Archived: St Andrews Court

St Andrews Court is a care home which is registered to provide personal and nursing care for up to 12 people with mental health needs. St Andrews Court accommodates 12 people in one adapted building and there were 12 people being supported at the time of our inspection.

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

Numerous incidents including abuse and/or allegations of abuse were not adequately responded to and escalated to relevant partner agencies such as the local authority. This meant people were not protected from harm. People did not all feel safe. Incidents including where people and staff had come to harm, were not learned from and risks were not adequately managed. This was a breach of the regulations.

We identified a second breach of the regulations due to inadequate risk management and further significant shortfalls in the safety of the service. People’s risks and complex needs were not adequately assessed and known to all staff, and the premises presented hazards and further risks to people’s safety. Where people’s risks were known to staff, they were not consistently managed. Systems also failed to ensure safe medicines management at all times.

We identified a third breach of the regulations because there were not enough suitably skilled and qualified staff, including nurses, to safely meet all people’s needs. This meant clinical support, agreed with local authorities, could not always be provided to people. Recruitment checks had been carried out appropriately and the home was clean.

People’s needs were not adequately assessed or always known to staff. This meant people’s needs could not always be met. People gave mixed feedback about the support provided. Staff did not have adequate training and guidance for their roles.

Staff did not always take care to ensure people had enough to eat. People’s choking risks were not effectively managed which put people at risk of harm. People gave mixed feedback about the food; some people made and prepared their own meals.

People were not 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 systems in the service did not support good practice and we identified a fourth breach of the regulations, around consent.

The provider failed to ensure the service was adapted to meet all people’s needs. The service was decorated in a homely way. Staff helped people to access healthcare support.

We identified a fifth breach of the regulations because the provider failed to consistently support people’s autonomy, independence and involvement in the community. Institutional practices negatively impacted on people’s dignity, privacy and positive experiences. People were not all encouraged to have control and choice as far as possible.

People were not always well treated and supported, and people’s diverse needs were not always met. Staff often had a caring approach, but this was not consistent. People were not adequately supported to have their needs heard and met.

We identified a sixth breach of the regulations because people did not all receive personalised care and were not empowered to have choice and control over their care. People were not involved in care plan reviews, and the views people expressed were not always listened to. Care planning failed to ensure everyone had good access to activities and have their communication needs met. People did not show full confidence in the complaints process.

We identified a seventh breach due to the provider’s continued failure to notify CQC of specific events and incidents at the service as required by law.

We identified an eighth breach related to the provider’s poor governance systems which exposed people to ongoing risk of harm and poor care. Our inspection found widespread and significant shortfalls in the quality and safety of the service. Systems failed to ensure risks and incidents were appropriately responded to; that there were adequately skilled staff to safely meet people’s needs; that regulatory requirements were met and that there were continuous and sufficient improvements to the quality and safety of the service. The provider failed to understand the principles of good quality assurance and failed to act to address serious concerns highlighted through our urgent enforcement activity.

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 Requires Improvement (published September 2018).

At this inspection, enough improvement had not been made and the provider was still in breach of regulations for their continued failure to notify the Commission of specific incidents and events as required. This inspection found the provider was in breach of additional regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection, we identified an additional seven breaches of the regulations. This was because the provider failed to provide safe care and treatment and to adequately protect people from abuse and improper treatment. The provider failed to ensure there were enough, sufficiently skilled staff and consent was appropriately sought for the care and treatment provided. The provider failed to ensure people were always treated with dignity and respect and that people always received person-centred care. The provider failed to establish and operate effective systems and processes to ensure compliance with the regulations and to assess, monitor and improve the quality and safety of the service.

After our inspection, we took urgent enforcement action to require the provider to immediately address significant concerns that placed people at immediate risk of harm. We informed relevant partner agencies of our serious concerns and carried out a further visit to check what action the provider had taken to ensure people’s safety. We found the provider had failed to take enough action to ensure people’s safety and we identified additional concerns that continued to place people at immediate risk of harm. We continued to liaise closely with the local authorities and other relevant partners. We also carried out responsive inspections of other services registered with the provider based on the concerns at this service. Due to the seriousness of our concerns we took further enforcement action to remove this location from the provider’s registration. The local authority sourced alternative homes for each person who previously lived at St Andrews Court and this service is no longer active.

