Archived: Andrin House Nursing Home

Andrin House Nursing Home is a residential care home providing personal and nursing care to people in one adapted building. The service can support up to 37 people. At the time of inspection there were 30 people using the service.

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

People received their medicines safely from trained staff. Guidance for staff to follow when administering medicines to be taken 'as and when required' was not on all care files. We found thickener (used to reduce the risk of choking if someone had difficulties swallowing) in a person's room which meant not all medicines were stored securely.

Recording of kitchen cleaning and temperature checks had lapsed but we did not find any negative impact had been caused to people. Staff had been trained in infection control and used appropriate personal protective equipment (PPE).

Quality assurance checks were effective in most areas of the service. However, audit processes had not identified the issues with the kitchen checks or gaps in some records related to people's care, for example, repositioning charts.

We have made a recommendation about the quality assurance checks in the service.

People were cared for safely. Staff understood safeguarding procedures. Safe recruitment practices were followed to ensure staff were suitable for their roles. Lessons were learned when things went wrong.

People’s care files contained clear information about their care and support needs. Staff knew people well and had a good understanding of their wishes and individual preferences. People’s personal histories, preferences and dislikes, diversity needs such as cultural or religious needs and links with family were all considered within the care plans. Staff received training to meet people’s needs.

Where required, people were supported with their eating and drinking to ensure their dietary requirements were met. People were supported to promptly access health care services when needed.

There was on ongoing redecoration programme. Improvements had been made to the décor and environment since the last inspection.

People received support from consistent, compassionate staff. Staff were caring in their approach and had positive relationships with people and their relatives. People were treated with respect. Staff maintained people’s dignity and promoted their independence. Consent was sought before care was delivered.

The registered manager was committed to driving improvements of the service and ensuring people received high quality care. The management team were aware of their legal responsibilities and worked in an open and transparent way. Feedback was sought from people, relatives and staff.

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

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 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Andrin House Nursing Home accommodates up to 37 people in an adapted building. At the time of the inspection 23 people were using the service. People using the service have an identified nursing need, which includes people living with dementia.

Andrin House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection on 23 and 24 April and 2 May 2018, we asked the provider to take action to make improvements. To promote the safety and welfare of people and further promote their safety and well-being through robust staff recruitment processes and the ongoing supervision and appraisal of staff. To provide care and treatment that was personalised and met their needs. To meet their conditions of registration through the appointment of a registered manager. And to have effective governance arrangements to monitor the quality of the service.

The provider had taken action to make improvements following the Care Quality Commission (CQC) inspection of April and May 2018.

Andrin House Nursing Home had a 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had engaged the services of a consultancy firm to support them in bringing about the required changes to the governance of the service. The registered person reviewed internal audits as to the quality of the service that were carried out by the registered manager. However, audits in two areas, care planning and medicine, had not identified the shortfalls found through the CQC inspection. The registered person and registered manager, regularly met to review their progress in the changes made.

The registered person and registered manager, with the support of the consultancy firm were looking to prioritise further plans for improvement, based on risk, detailing the improvement, how it was to be made, the person with the overall responsibility and the timescale involved.

The provider had been transparent and had displayed the rating following the previous inspection within the service and on the website as required by legislation. The provider had met with staff following the previous CQC inspection and the minutes noted they had taken responsibility for the shortfalls found and discussed the areas for improvement.

People using the service, family members and staff had completed questionnaires to identify areas of improvement. The registered manager had analysed the results and had made tangible improvements in the day to day management of the service, which had had a positive impact on people using the service and the staff employed.

The registered manager had reviewed the policies and procedures for the service and had undertaken a range of audits to assure themselves of the quality of the service being provided. A system for supporting staff had been introduced, which included regular supervision, meetings and training. Information kept within staff files had been reviewed by the registered manager and updated where appropriate. Staffing levels were kept under review and were flexible to meet the needs of people.

