We carried out an inspection of St Andrews House on 16 and 17 January 2018. The first day wasunannounced.
St Andrew's House provides accommodation and both nursing and personal care for 24 people who have a physical disability. It is an extended, detached older property located in the town centre of Barnoldswick. Accommodation was provided on two floors with a passenger lift. There were 13 people accommodated in the home at the time of the inspection.
St Andrews House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service was managed by a registered manager who had been in post since September 2017 and registered with CQC in December 2017. A registered manager is a person who has registered with the CQC 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 on 1, 2 and 11 August 2017 we found seven breaches of regulation in respect of infection control, recruitment processes, maintaining the environment, medicines management, care planning and risk assessment and quality assurance systems. The overall rating for this service was ‘Inadequate’ and the service was placed in special measures. This meant the service was kept under review and an inspection would be undertaken within six months to ensure significant improvements have been made. At that time we asked the provider to complete an action plan to show what they would do to improve the service and by when.
Following the last inspection regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. Admissions to the home were suspended until commissioners and CQC were satisfied that significant improvements had been made. The medicines management team, infection control team and local commissioners worked with the provider, registered manager and staff to support them with improvements. Recent feedback from other agencies was positive regarding the improvements made and an action plan was available to support further improvements. The local authority suspension on admissions was lifted.
During this inspection we found new quality assurance and auditing processes had been introduced to help the provider and the registered manager to effectively identify and respond to matters needing attention. However some of these improvements had been introduced over a short period of time and were in their infancy; further work was needed to embed these processes into the day to day practice at the home. Therefore our findings demonstrated there was a continued breach of the regulations in respect of effective quality assurance systems. You can see what action we told the provider to take at the back of the full version of the report. We will check this during our next planned comprehensive inspection.
Since the concerns raised at the last inspection the registered manager, directors and staff had worked hard as a team to introduce much needed changes and improvements. People and staff were happy with the improvements that had been made and considered the service was managed well. Communication had improved and people felt they had been involved in decisions and consulted about any changes.
People were happy with the personal care and support they received and made positive comments about the staff and about their willingness to help them. They also made positive comments about the registered manager and the directors. The registered manager, directors and staff were observed to have positive relationships with people living in the home and people were relaxed in their company.
Improvements had been made to ensure the home was a clean, safe, bright and comfortable place for people to live in. Appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People told us they were happy with the improvements to the home and described how they had been involved in decisions about the changes.
The recruitment of new staff had improved. A safe and robust recruitment procedure was followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent. People considered there were enough suitably skilled staff to support them when they needed any help. Staffing levels were monitored to ensure sufficient staff were available.
The way people’s medicines were managed had improved. People had their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely. Additional training had been arranged for staff.
The systems to obtain the views of people, their visitors and staff had been improved. People felt their views and choices were listened to and they were kept up to date with the recent changes. They were encouraged to be involved in the decisions about the day to day running of the home and were kept up to date with any changes. People told us that communication between management, staff and people in the home had improved.
Records relating to people’s care and support had improved. The information in people’s care plans was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and they were involved in decisions about their care; arrangements were in place to improve their involvement in the review of their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.
People told us they felt safe in the home and staff were caring; they said they were very happy with the service they received. People appeared comfortable in the company of staff and it was clear they had developed positive trusting relationships with them. Safeguarding adults' procedures were in place and staff understood how to protect people from abuse. There were no restrictions placed on visiting times for friends and relatives.
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.
From our discussions and observations it was clear staff acknowledged people’s diversity, treating people equally and ensuring that they promoted people’s right to be free from discrimination.
We found people had access to a wide range of appropriate and meaningful activities both inside the house and in the local community. People told us they enjoyed the meals and their dietary needs and preferences were met. People were offered a choice of meal; food and drinks were offered throughout the day. We observed meal times were a relaxed and enjoyable social experience.
People told us they were happy and did not have any complaints. They knew how to raise their concerns and compliments and were confident they would be listened to. Appropriate and prompt action had been taken to respond to people’s concerns and suggestions.