Archived: St Andrews Lodge

As part of our inspection we spoke with seven people who were able to share their views about the home with us and talked with four care staff and the Registered Provider and owner. We spent periods of time observing the care people received in the downstairs lounge and dining area and reviewed people's care records. We followed the care of one person since their admission. This meant we spoke with staff about their care, reviewed their care files and spoke with a mental health professional involved in their care. In addition, we reviewed the information we had received from the service about incidents which had occurred over the past six months.

There was not a Registered Manager in post at the time of the inspection and the Registered Provider and owners had not been able to be as involved in the day to day running of the home due to personal circumstances.

We considered our inspection findings to answer the following five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found people were treated with dignity and respect by staff. Staff spoke about people's care and needs in an individualised manner and were aware of people's personal preferences, potential risks and how to minimise the risk to people and themselves.

Staff told us that there had been recent changes to the staffing levels at night which at times made them feel unsafe due to the unpredictable nature of some people's problems. Two staff at night had been reduced to one and some staff felt uncomfortable with the new arrangement. There had been a number of incidents at the home recently which had involved the police being involved with one incident and verbal and physical aggression towards staff.

People told us they didn't always feel safe either due to a few people's behaviour at the home. Some people told us they retired to their room and locked their door. Some people told us they had their belongings and money go missing and no action had been taken.

We were concerned that serious incidents had not been notified to the Care Quality Commission or to the local safeguarding team. Additionally, information about people's care and welfare and risk was not being shared with the mental health team routinely or people's probation officers.

Although most staff had received safeguarding training and there were policies in place, staff were not confident applying this to their practice.

CQC monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were informed no applications had needed to be made. Staff had some understanding of DoLS but this was limited.

Is the service effective?

People we spoke with told us "I like doing the garden, help out in the kitchen"; "Food is lovely"; "I'm happy here"; "I like the company"; "No residents' meetings at the moment, we want them monthly"; "Staff do their best"; " I miss the outings we used to have in the van".

Most people we met were very happy at the home. Some had lived at the home for over thirty years. Staff knew people well and were able to support people and understood how to meet their needs. Staff encouraged people to be as independent as possible and most people had care plans and risk assessments which reflected their needs and risks.

We were concerned that there were people at the home who were not in the right environment and that their behaviour was impacting on others. Their care plan had not been updated to reflect their needs and risk. Although the home had "house rules", due to the lack of visible management these had not been followed by some people and there had been no consequences for continual breaches.

People were involved in their care planning and treatment decisions. Where people's capacity to make an informed decision was not clear, we were informed the home had followed the correct legal processes to ensure people's human rights were respected. People were able to access advocates in these instances.

Is the service caring?

During our visit we observed a calm atmosphere and saw that staff were kind and considerate. Some people staff were working with required patience and information repeated several times. We observed staff to be gentle, reassuring and repeated information for them calmly. Staff clearly cared about the people at the home and spoke about them and the home with fondness. Staff were kind and caring towards each other also, conscious of the different skill mix and experience and supportive of new staff. People at the home cared about each other, people were tolerant of people's individual behaviours which could be irritating to them and there was genuine warmth and affection felt by everyone we met towards to providers.

Is the service responsive?

We found that due to the lack of a manager in the home, some processes to ensure the service remained proactive and responsive had slipped. Residents told us they were not having regular meetings anymore and that their outings in the van which they loved had stopped.

We found some people needed their needs re assessed by their funding authorities and this had not been followed through. Incidents about people's behaviour were not routinely shared with external professionals involved in people's care.

We found where people's mental health or physical health had deteriorated relevant professionals had been involved and assessments completed. The staff knew people well so were aware of people's early warning signs and responded appropriately contacting the mental health team for an assessment where indicated.

People felt they could complain if they needed to but they had no complaints. People told us that apart from a few people causing difficulties they were happy.

Is the service well-led?

The service did not share the information they had with people's mental health workers and probation officers to receive support and guidance and keep people safe. The lack of a Registered Manager and consistent management presence was being felt by some staff and people at the home. The lines of accountability were not clear and staff were very conscious of wanting to support the owners and not bother them with work related matters during a difficult personal time.

We found staff appraisals had not been completed and although essential training had been completed by most staff, some newer staff with no mental health experience had not had the opportunity to discuss their personal development needs. However staff were extremely supportive of each other and shared their knowledge. Although there had been a staff meeting in May, some staff felt they were not involved in decisions such as the staff rota and were not being kept up to date with the sale of the property and how this might affect them, if at all.

We found that people had contracts in place which detailed the fees they were required to pay and what this money included.

We talked with seven of the 16 people who were at the home during this inspection. People said 'I'm quite happy and I get on well with the staff', 'The staff are very good and the manager is always very helpful', 'I have a really good quality of life here', 'Since I came here I've made an incredible improvement'.

One person was self-funded. This person did not have a contract between them and the home. The financial records were disordered for this individual and not recorded accurately. The provider said 'The records are not accurate'.

We found people were involved in decisions made about their care. People were able and encouraged to make decisions regarding daily activities.

People had care plans that enabled care workers to look after their welfare. Care plans contained information that was specific to each person.

People told us they felt safe. Care workers were knowledgeable about safeguarding adults procedures.

We followed up on medicines management. We found that home had improved their medicines management systems.

Care worker records contained the correct information about requirements relating to workers. Records were stored securely and were accessible.

We found there were stable staff numbers on duty which had been maintained over the past seven weeks. However, some of these staff had not received the pre employment checks required to show they were suitable to work with vulnerable people.

Not all staff had received training which included medication management, first aid or fire safety despite working alone at the home whilst the second member of staff slept.

Routine medications were well managed at the home. However, medications stored as controlled drugs were not always administered, recorded or disposed of accurately.