Andrew Smith House - Nelson

Updated 31 August 2022

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 Health and Social Care Act 2008.

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

One inspector, one medicines inspector, one specialist nurse advisor and one Expert by Experience undertook the inspection. 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

Andrew Smith House – Nelson 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. Andrew Smith House – Nelson is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was not a registered manager in post. There was a manager newly recruited to the post however they were previously the deputy manager at the service. The manager had commenced the application process to be registered with the Care Quality Commission.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection we looked at all information we held about the service and asked for feedback from professionals and partner agencies. We also reviewed concerns and complaints raised by people. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with seven people who used the service and ten relatives over the telephone as well as two people in the service. We also spoke with 16 members of the staff team. These included, two housekeeping, one laundry assistant, a kitchen assistant, one maintenance staff member, two care staff, one senior carer, one administrator, two nurses, the deputy manager, the manager, a director and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We undertook a tour of the building as well as observations in the communal areas of the service and the storage of medicines. We looked at five care records and associated documents including 11 medicines administration records and related documentation. We reviewed five staff files, training records, and audits and monitoring in relation to the management and oversight of the service.

Updated 31 August 2022

About the service

Andrew Smith House – Nelson is a residential nursing home, providing accommodation for up to 60 persons, who require nursing or personal care. It specialises in providing care for people living with a dementia, learning disabilities or autistic spectrum disorder, older people, people with a physical disability and younger adults. The service is purpose built and split into four units over two floors. There were 54 people living in the service at the time of the inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. One of the units in the service supported up to 10 people who were living with a learning disability. At the time of the inspection there were eight people living on this unit.

Right Support: a range of policies and procedures were in place which supported and guided staff. Staff were supportive of people’s individual needs and people were noted to be undertaking activities of their choosing. We saw people accessing the community safely, as they wished.

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. We have made a recommendation in relation to ensuring people are involved and supported in making decisions about their care.

Right Care: person centred individualised care was promoted and staff clearly understood the needs of people and supported their privacy and dignity. Training programmes were in place and ongoing. Staff were observed engaging positively with people and promoting person centred support. However, we made recommendations about, ensuring relatives are kept informed about people’s assessed needs and professional reviews.

Right Culture: There was a positive atmosphere in the service. Staff were confident in ensuring people received good, effective care and promoting good outcomes for people. The manager was open and honest and provided evidence of areas to improve the service.

People told us they felt safe, and staff understood how to deal with allegations of abuse. The service continued to manage medicines safely. Risks were assessed and managed. Infection prevention and control was being managed. Where masks were not always being worn, in line with current guidance the manager confirmed they would take action to ensure these were worn safely. Staff recruitment was on-going. We discussed the importance of ensuring newly recruited staff were supported in their role by existing and skilled staff. We made a recommendation about sufficient and experienced staff deployed in the home.

Not all people told us they were asked for consent. Staff training, supervision and appraisals were ongoing. There was evidence of assessments undertaken however not all relatives confirmed they were kept informed and updated, we made a recommendation about this. Records included information in relation to the involvement of professionals. Not all relatives confirmed they had been informed of reviews.

People were mainly positive about the care they received and confirmed they were treated with dignity. Others told us of concerns about living in the service and support they received. We made a recommendation about ensuring people were involved and supported in making decisions. We observed staff ensuring people’s, privacy and dignity was respected. Records were stored securely with passwords and login details for staff to access computers.

Care records contained information about how to support people’s individual needs. Where these required reviewing, we were advised this would be undertaken as soon as possible. People’s end of life care needs were recorded where relevant. Not all people or relatives confirmed they had been involved in reviews. There was a dedicated activities team and evidence of activities undertaken. A system to handle complaints was in place. Not all people and relatives fedback that their concerns had been dealt with we made a recommendation about this.

We saw evidence of surveys and meeting minutes. However, not all people and relatives confirmed they had been engaged and involved. Audits were undertaken including senior audits and action plans going forward. The new manager, who had been the deputy manager told us, and we saw records to confirm the actions planned to address the gaps in the follow up of these. We received mixed feedback about the manager. Staff were positive about the new manager and the improvements since they came to post. Certificates of registration were on display and notifications were being submitted to the Care Quality Commission.

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 good (published 2 October 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Andrew Smith house -Nelson on our website at www.cqc.org.uk.

Recommendations

We have made recommendations about, ensuring people are involved and supported in making decisions about their care, ensuring relatives are kept informed people’s assessed needs and professional reviews, the deployment of sufficient and experienced staff and the management of complaints and concerns.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.