the last 12 months. There were regular meetings with people who used the service and their relatives to gain feedback on the service provided.

Inspection carried out on 24 January 2013

During an inspection to make sure that the improvements required had been made

This was a follow up inspection. Please see our previous report for full comments.

During this inspection we spoke to people about these specific outcomes. People told us that they all felt well cared for. One person stated "I'm quite content with the treatment I get here", another told us "the care is perfect". Most people stated that they get to see a Dr immediately if they are unwell.

A visiting health professional told us that the provider was very professional and that they had found that staff knew the care needs of people who used the service.

We found that the provider had put in place systems to monitor cleaning schedules and that care plans were up to date and appropriate action taken. The provider had ensured that resident and relative meetings had occurred and that staff were receiving regular supervision.

Inspection carried out on 1 October 2012

During a routine inspection

All the people we spoke with were very happy at the home. One person informed us "I came for two weeks and have stayed for two years". Another person stated staff are really good and nothing is too much trouble".

One person we spoke with stated "I love it. I think its wonderful", another person told us that they have "absolutely no complaints".

Although people were very happy we found some concerns with care plans, infection control and quality assurance.

Inspection carried out on 4 November 2011

During an inspection to make sure that the improvements required had been made

People told us they were well cared for at the home. One person said �I�m perfectly happy here and the carers are wonderful.� One relative said �The care is very good. They (staff) know what they are doing.� People told us that they felt safe living at the home and there were systems in place to ensure appropriate staff were recruited. One person who lived at the home said �I can�t think of one member of staff here who isn�t suitable.�

Inspection carried out on 5 April 2011

During a routine inspection

People were treated with dignity and respect. They were able to make decisions about their daily lives and were supported to provide consent to care and treatment. This consent was not always renewed as care needs changed.

People who used the service told us that they felt safe with the staff at the home. One relative said �I think (named person) is pretty safe here, that is the main consideration�. They were satisfied with the catering arrangements.

People received the care they needed and got their medications when they needed them. People told us �the staff come round and give you your tablets when they are due� and �the staff watch you take your tablets�. Records of medications were not always properly maintained but this did not impact on people�s care.

People were satisfied with their environment and the levels of equipment provided. We found that people who used the smoking lounge did not have as good a standard of day time accommodation as non-smokers.

People who used the service told us they felt the care workers had the right skills and training to do their job. One said �the staff seem to know what they are doing�. They told us that staff were suitable and provided in sufficient numbers. They said there were sometimes delays in gaining staff assistance during busier times of the day, but generally there were always care workers around.

Overall monitoring of the care and service was mainly achieved informally. This did not provide full assurance of forward planning or that people were fully involved in this planning. Despite this, people did say that they were happy with the way the home was run.

People felt able to raise any concerns although they could not remember being given a formal complaints procedure. They told us said �you can talk to the manager, if she can, she puts it right�. Records belonging to people who used the service and staff were confidentially stored.

Reports under our old system of regulation (including those from before CQC was created)