St Andrew's Nursing and Care Home

St Andrew's Nursing and Care Home is situated in Ewerby near Sleaford, providing accommodation for people who require residential and nursing care. The service can support up to 45 older and younger adults, some of whom may experience memory loss. There were 33 people living in the service at the time of inspection.

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

There were quality assurance processes in place. However, audits continued to be ineffective and had not identified shortfalls in the service.

People’s care records were not always accurate or effective in order to give staff guidance on how to meet the nutritional needs of people.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Systems and processes around safe recruitment needed improvement. Checks had not consistently been carried out in respect of some staff’s right to work in the UK. The provider had not always assured themselves of gaps in employment and had not always ensured references were sought from staff’s last employer when staff were recruited by a recruitment agency.

Medicines management at the service had improved. There was guidance for staff to follow on how to safely administer “As and when medicines.” However, the service would benefit from improvements in the recording of medicated creams.

There had been an inconsistency in management at the service since the last inspection. Managers at the service have been interim, with no registered manager since August 2021.

Staff had received training in order to recognise how to protect people from abuse. People and their families told us they felt safe at the service.

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 09 August 2021) and there were breaches of regulation 12 and 17. CQC issued the provider with a warning notice in relation to Regulation 17 (Good governance).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulation 17 (Good governance.)

Why we inspected

We carried out an unannounced focused inspection of this service on 27 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Andrew's Nursing and Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safety of people's care and good governance at the service.

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.

St Andrew's Nursing and Care Home is situated in Ewerby near Sleaford, providing accommodation for people who require residential and nursing care. The service can support up to 45 older and younger adults, some of whom may experience memory loss. There were 36 people living in the service at the time of inspection.

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

Staff had access to personal protective equipment. Although, national guidance around donning and doffing were not always followed. The provider had implemented systems and processes to protect people from COVID-19 however, these were not always adhered to.

There were quality assurance processes in place. However, audits did not identify shortfalls in the service and audits were not robust. People received their prescribed medicines, however, further improvements in practice were required. Documents were not in place to support staff to administer ‘as and when required’ medicines.

Falls and accidents were reviewed and monitored. However, there was not always evidence of positive actions and lessons learnt following these reviews. People using the service told us they felt safe.

Staff had received training in order to recognise how to protect people from abuse. However, the registered manager and staff did not recognise when their own practices were resulting in psychological harm to the people being cared for at the service.

We received mixed feedback from people using the service regarding receiving person-centred care. People using the service who lacked capacity to make their own decisions had care plans in place to ensure they were treated in the least restrictive way possible and in their best interest; Policies and systems in the service supported this practice.

The registered provider had carried out sufficient pre–employment checks. Staff were up to date with their mandatory training.

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 Good (published 19th December 2019). At this inspection the service rating has deteriorated to requires improvement. Breaches of legal requirements were found.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. Additionally, we received concerns relating to staffing levels in the service. We have found evidence that the provider needs to make improvements.

Please see the Safe and Well-led sections of this full report

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so

We have identified breaches in relation to The Safety of people’s care, governance in the service and safeguarding at this inspection.

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 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

We found the following examples of good practice.

• Sufficient stocks of Personal Protective Equipment (PPE) were in place including masks, gloves, aprons, hand sanitiser and visors. Staff were wearing this appropriately.

• Infection control polices reflected the current national guidance.

• People living in the service and staff were being tested regularly. This was to ensure if any staff or people had contracted COVID-19 and were asymptomatic, this was identified and acted upon in a timely way.

• There was a clear procedure in place to ensure people were admitted to the service safely.

• A process was in place to ensure visitors were screened prior to them entering the service.

• Staff were provided with training in infection prevention and control.

• Improvements had been made to the internet signal to ensure technology could be used in to ensure people and their relatives could see each other.

Further information is in the detailed findings below.

About the service

St Andrew’s Nursing and Care Home is situated in Sleaford, providing accommodation for people who require residential and nursing care. The service can support up to 45 older and younger adults, some of who may experience memory loss. There were 37 people using the service at the time of inspection.

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

There were systems and processes to protect people from abuse. People’s risks had been identified and measures had been taken to reduce the risk of harm. Accidents and incidents were recorded and monitored. Medicines were managed safely. People were supported by a suitable number of staff. The registered provider had carried out appropriate pre-employment checks on staff.

