Archived: St Andrew's Care Home

Updated 11 January 2018

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced comprehensive inspection took place on 15, 22 and 27 November 2017. The inspection team comprised of two inspectors on the first and second day and one inspector on the third day. This inspection was brought forward because the Care Quality Commission (CQC) were made aware of concerns relating to the standard of care and the way the service was run. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People in care homes receive accommodation and personal care as a single package under one contractual agreement. The care home accommodates 23 people in two buildings separated by a courtyard

Prior to this inspection, we reviewed the information we held about the service. This included a Provider Information Return (PIR) which had been completed in 2016. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the home. This included the previous inspection report and notifications sent to us. A statutory notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern. We also reviewed information we received from the community nurse team and the safeguarding nurses relating to specific safeguarding concerns.

We met most of the people using the service and spoke with them about their experience of living at the home. We spoke with five visiting relatives. We looked at four people’s care including their care plans. A number of people living at the service were unable to communicate their experience of living at the home in detail with us as they were living with dementia. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people, who could not comment directly on their experience.

We spoke with the manager and seven staff which included care staff, housekeeping and kitchen staff. We looked at systems for assessing staffing levels, for monitoring staff training and supervision, staff rotas, and staff files, which included five recruitment files for newly recruited staff and training records. We also looked at quality monitoring systems used such as audits, checklists and the service improvement plan. We liaised with commissioners and health and social care professionals who regularly visited the home.

Updated 11 January 2018

St Andrew’s Care Home provides accommodation with personal care to a maximum of 23 older people, some of whom are living with dementia. When we visited 19 people lived at the home on the first day. On the second and third day, there were 18 people as one person had been admitted to hospital. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The care home accommodates 23 people in two buildings separated by a courtyard.

The bedrooms in the main house are over two floors and reached by a passenger lift. There are four bedrooms in an annexe; three of which are reached by a stair lift. The annexe is accessed across a courtyard away from the main building.

This unannounced comprehensive inspection took place on 15, 22 and 27 November 2017. It was carried brought forward due to the service being part of a whole home safeguarding process.

When we inspected, the service did not have a registered manager, they had voluntarily cancelled their registration with the Care Quality Commission (CQC) from August 2017. A registered manager is a person who has registered with the 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. A new manager had been appointed on 24 July 2017. At the time of the inspection, they had applied to register as a manager with CQC.

The service was not well led. The service lacked effective leadership and the management style was often reactive rather than proactive. There was not an effective system to regularly monitor and assess the quality of the service and the risks to the people living there. The provider had not demonstrated good practice in the way they had recruited new staff and assessed people new to the service. They had not considered the impact on staff or people living in the home when they admitted a person as an emergency. The provider had not considered the outcome of not funding agency staff during day shifts which had impacted on staffing levels and resulted in two staff working long periods of time.

The provider had not kept people living at the home and relatives or visitors informed of the changes of management. They had imposed charges for equipment without an explanation to relatives or the person involved; they had not overseen how people’s personal allowances were managed. This meant there was no audit trail to record transactions and people’s relatives had been presented with bills backdated to 2015. They did not make records of their audits available at the service to show how they had judged the environment and people were safe and well cared for.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, there was not a consistent approach to making applications to the local authority in relation to some people who lived at the service. People were not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the systems in the service do not support this practice. People were not routinely involved in their care plans or reviews so their consent was not gained. Best interest decisions were not recorded and documentation linked to lasting power of attorney was not requested. These practices meant people’s legal rights were not protected.

Recruitment practice did not ensure all the necessary information was in place before staff started working at the home. We saw examples of kind care, with staff showing affection and compassion towards people. However, there were also practices which undermined people’s dignity and privacy. Staff were attentive and positive about their role but some people commented that they could feel rushed by some staff who did not take to time to ensure they understood them.

Safety checks were carried out but the systems in place were not thorough and potentially left people at risk of harm. Laundry arrangements and a lack of guidance around infection control posed potential risks to staff and people’s health. A few items of furniture were damaged and the odour in one room had not been addressed in an effective way. Work had taken place to re-decorate areas of the home and the furniture in the dining room had been updated, which people commented positively on.

People were supported to see, when needed, health care professionals. Care staff recognised changes to people’s physical well-being and visitors said they were kept informed by staff regarding their relative’s health and well-being. The administration and storage of medicines was well managed, apart from for one person, where their prescribed creams were inappropriately stored. People were supported with their meals, where needed, and people’s weight and fluid intake was monitored.

During our inspection, we found a number of areas that needed to improve to maintain the safety and well-being of people that had not been identified by the registered manager or the providers. We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made recommendations linked to the design of the environment, making complaints information accessible and end of life care. You can see what action we have told the provider to take at the back of the full version of this report.

We are taking further action against this provider and will report on this when it is completed. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 expectation 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 begin 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 months, 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 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.

During the inspection, we contacted the local authority safeguarding team, commissioners, deprivation of liberties team and community nursing team so they were aware of the potential risks to people’s safety and well-being at the home.

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.