St Andrews House

St Andrews House is a care home providing personal care to a maximum of 35 older people, including those living with dementia. At the time of our visit, 28 people were living there. Accommodation was provided across 4 floors in an adapted building. The provider is a registered charity run by a board of volunteer trustees.

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

This is the fifth consecutive inspection where the provider has failed to demonstrate compliance with the regulations and achieve the minimum expected rating of good.

At our last inspection, we found improvements were required around managing people’s risks and risks to support safe medicines management, infection control, management of falls, fire safety and quality assurance processes and the safe management of medicines. At this inspection, we found limited improvements had been made and issues remained. The provider remained in breach of the regulations.

People were at the risk of harm of preventable injury as the provider failed to ensure risks had been identified and mitigated. People were at the risk of infectious illness as the provider failed to ensure appropriate infection prevention and control practices were being consistently followed.

The provider did not have effective systems in place to review incidents, accidents or significant events to see if something could be done differently to keep people safe.

The provider did not have effective systems in place to identify improvements and drive good care. The management team and provider failed to keep themselves up to date with best practice in health and social care.

People received their medicines as prescribed.

People were supported by enough staff who had been appointed after safe recruitment processes had been followed.

People were protected from the risks of ill-treatment and abuse and staff had been trained to recognise potential signs of abuse and understood what to do if they suspected harm or abuse.

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

People were supported by staff members who were aware of their individual protected characteristics like age, religion, gender and disability. People were provided with information in a way they could understand.

The provider had systems in place to encourage and respond to any compliments or complaints from people or those close to them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 August 2023) and there were breaches of regulation regarding keeping people safe and the management of the location.

At this inspection we found the provider remained in breach of those regulations and the overall rating has changed to inadequate.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

The overall rating for the service has changed to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Andrews House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to keeping people safe and how the location was managed. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore

in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social 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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St Andrews House is a care home providing personal care to a maximum of 35 older people, including those living with dementia. At the time of our visit, 32 people lived at the home. Accommodation was provided across 4 floors in an adapted building. The provider is a registered charity run by a board of volunteer trustees.

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

This is the fourth consecutive inspection where the provider has failed to demonstrate compliance with the regulations and achieve the minimum expected rating of good.

The provider had failed to drive forward all aspects of required improvement at the home following previously identified breaches of regulation. There was a continued lack of effective governance, provider, and management oversight. Systems and processes used by the provider to monitor safety, mitigate risks, and drive improvement were not effective in identifying the concerns we found during this inspection. Some of the provider’s policies and procedures were not effective. We have made a recommendation to the provider in relation to the nominated individual continuing to update and embed their practice.

People remained at risk of avoidable harm. Environmental risks including those relating to fire safety were not identified by the management team or provider. Whilst people had access to external health and social care professionals to manage changes in their needs; care records were not always updated fully for staff to refer to. Infection control practices were not always followed, increasing people’s exposure to infection risks. Medicines management at the service did not follow best practice guidance or the provider’s policy. Not all staff had received training to identify and respond to people’s identified risks. Some people we spoke with told us staff were not always responsive when they used their call bell alarms. We have made a recommendation to the provider to review the systems in place to ensure people’s needs are responded to promptly and for the provider to maintain effective oversight.

Where people could make independent decisions about the care they received; most people felt they were involved in the care planning process. However, this was not consistent for some people. Staff understood the need to involve people in decisions about their care, however we received mixed feedback from people about their experiences of this. Some people told us they were not supported to engage in activities which were important to them. Activities outside of the home were not taking place for people who did not have regular informal support from their families. People told us activities taking place in the home had a positive impact on their well-being. The registered manager had measures in place to support people with communication needs and effective processes were followed to respond to complaints raised to the management team.

Where required, we checked the provider was lawfully supporting people under the principles and codes of practice of Mental Capacity Act 2005. We found 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.

People told us they felt safe and the service protected people from the risk of abuse. Staff were recruited safely with additional checks on their suitability undertaken.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 5 October 2022) and there were breaches of regulation. The provider continued to send us monthly action plans as per the imposed conditions on their registration which were imposed on 08 January 2020.

At this inspection we found insufficient improvements had been embedded into everyday practice. We found the provider remained in breach of the regulations.

