Archived: St Andrews Lodge Care Home

Updated 28 July 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was 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 inspection visit took place on 9 and 10 August 2016 and was unannounced on both days. The inspection was carried out by one adult social care inspector and a specialist advisor on the first day and one adult social care inspector on the second day. The specialist advisor who supported the inspection had specialist knowledge in the care of people with mental health diagnoses. Prior to the inspection we reviewed the information we had about the home, including notifications of events the home is required by law to send us.

We spoke with almost all the people who lived in St Andrews Lodge Care Home. On this occasion we did not conduct a short observational framework for inspection (SOFI) because most people were able to share their experiences with us. But we did use the principles of this framework to undertake a number of observations throughout the home. This helped us understand the experiences of people when they were not able to communicate with us. We spoke in depth with six people who lived in the home, the registered provider and five members of staff. We also obtained feedback from three healthcare professionals about the home and people’s care.

We looked around the home, spent time with people in the lounge, in their rooms and in the dining room. We observed how staff interacted with people throughout the inspection and spent time with people over the lunchtime and evening meals. We looked at the way in which medicines were recorded, stored and administered to people and reviewed the processes in which people’s monies were managed.

We looked in detail at the care provided to seven people, including looking at their care files and other records. We also looked at some records relating to a further three people. We looked at the recruitment and training files for three staff members and other records in relation to the operation of the home, such as risk assessments, policies and procedures.

Updated 28 July 2017

St Andrews Lodge Care Home is a care home for people who are experiencing severe and enduring mental health conditions. The home provides accommodation, personal care and support for a maximum of 21 people. People who live at the home receive nursing care from the local community health teams.

The home did not have a registered manager, although, at the time of our inspection, one of the providers was in the process of applying to become the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection took place on 9 and 10 August 2016 and both days were unannounced. At the time of our inspection there were 19 people using the service. This inspection was the home’s first comprehensive inspection following a change in their registration.

The people living at St Andrews Lodge Care Home ranged in age from, 27 to 72 years old. Some people were more able than others, with six people requiring personal care and some people had needs relating to their mobility. Almost every person had needs relating to their mental health conditions and some required support in relation to alcohol and substance abuse. A number of people required support in relation to their behaviours which presented risks to theirs and others’ safety.

People who lived in St Andrews Lodge Care Home were not always safe. People had been exposed to harm from others whilst living in the home. People living in the home expressed concerns about this, with several people telling us they did not feel safe at the home. Where people had been harmed by others, staff had not always identified these as significant incidents, had not taken sufficient action to protect people, and had not reported them to appropriate agencies such as safeguarding or the police.

Appropriate action had not always been taken to protect people from the risk of harm. Risk assessments were sometimes not completed, or were very basic and did not instruct staff on how to minimise or manage risks. This included risk of suicide, risk of falls and risk of harm to self and others.

Decisions relating to the management of some risks were not always made in conjunction with outside professionals where required. It was not always clear how some decisions had been made, and some decisions that had been made exposed people to increased risk. For example, the decision not to monitor one person who was at risk of causing harm to themselves. This decision was not discussed with the registered provider, any outside professionals and no other protective measures were put in place to safeguard this person.

Staffing levels at St Andrews Lodge Care Home were not adequate to meet the needs of the people living in the home. During the day there were two members of care staff and the registered provider caring for the needs of 19 people. During the night there was one member of waking staff and one sleeping staff. People told us they felt there were not enough staff. People said “Staff sometimes are not always around” and “Sometimes you can’t find them”. Some staff raised concerns about the staffing numbers stating they felt these were unsafe. During the day staff had to tend to some people’s personal care needs, support people with any outings, appointments and activities, spend time with people and prepare all the meals for the home.

People at the home were not protected from discrimination and we identified concerns relating to the culture in the home. People were not always treated with respect and some comments used about people were degrading.

Staff had been using a behaviour management technique inappropriately in relation to one person. Where this person displayed behaviours, such as being verbally aggressive, staff instructed them to go to their bedroom for a ‘time out’. This technique, whereby a person is encouraged to manage their own behaviour through quiet reflection and time alone, was in this case used as a punitive measure and did not demonstrate respect for this person or their rights.

Staff did not have a good understanding of the Mental Capacity Act 2005 (MCA), and relevant mental capacity assessments and best interests decisions had not been completed. Blanket restrictions were applied to people without any reference to the individuals lacking the capacity to make the decision. Where people did lack the capacity to make certain decisions, there was no evidence of decision specific best interests decisions being made. Some of these rules were unnecessarily restrictive and qualified as restraints under the MCA.

People did not receive care which was person centred and reflected their individual needs. People were not involved in the planning of, and decisions about, their care. People’s care plans did not contain sufficient detailed information for staff to meet people’s needs. For example, where people had specific needs relating to their behaviours, staff did not have information about what triggered these behaviours in people, how they presented themselves, how they should best communicate with people and what actions to take to distract or manage people.

There were restrictive practices in relation to access to hot drinks. The registered provider had organised for ‘tea rounds’ to be conducted several times during the day and people had been instructed not to ask for hot drinks outside of those allocated times.

People’s support did not encourage development or recovery. People did not have personal goals they were working towards or plans to develop new skills or regain skills. Actions relating to improving people’s well-being or ensuring people felt comfortable in their home, had not been identified or acted upon.

The systems in place for assessing and monitoring the quality and safety of the care at the home had not been effective in identifying the issues we found during this inspection. There was a lack of oversight in relation to risks and protecting people from abuse. Records for people were not always accurate or up to date.

People spoke highly of the registered provider and felt they were approachable and would listen to concerns. People told us they enjoyed the food and we saw some nice interactions between people and staff.

There were safe processes in place to manage the administration, storage and disposal of medicines and there were safe staff recruitment processes in place.

In light of some of the significant concerns we identified relating to people’s safety, we made alerts to the local safeguarding team. Since the inspection the local safeguarding team, the local authority and commissioners have been working with the provider.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to people not always being protected from harm and people’s records not always being accurate or up to date. You can see what action we told the provider to take at the back of the full version of this report.

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.

Following the issuing of this report we served the provider with a notice to cancel their registration. The provider made representations in respect of this which were reviewed by an independent person within CQC. They upheld the notice of proposal. The provider did not take up their right of appeal to a tribunal so the notice took effect and the provider's registration was cancelled as a result.