St Andrews House

Updated 19 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 Care Act 2014.

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

This inspection was completed by 2 inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Andrews House 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 House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We asked the local authority and Healthwatch for any information they had which would aid our inspection. Local authorities together with other agencies may have responsibility for funding people who used the service and monitoring its quality. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spent time observing care and support in the communal areas and how staff interacted with people living in the home. During our inspection we spoke with 8 people and 1 relative. We did this to gain people's views about the care and to check that standards of care were being met. We also spoke with the registered manager, the deputy manager, 2 care staff and an externally commissioned care consultant who was supporting the management team.

We reviewed a range of records. These included care plans and records of medicines administration for 4 people. We looked at a variety of documents relating to the management of the service, including quality monitoring checks. We reviewed the recruitment process for 2 staff members.

Updated 19 January 2024

About the service

St Andrews House is a care home providing personal care to a maximum of 35 older people, including those living with dementia. At the time of our visit, 28 people were living there. Accommodation was provided across 4 floors in an adapted building. The provider is a registered charity run by a board of volunteer trustees.

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

This is the fifth consecutive inspection where the provider has failed to demonstrate compliance with the regulations and achieve the minimum expected rating of good.

At our last inspection, we found improvements were required around managing people’s risks and risks to support safe medicines management, infection control, management of falls, fire safety and quality assurance processes and the safe management of medicines. At this inspection, we found limited improvements had been made and issues remained. The provider remained in breach of the regulations.

People were at the risk of harm of preventable injury as the provider failed to ensure risks had been identified and mitigated. People were at the risk of infectious illness as the provider failed to ensure appropriate infection prevention and control practices were being consistently followed.

The provider did not have effective systems in place to review incidents, accidents or significant events to see if something could be done differently to keep people safe.

The provider did not have effective systems in place to identify improvements and drive good care. The management team and provider failed to keep themselves up to date with best practice in health and social care.

People received their medicines as prescribed.

People were supported by enough staff who had been appointed after safe recruitment processes had been followed.

People were protected from the risks of ill-treatment and abuse and staff had been trained to recognise potential signs of abuse and understood what to do if they suspected harm or abuse.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests; the application of the policies and systems supported good practice.

People were supported by staff members who were aware of their individual protected characteristics like age, religion, gender and disability. People were provided with information in a way they could understand.

The provider had systems in place to encourage and respond to any compliments or complaints from people or those close to them.

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 23 August 2023) and there were breaches of regulation regarding keeping people safe and the management of the location.

At this inspection we found the provider remained in breach of those regulations and the overall rating has changed to inadequate.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Andrews House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to keeping people safe and how the location was managed. 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.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.