Why we inspected

We undertook this focused inspection to check the provider now met their legal requirements. This report only covers our findings in relation to the Key Questions safe, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement based on the findings at this inspection. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Andrews House on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified continued breaches in relation to Regulation 12 (Safe care and treatment) and regulation 17 (Good governance). We have made recommendations in the safe and well-led sections of the full report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Requires Improvement' and the service remains in 'special measures' as there is still a rating of inadequate in key question, well-led. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social 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 next inspect, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

St Andrews House is a care home providing personal care to a maximum of 35 older people. At the time of our visit, 34 people lived at the home. Accommodation is provided across four floors in an adapted building. The provider is a registered charity run by a board of volunteer trustees.

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

This is the third consecutive inspection where the provider has failed to demonstrate compliance with the regulations and achieve the minimum expected rating of good.

Lessons had not been learnt and opportunities to improve the service had been missed. There was a continued lack of effective governance, provider and management oversight. In addition, the quality and safety of the service had deteriorated further since our last inspection and action had not been taken to address the breaches of regulations we had previously identified. Systems and processes designed to identify shortfalls and to drive improvement had not been strengthened and had not identified the concerns we found. Some of the providers policies and procedures were not effective.

Action was not always taken to protect people from the risk of abuse. People were at risk of harm because risk associated with their care, the environment risks and fire safety were not always identified, assessed or effectively managed. Some aspects of medicines management and the prevention and control of infection required improvement. Staff were not always recruited safely in line with the providers expectations. Some care plans lacked the information staff needed to provide personalised and safe care. Some action was taken to address this.

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. People were supported to maintain relationships and they spent their time doing things they enjoyed. The atmosphere at the home was relaxed, and people enjoyed the company of each other and staff. Staff felt supported. Despite our findings people were satisfied with the service they received, and people and their relatives felt the service was safe. There were sufficient staff on duty to provide people’s care and to support people to do things they liked and enjoyed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 September 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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 see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Andrews House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation safety and management of the home. We also identified breaches in relation to protecting people from harm, staff recruitment and overseeing the delivery of care and support.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social 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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St Andrews House is a care home providing personal care to a maximum of 35 older people. At the time of our visit, 23 people lived at the home and one person was in hospital. Accommodation is provided across four floors in an adapted building. The provider is a registered charity run by a board of volunteers. The home works within a Christian ethos.

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

People felt safe, but the provider remained unable to demonstrate environmental risks, including fire safety were well managed. Responsive action was taken by the provider to mitigate risks to people.

Staff knew how to manage risks, but guidance was not always in place to help them provide safe care. This shortfall had already been identified by the management team.

Safeguarding procedures were in place to protect people. The manager understood their responsibilities to keep people safe and knew when to share information with the local authority and CQC.

People received their medicines when they needed them, but the management of some medicines continued to require improvement.

Staff had been recruited safely and enough staff were on duty to meet people’s needs in a timely way. People were happy with the cleanliness of their home and staff practiced good infection prevention and control.

Some action had been taken to strengthen quality monitoring processes to improve outcomes for people, but the provider's quality assurance systems required further improvement. This demonstrated a failure to make and sustain improvements to benefit people.

People felt listened to and spoke positively about the management team, but further improvement was required to demonstrate feedback was consistently gathered and used to drive forward improvement.

Most relatives felt the service provided to their family members had improved. Overall, staff felt supported and enjoyed working at the home.

The management team welcomed our inspection feedback. They understood their responsibility to be open and honest when things had gone wrong.

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 (report published 12 February 2020). We identified four breaches of the regulations. Conditions were imposed on the provider’s registration which required them to provide us with monthly reports on how they were meeting the regulations. At this inspection not enough improvement had been made. The imposed conditions remain in place and the provider continues to be in breach of two regulations.

Why we inspected

The inspection was prompted by the failure of the provider and manager to provide CQC with assurance that timely action had been taken address the regulatory breaches and make required improvements which posed a risk to people. As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering

what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two continued breaches in relation to the safety of people’s care and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

People’s experience of using this service:

The service did not have a registered manager. The previous manager had retired in September 2019 and a new manager had been appointed. The new manager was not available during our inspection and following our visits we were notified they no longer worked at the service. The provider’s lack of oversight, knowledge and understanding of legislative requirements meant previously demonstrated standards and regulatory compliance had not been maintained. Effective systems were not in place to provide management support to senior staff or to identify service shortfalls, and to drive improvement. The provider’s policies and procedures were not fit for purpose. People and relatives felt they had not been consulted about changes made to the service and these had not been effectively communicated to staff.

Staff understood their responsibility to keep people safe. However, individual and environmental risk was not always identified, assessed and well-managed. This demonstrated lessons had not been learnt. Some areas of medicine management required improvement. Action was taken to address this. People’s needs were not always met in a timely manner. Despite our findings people told us they felt safe.