People’s needs were assessed prior to admission to the service. New staff received an induction and on-going training. People were supported to maintain a balanced diet and had meals they enjoyed. Staff worked in partnership with other agencies to provide timely care for people. The premises were fit for purpose and personalised to people who lived there. People’s capacity had been assessed.

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.

Staff interacted positively with people and knew them well. People felt staff treated them with kindness and dignity. People were encouraged to make choices in their daily lives.

Personalised care plans were place which outlined people’s needs and support requirements. People were given information in different ways to enable them to make a decision. People were supported to join in activities. Staff supported people who followed a chosen faith. Complaints were managed in line with the registered provider’s policy. People’s end of life wishes had been assessed.

There was an inclusive, person centred culture in the service. Staff and managers were clear about their responsibilities. Organisational values which were embedded in to the staff team. People, staff and relatives spoke highly of the management team. The service had strong links in the community. Managers were continually seeking ways to improve care.

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 good (published 16th May 2017).

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.

There was 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 home is run.

People and their relatives told us that they felt safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff who were competent to do so. The risk assessments recorded what action staff should take if someone was at risk. Referrals were made to appropriate health care professionals to minimise risks and meet people’s health needs.

There were sufficient staff to keep people safe and meet their needs. The registered manager had followed safe recruitment procedures. Medicines were given to people on time and as prescribed.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. Staff understood the processes in place for ensuring decisions were made in people’s best interests. Staff and the registered manager were ensuring these steps were taken for people living at the home. Staff sought people’s consent and recorded this.

Staff were caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt that staff were understanding of their needs and they had positive working relationships with them.

People and their relatives were involved in the assessment and reviews of their needs. Staff had knowledge of people’s changing needs. They supported people to make decisions or changes to the way their planned care was delivered. Staff offered choices to people regarding all aspects of their care and support, and upheld these choices. People told us that they had access to activities and hobbies.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people, relatives, health and social care professionals were sought as part of the service’s quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

St Andrew’s Nursing and Care Home can provide nursing care and personal care for 45 older people and people who live with dementia. There were 40 people living in the service at the time of our inspection.

There was 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.

We carried out an unannounced comprehensive inspection of this service on 10 February 2016 when we found that there was a breach of a legal requirement. This was because the registered persons had not consistently completed robust checks to monitor and assure the quality of all the facilities and care provided in the service. This had resulted in shortfalls in the care and facilities provided for people not being quickly addressed.

After our inspection of 10 February 2016 the registered persons wrote to us to say what improvements they intended to make in order to meet the legal requirement in relation to the breach. They said that a series of new and more robust quality checks would be introduced to ensure that in future people consistently benefited from receiving all the care and facilities they needed and expected. They said that the necessary improvements would be completed by 22 March 2016.

This report only covers our findings in relation to the action taken by the registered persons to meet the breach of legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Jasmine Healthcare Ltd on our website at www.cqc.org.uk

At this inspection, we found that the registered persons had introduced most of the quality checks that were necessary to ensure that people reliably received all of the care and facilities they needed. This meant that the breach of the legal requirement had been met. However, some further improvements were still needed. These included strengthening the way in which people were consulted about the development of the service. In addition, more steps needed to be taken to address some remaining defects in the accommodation.

We found that improvements also needed to be made to parts of the accommodation in order to provide people with a safe setting in which to receive care. This was because repairs needed to be made to the passenger lift. In addition, we noted that the provider had not made robust arrangements to reduce the risk of people being accidentally burnt by radiators that were not fitted with guards.

Furthermore, we found that there were shortfalls in some of the quality checks that had been completed.This was because they had not effectively identified and resolved the problems we had noted during the course of our inspection. In addition, the provider had not completed an up-to-date assessment of the fire safety system used in the service. This oversight had contributed to some routine fire safety checks not being completed. These mistakes had reduced the level of fire safety protection available in the service.

We said that all of the shortfalls in care delivery and accommodation needed to be addressed. This was necessary so that people could receive responsive care in a safe setting.

After our inspection dated 10 June 2014 the provider wrote to us and said that it had made the improvements that were necessary to address all of our concerns.