We found improvements were required to ensure information was consistently in place for staff to follow, where medicine had been prescribed to be taken as and when required, to ensure consistency of its use. We found improvements in the monitoring of the safe storage and administration of medication had been introduced. People were confident that they received their medicines as prescribed and records confirmed this.

We found improvements were needed to documentation completed by staff recording people’s care and support. We found there was duplication of some information along with missing information. Not all records were stored in one place, which meant some records were not always being completed. This meant that when people’s needs were reviewed some information was not being considered. The registered manager confirmed that documents to record people’s specific needs, such as dietary intake would be reviewed. To support the effective use of information to help staff in the reviewing of people’s care to ensure it met their needs.

Potential risks to people had been reassessed with the involvement of the person and family member. Measures had been introduced to reduce potential risks and these were documented with clear links to people’s care plans. People using the service and family members were confident that they were safe.

People’s capacity to make informed decisions had been considered and family members had been involved in the assessment process and the development of care plans. People were supported to have maximum 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.

We observed positive interactions between people using the service and staff. People’s privacy and dignity was supported and staff were aware of the importance of confidentiality. People in the main spoke positively about staff and the service and care they received.

People’s care, support and treatment had been reassessed and had been used to develop care plans reflective of people’s needs, which were person centred reflecting their wishes and preferences and included the views of family members. People’s care plans included, people’s wishes regarding end of life care, where they had chosen to share their views.

People using the service and family members were aware of recent changes in the management of the service. Family members, told us they appreciated the direct approach of the registered manager and confirmed that any comments they had made had been acted upon. Family members were aware of how to make a complaint, however they told us they had had no need to make a formal complaint.

The noticeboard provided information on a range of topics, which included the complaints procedure, the date of future events including social activities and dates of meetings for those using the service and family members.

Andrin House Nursing Home did not have a 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The manager of Andrin House Nursing Home was on planned leave at the time our inspection. A manager of the registered person’s other service based in Leicester, facilitated the inspection.

Andrin House Nursing Home accommodates up to 37 people in an adapted building. At the time of the inspection 24 people were using the service. People using the service have an identified nursing need, which includes people living with dementia.

Andrin House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The overall rating for the service awarded at the previous inspection which took place on 1 and 14 June 2017 was requires improvement at which time we identified two breaches of the regulations. Following the last inspection we asked the provider to take action to make improvements to promote people’s safety and to improve systems and processes to monitor the quality of the service. The provider submitted an action plan outlining their plan for improvements.

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 expectations 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 being 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 month, 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 service 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 no longer rated as inadequate for any of the five key questions it will no longer be in specialist measures.

The registered person and manager did not have systems and processes to assure themselves as to the quality of the service being provided. This lack of oversight as to the quality of the service and the services governance meant shortfalls and areas for development and improvement had not been identified. A number of external stakeholders had identified improvements were required in a number of areas, which had resulted in the developing of action plans to bring about improvement. We found some evidence to support that the action plans developed by the external stakeholders were being implemented. The leadership and management of the service were not effective. This directly impacted on the quality of support and care people received and meant they did not experience the best possible health and quality of life outcomes.

The provider’s policies and procedures for the governance of the service, with regards to quality assurance, staff supervision and appraisal were not implemented. There had been very limited opportunities for staff to receive feedback about their performance as there were minimal staff supervisions and a lack of regular team meetings. Staff had not had an appraisal and there was no system to assess the competence of staff.

Systems to support staff recruitment were poor as some staff records did not contain the information required to ensure they were appropriate to work within the care sector. The support staff received upon their appointment was haphazard as there was no clear system for the induction of staff. We found no records to evidence staff induction. We found there were sufficient staff to meet people’s daily care needs. Staff had received training in a range of topics, however staff had not received training to enable them to support people effectively when their behaviour challenged.

