About the service St Andrews Care Home is a purpose-built residential care home providing personal care to 57 people at the time of the inspection. The service can support up to 70 people.
People’s experience of using this service and what we found
People were exposed to the risk of harm due to a lack of robust risk management by the management of the service. People’s care plans and risk assessments were not up to date and lacked guidance for staff. Where care plans identified action was to be taken by staff to minimise the risk of harm to people, these were not always completed.
People had experienced unexplained injuries and bruising, these were not consistently investigated. Potential safeguarding concerns had not been referred to the local authority.
Incidents and accidents reported by staff were not reviewed or analysed by management or the provider. There was a lack of assurance that lessons were learnt, and action taken to minimise the risk of these types of events happening again.
We were not assured the provider was doing all that was needed to ensure COVID-19 outbreaks would be prevented at St Andrews Care Home. The service was not consistently following Government guidance, about how to operate safely during the COVID-19 pandemic, in areas such as the wearing of personal protective equipment (PPE) and actions required when people were isolating.
The provider had failed to act to rectify shortfalls found at previous inspections. This is the third consecutive inspection where the service has been rated requires improvement, and is now inadequate, in the Well Led domain with a breach of the regulations.
Management had failed to use the care planning, risk assessment and monitoring systems in place effectively to ensure that people were safe. Action had not been taken where identified by the care planning alert system. Concerns relating to the health, safety and well-being of people were not responded to in a timely manner.
The provider had failed to ensure the service was consistently well-managed with effective oversight and governance.
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 8 February 2020) and there was a breach in 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 enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to wound management, pressure care, incidents and management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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 coronavirus and other infection outbreaks effectively.
The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Andrews Care Home on our website at www.cqc.org.uk.
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 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 breaches in relation to the assessment of risks to people’s health and well-being, safeguarding people from harm and management oversight at this inspection.
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
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.
Special Measures
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.