Our inspection dated 05 November 2014 examined the way in which people were supported to eat and drink enough and to keep their skin in a healthy condition. In addition, we looked at how people were protected from avoidable environmental hazards. Further, we established what steps had been taken to strengthen the way in which quality checks were completed.

We found that the provider had introduced all of the necessary improvements.

The summary is based on our observations during the inspection, speaking with 13 people who used the service, five relatives, the manager and four staff. In addition, we looked at care records, observed care being provided, reviewed parts of the health and safety system and examined the accommodation.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

People said that staff were respectful, kind and attentive. They considered staff to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service. However, we witnessed two occasions on which people were not treated in ways that fully respected their rights to dignity and privacy.

Is the service responsive?

We saw that most people's individual needs for care had been assessed and met. Staff knew about each person's care needs, choices and preferred routines. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person's changing needs and wishes. However, we found that some aspects of people's care needs were not being reliably met. In particular, there were shortfalls in the arrangements used to ensure that people had enough to eat and drink. In addition, there were oversights in the way people were assisted to keep their skin healthy by reducing the risk of pressure ulcers. Some relatives said that they had not been promptly informed when person's care needs had changed.

Is the service safe?

Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse. There were reliable systems for managing people's medication so that medicines were used safely and consistently. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. These measures helped to keep people safe from abuse and to promote their welfare.

Is the service effective?

People were helped to stay safe by avoiding most risks to their health and safety. There were safe working practices to help people with reduced mobility so that there was a reduced likelihood of people experiencing falls and accidents. However, other risks had not been effectively managed. These included the risk of people being burnt because some radiators were not guarded. In addition, repairs had not been promptly completed to ensure the safe and reliable operation of the passenger lift. Some of the people who used the service considered that more staff needed to be provided. On a limited number of occasions the provider had not always arranged for all care worker shifts to be filled. Although this had not directly affected the quality of the service people had received, the situation increased the risk that people would not promptly receive all of the care they needed in the future.

Is the service well led?

People had been consulted about their experience of using the service. There was a clear line of management. This meant that important decisions about organising someone's care were made by senior staff while carers could use their own judgement to provide a flexible service. The quality assurance system was not robust in that some checks had been overlooked and others had not been completed correctly. These shortfalls had allowed problems in the delivery of care to continue and potential environmental risks to remain unresolved.

We asked the provider to send us an action plan to inform us of how they would address these concerns.

On this visit we looked at information the provider had sent us, spoke to the registered manager and looked at records.

We saw that the provider had implemented a new system of care plans to better support staff in completing records that related to people's care and welfare.

The provider had taken the appropriate action to address our concerns to help ensure people received appropriate care and support.

We looked at records. These included care plans and information about how the service was managed. We conducted a tour of the building and observed the interactions between the care staff and people living at the home.

We saw that there were sufficient numbers of suitably qualified and experienced staff to enable people to be supported in a safe and appropriate manner. We spoke with a visitor whose relative was confined to bed through illness who told us, '(My relative) has a special bed to prevent pressure sores. The staff come every two hours to re-position them and medication is dealt with straight away.'

The provider had systems in place to regular monitor and assess the quality of the services provided.

Some of the records that related to people's care were incomplete and failed to show that people's needs had been assessed and / or their care plans updated to inform care staff of how to support people in a safe and appropriate manner.

We spoke to five people living at St Andrews, two relatives of people living there, together with the Registered Manager, four members of staff and a Director of the company that owns St Andrews.

We also looked at records. These included care plans, records of meetings and information about how the service operates. We also looked at information from surveys undertaken by the provider to assess the quality of service.

The people we spoke with said they were happy with the care and support they received and felt it was delivered in a safe way. They told us that staff offered them choice and respected their opinions while encouraging them to be as independent as possible.

One person living at the home told us, 'I think the staff are lovely. They try and keep me jolly, you know.'

People also said they felt confident taking any suggestions or concerns to the manager or any of the staff team. They were satisfied with support they received and the service provided.

The people we spoke with raised no concerns other than one told us that sometimes they had to wait a long time for the call system to be responded to by staff. However another person we spoke to said, 'If I ring the bell they always come. They do anything you ask.'