Staff were recruited safely. However, staff had not received the support and guidance they needed to fulfil their roles. Records indicated some staff had not completed an induction and staff training was not up to date. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People received care and support from staff who were caring, respectful and kind. However, people told us recently staff were not available at the times they needed them. People’s privacy and dignity was upheld, and their independence promoted. Staff understood the needs of the people they supported and staff practice demonstrated their commitment to providing good care. People were supported to maintain important relationships and had access to a health and social care professionals when needed.

People’s needs were assessed prior to moving into St Andrews House. However, the provider’s initial assessment tool did not create the opportunity to gather information about people’s varied beliefs, values and life style choices. Some care records did not provide staff with the information they needed to provide personalised care. Action was planned to address this. People and relatives felt able to raise any complaints and concerns. People could choose to take part in a wide range of individual and group activities.

People and relatives were very positive about the service provided but felt improvement was needed to the way the home was managed. Staff worked in partnership with other professionals to improve outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published July 2017).

This is the first time the service has been rated ‘Requires Improvement’.

Why we inspected: This was a planned inspection based on the previous rating.

The registered provider was in breach of Regulations 6, 11, 12, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Enforcement: You can see what action we have asked the provider to take at the end of this full report.

St Andrew’s House is a residential care home for 35 older people. It provides both permanent and respite care. At the time of our visit 33 people were living in the home. The provider is a charity ran by the Coventry and District Free Church Homes for the Elderly and the home works within a Christian ethos.

The 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.

At the time of our inspection visit the registered manager was on a leave of absence. Their duties were being covered by two deputy managers.

During our last visit the registered manager had not made applications for people who were being deprived of their liberty. During this visit we found an application had been made for one person but there were others in the home who met the conditions for an application to be made. After our visit, the registered manager confirmed to us they had made the relevant applications.

The home undertook general assessments of people’s mental capacity but these were not decision specific as determined in the Mental Capacity Act.

People felt safe living at St Andrews House. Staff understood how to protect people from harm, and provided good support to reduce identified risks. Medicines were managed safely.

There were enough staff available to meet people's needs, and staff recruitment procedures meant staff did not work at the home unless robust checks had been undertaken.

People and relatives thought staff were very supportive and caring. People's privacy and dignity was upheld, and staff respected people's wishes. Family and friends were welcomed to visit the home at any time.

People and their relatives were involved in planning their care, and people decided how they wanted to live their lives on a day to day basis. Staff supported people's choices.

People enjoyed their meals and the choices available to them. They were supported to access healthcare professionals when needed.

People, relatives and staff thought the management of the home were approachable and responsive to their needs. They could informally or formally approach management with concerns or issues for discussion. No formal complaints had been made.

There were effective management systems to assure people were safe and quality care was provided.

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Throughout our visit we saw people being responded to promptly and positively. Everyone we spoke with who lived at the home was positive about the quality of care, the environment and the choices. The only critical comments we noted were in the most recent survey and in a comment by one person regarding activities. This reflected the desire for more 'hands on' and individually tailored activities. The manager was aware of this and was able to assure us this was in the process of being addressed.

We saw people being supported in being as independent as possible. In the morning, people came to the front of the building to collect newspapers that the home had delivered for them.

We spoke with two people who were at the home for a short period. They told us the home was 'fabulous' and 'wonderful.'

We spoke with two visitors who told us, 'We're pleased with it.' They said, 'St Andrews had improved over the years. If we ever had to move to a home, we'd be happy to come here.'

On our inspection we found two of six medications looked at did not tally. We asked the provider to send us a report explaining what action they had taken to become compliant with Regulation 13, Management of medicines.

The report from the provider gave details of the new auditing procedures put in place to ensure that any errors in medication administration or recording would be promptly noted and rectified. It detailed how the new processes would reduce the likelihood of errors occurring. They also sent us a copy of the new recording tool, which showed a daily check of amounts of medications remaining in packets.

We saw people were comfortable in spacious, bright and clean surroundings. The home had been refurbished and extended to a high standard. There was still some work to be completed. The home had ample storage space so wheelchairs and hoists were all safely stored.

Staff were attentive and polite. We saw people being supported and moved appropriately.

We had very positive responses from relatives and people at the home we spoke with. 'Always made welcome' 'Happy atmosphere' 'Very satisfied with everything' 'Won't find anywhere better' were typical responses.

We noted some small discrepancies in two boxed medications that regular auditing by the service should have picked up.

The manager had been absent from the home for five months. This had been longer than expected. Some staff expressed concern about this. Relatives and people at the home we spoke with about this felt that the home was continuing to run well.