People’s needs were not sufficiently assessed before they moved into Andrin House Nursing Home. People’s needs were regularly reviewed, however people’s care plans and risk assessments were not updated to reflect people’s changing needs and referrals to external health care professionals were not always made when a person’s needs changed. People did have regular access to a doctor who visited the service regularly at the request of a nurse.

People’s views about the service had not been sought and there was no system in place for people to influence or make decisions about their environment and the care they received. People were not supported to have maximum choice and control of their lives and staff did not fully support them in the least restrict way possible; the policies and systems in the service do not support this practice.

People did not receive person centred care; there were institutional approaches and practices to care being observed and documented, which meant people did not receive individualised care or care as detailed within their care plan. We observed some people were encouraged to take part in activities, for example board games or reading a newspaper. However there were a number of people seated in comfy chairs in the communal room, who spent a majority of their day with their eyes shut as there was little to stimulate them.

People's safety could not be assured as records were not always accurate and information staff had access to promote people's safety, which included risk assessment and care plans did not contain sufficient, consistent or up to date information. People’s medicine was managed safely.

People's nutritional needs were assessed however these were not always an accurate reflection of their needs. Records recording people’s food and fluid intake were not reviewed to identify whether their food and fluid intake was sufficient for their needs. The dining experience for people was not optimised, with people sitting at the table for lengthy periods of time before their meal was served.

People who used the service and visiting family members spoke positively about the care.

The registered manager of the other service, owned by the provider, had when we returned on 2 May 2018 begun to bring about improvements. The contents of staff files had been reviewed and staff had been informed as to what information was required so that their suitability to work within the care sector could be assured and the required documents kept within their records. A schedule for the supervision of staff had been put in to place.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Andrin House provides accommodation, nursing and personal care to up to 37 older people. It is located in a residential area of Derby, close to the city centre. The premises are on two storeys with a passenger lift for access, a range of bedrooms, lounges, a dining area, and a secluded garden. At the time of our inspection there were 30 people using the service.

The service has not had a registered manager since 18 February 2016. 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. The provider told us he was in the process of recruiting a manager for the service who would be registered with CQC. This is necessary as it is a condition of the provider’s registration that a registered manager is in place.

The atmosphere at the service was warm and friendly and people and relatives told us the care provided was good. They said they thought the service was well-managed and made many positive comments about the manager. However the provider did not have effective systems in place to ensure that people always received good quality safe care in a suitable environment.

Improvements were needed to the premises. For example, we found unrestricted windows, water in hand basins that was too hot, radiators without appropriate covers, and an unlocked store cupboard containing hazardous chemicals. Improvements were also needed to the way staff were supported and supervised and people’s views on the service collected and responded to.

Although people and relatives told us they thought people were safe at the service improvements were needed to the way risk was managed. One safeguarding incident had not been reported to the local authority and CQC and some people’s care plans and risk assessments were not fit for purpose. Some improvements were also needed to medicines management.

Staff mostly had the training they needed to provide effective care, although some staff had not completed recommended fire safety training. People and relatives said they thought the staff were well-trained. During our inspection visits we observed staff working with people in a skilled and competent manner.

People told us the care and nursing staff provided good quality care and we saw example of this during our inspection visits. Care plans were personalised to give staff an idea of the person themselves and their likes and dislikes. They contained details to help staff meet people’s needs in the way they wanted, for example, how many pillows they liked on their bed and the type of music they preferred. However, some people’s care records were incomplete so we could not be sure the care they received was responsive.

People and relatives said they were satisfied with the numbers of staff on duty. They told us staff were quick to come to people’s assistance when they needed it and we observed this in practice. There was a constant staff presence in the lounges and staff continually checked on people in other parts of the premises to ensure they were safe.

People made many positive comments about the food served. They told us they had plenty of choice and could have second helpings if they wanted. When lunch was served the food was fresh, nutritious, and well-presented. If people needed support with their food and drink staff provided this.

The service employed both nurses and care staff and people could see their GPs and other healthcare professionals when they needed to. Some people’s records showed that their heath had improved since coming to the service.