Follow up

During and after our inspection processes, we requested information from the provider about what action they were taking to address our serious concerns. We also worked alongside the relevant local authorities in light of the immediate and urgent concerns we identified. We placed the provider into special measures and carried out urgent and non-urgent enforcement action in relation to this service. During our enforcement processes, we continued to monitor the service for any further concerning information to help inform our inspection activity. At the time of publishing this report, the service has been de-registered by CQC.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service was therefore placed into ‘special measures’. We have completed the process of preventing the provider from operating this service by varying the conditions of the provider’s registration.

The home is registered to provide accommodation and personal care for adults who have a mental health related illness. A maximum of 12 people can live at the home. There were 11 people living at home on the day of the inspection.

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 service is run.

At the last inspection, the service was rated Good overall with the rating of Requires Improvement for safe. This was because the provider needed to improve their medication systems. The rating for safe remains as Requires Improvement following this inspection as medication management required further improvement and reporting procedures needed to be improved to ensure where required a notification was sent to CQC. We have made a recommendation about the management of some medicines.

The provider had a programme of audits in place to monitor the quality and safety of people’s care and support. The provider continually strived to make things work better so that people benefitted from a home that met their needs. However, further improvements are needed to demonstrate the provider’s overall governance on how reportable incidents are recognised and sent to the Care Quality Commission as part of their regulatory responsibilities.

People told they felt safe living at the home and that staff supported them to maintain their safety. Staff told us about how they minimised the risk to people’s safety and that they would report any suspected abuse to the management team. People got the help needed because staff offered guidance or support with their care that reduced their risk of harm.

There were staff available to meet people’s needs and respond to requests for support in a timely way. People told us they received their medicines from staff who managed their medicines in the right way. People also felt that if they needed extra pain relief or other medicines as needed these were provided. Staff wore protective gloves and aprons to reduce the risks of spreading infection within in the home.

People told us staff knew about their care and support needs. Staff told us they understood the needs of people and their knowledge was supported by the training they were given. Staff knowledge reflected the needs of people who lived at the home. People told us staff acted on their wishes and their agreement had been sought before staff carried out a task. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

People told us they enjoyed their meals, had a choice of the foods they enjoyed and were supported to eat and drink enough to keep them healthy. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us they enjoyed spending time with staff, chatting and relaxing with them. We saw people’s privacy and dignity was maintained. People’s day to day preferences were listened to by staff and people’s choices and decisions were respected. Staff knew it was important to promote a person’s independence and to ensure people had as much involvement as possible in their care and support.

People were involved in planning their care, which included their end of life planning where required. The care plans reflected people’s life histories, preferences and their opinions. People told us staff offered them encouragement to remain active and maintain their hobbies and interests. People also told us they enjoyed the social aspect of the home.

People were aware of who they would make a complaint to if needed. People told us they were happy to talk through things with staff or the registered manager if they were not happy with their care.

People enjoyed living in the home which met their needs and continued to develop their independent living skills. The registered manager and staff demonstrated their commitment to care for people. They linked with care provider forums ensured people had access to the local community. The service had a good links with health and social care professionals.

Everyone we spoke with was complimentary about the overall service provided, their care and the staff. One person who lived there told us, 'It is good here. I can come and go as I want'. Another person said, 'I would not like to have to go anywhere else to live I am happy here'.

We saw that people's needs had been assessed by a range of health care professionals including specialist doctors. This meant that staff had enabled people to have their health care and safety needs monitored and met.

People had been provided with varied food and drink options to prevent malnutrition and dehydration.

We found that the premises were spacious, adequately maintained, comfortable and safe.

Generally we determined that staffing levels were adequate to ensure that people's needs were met and that they were safe.

We saw that complaints processes were in place for people or their relatives to use if they were not happy with the service provided.

We saw that people were involved in making choices about what they wanted to do and what they ate and drank. One person told us that staff supported them to buy their clothes.

We found that people's care records provided an overview of people's needs and preferences. We found that people were involved in their care planning and a range of different activities. So that they were supported to do the things that were important to them. One person told us, "I was involved in my care planning'.

We found that arrangements were in place to ensure that people were safeguarded from abuse.

The provider ensured that staff were properly trained, supervised and appraised. Staff were properly supported so that they could provide safe care to people living in the home.

There was a system to monitor the quality of service people received through regular reviews and audits.