Archived: St Andrews Lodge

We received information prior to our visit on 8 October which gave us concerns that the improvements we had told the provider to make were not being sustained. Our evidence from this inspection and from information we received from Commissioners and other sources provided evidence that the improvements had not been sustained or developed. We found evidence that people were not receiving care which was safe and met their needs. People were not protected from the risk of abuse.

We found serious concerns in relation to the management of medicines in the service. We took a specialist pharmacist advisor with us to look at the medicines management in St Andrews Lodge. The specialist is the Head of Pharmaceutical Care and Clinical Standards for an independent provider. They had serious concerns about the governance of medicines which had a wide reaching effect on the safety of medicines management at St Andrews Lodge.

We found that staff were not always being recruited in a way which would protect people using the service from harm.

We found people were not being safeguarded from abuse or the risk of abuse. Some people had been assessed as needing close supervision from staff in order to protect other people from abuse and we found this close supervision was not always happening. This resulted in a high number of incidents between people using the service. We found staff were not always responding to people's basic care needs and this placed them at risk of neglect. We made sure these people were safe by telling the registered provider to take immediate steps and by referring people we had concerns about to the Nottingham City Council Safeguarding Vulnerable Adult's team.

Three people whose records we looked at had not had their medicines for pain as prescribed. This was because there was insufficient time since the last dose to allow the medicine to be given safely. Staff told us that the morning drug rounds on one unit in particular did not finish until 11:30 or 12:00. This means that subsequent drug rounds either start late or there is insufficient time between the drug rounds to allow a suitable time interval between doses. These people all lived on this unit.

Where medicines were prescribed to be given 'only when needed' administration guidance, to inform staff about when these medicines should and should not be given, was not in place. Staff confirmed that they did not have this information available.

Due to the complex needs of some people living at St Andrews Lodge they were unable to talk with us. We therefore used the Short Observational Framework for Inspection (SOFI) on one of the two units of the home. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We carried out this observation for a period of just over one hour during the morning.

We found people's dignity was not always respected and people were not always given choices about their care and support and consent was not always gained prior to care and treatment being given. .

Our observations and looking at records showed people were not always given safe and appropriate care. People were not always supported to maintain their nutrition.

We found people were not always protected from abuse or the risk of abuse as staff did not always act in line with training they had been given to respond to or report incidents.

We found the staffing levels were not being assessed to ensure there was enough staff to meet the changing needs of people using the service.

We found that complaints about the service were taken seriously, investigated and resolved with the person raising the concerns.

We looked at the care plans of two people who were at risk of weight loss and we saw their nutritional needs were planned for and monitored. One of these people had recently been discharged from the dieticians as they had made such good progress to maintain their weight.

We observed people who needed assistance with their meal and this was provided by staff in a discreet and respectful manner. It was apparent from observations that staff knew the needs of people and what level of support they needed.