People and relatives told us they were involved in making decisions about people’s care and support. During out inspection visits we saw staff always asked people for their consent and offered them choices before providing assistance and support. Staff had been trained in the MCA (Mental Capacity Act) and knew how to protect people’s rights.

People and relatives told us the staff were caring and kind and always found the time to interact with people. There was a calm and relaxed atmosphere at the service with relatives coming and going and having cups of tea with their family members. Relatives told us staff were patient with people and knew how to comfort them if they became distressed.

Staff provided people with dignified care and support. People had access to a range of communal areas, the garden, and their own bedrooms so they could choose whether to have company or spend time on their own. People’s bedrooms were personalised and people had brought some of their own possessions to make their bedrooms more homely.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an unannounced inspection of Andrin House in October and found two breaches in legal requirements. Those were in relation to Regulation 19 HSCA (Regulated Activities) Regulations 2014, fit and proper persons employed, and Regulation 17 HSCA (Regulated Activities) Regulations 2014, good governance.

Following the inspection the provider wrote to us to tell us what actions they would be taking to meet the breaches which had been identified.

We undertook this focused inspection on 21 December 2015 to check they had made improvements and to confirm that they now met the legal requirements in all the areas of concern that we identified. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Andrin House on our website at www.cqc.org.uk.

Andrin House is a care home with nursing for up to 37 people and specialises in care for older people. It is located in a residential area of Derby, close to the city centre.

There was no registered manager in post. An acting manager was covering this position. 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 focused inspection on 21 December 2015 we found the provider had made improvements to the recruitment process to ensure that all staff were suitable to work at the service. We saw that staff files contained evidence that appropriate checks were completed prior to staff commencing work at the service.

We saw that improvements had been made in relation to staffing levels and that there were sufficient staff on each shift to meet the needs of the people living at the service.

At our last inspection we found that the provider had not put in place suitable arrangements to monitor the quality of the service and there was no analysis of adverse incidents and events to prevent a reoccurrence. At the focused inspection on 21 December 2015 we saw that improvements had been made and there was evidence of actions being taken as a result of quality monitoring audits. This included complaints, feedback forms and meetings. We also saw there was evidence of actions being taken as a result of incidents and accidents and these results were analysed in order to attempt to prevent reoccurrence.

One the day we inspected the provider had 21 people using the service.

People we spoke with were happy with the care provided. Comments from people who used the service included: 'I've never been happier', 'they keep a good eye on you' and 'marvellous'.

People had care plans in place. Monthly reviews had been completed but not all care plans reflected the information contained in these reviews. This meant that staff may not have been aware that the person needs had changed. We found that not all risk assessments were being completed correctly.

We found that medication levels were not always recorded correctly and that relevant protocols were not in place.

The provider was not up to date with mandatory tests such as those of electrical items and gas safety. No audits of the building were completed to ensure it was adequately maintained.

Staff we spoke with told us that they felt supported. We found that not all staff were up to date with mandatory training. Supervision had not occurred in line with the provider's identified frequency.

The provider had a complaints system in place. There had been no formal complaints within the last 12 months. There were regular meetings with people who used the service and their relatives to gain feedback on the service provided.

During this inspection we spoke to people about these specific outcomes. People told us that they all felt well cared for. One person stated "I'm quite content with the treatment I get here", another told us "the care is perfect". Most people stated that they get to see a Dr immediately if they are unwell.

A visiting health professional told us that the provider was very professional and that they had found that staff knew the care needs of people who used the service.

We found that the provider had put in place systems to monitor cleaning schedules and that care plans were up to date and appropriate action taken. The provider had ensured that resident and relative meetings had occurred and that staff were receiving regular supervision.

One person we spoke with stated "I love it. I think its wonderful", another person told us that they have "absolutely no complaints".

Although people were very happy we found some concerns with care plans, infection control and quality assurance.