This inspection took place on 19 and 20 July 2018, the first day was unannounced. Andrew Smith 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.
Andrew Smith House is registered to provide nursing and personal care for people living with dementia, old people physical disability, nursing care and mental health care needs. It is situated in Nelson, Lancashire. Accommodation is provided on four units on two levels, with a lift to both floors and wheelchair access to all parts of the home. The home can accommodate up to 60 people. At the time of this inspection, there were 44 people who lived in the home.
The service had a registered manager in place. 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.
We previously inspected this service in June 2016. The registered provider was compliant with all regulations at that time and the service was rated overall ‘good’.
During this inspection we found shortfalls in relation to the management of risks associated to receiving care. This was because risks to people and incidents had not always been analysed to identify patterns and ensure lessons were learnt. People’s medicines had not been safely managed and staff recruitment procedures were not robust to protect people. There were significant shortfalls in staff training. Quality assurance systems were not effective in identifying shortfalls or areas where the service was not meeting regulations and failure to drive improvements. In addition, there was a failure to demonstrate how the provider had promoted a culture that encouraged candour, openness and honesty.
We found there were six breaches of the Regulations. These were breaches of Regulations 12,17,18,19 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.
Staff had received safeguarding training and knew how to spot abuse and the reporting procedures. Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. However, there had been significant incidents that exposed people to risks. Some significant incidents had been reported to the local authority and the Care Quality Commission however, there was no robust formal system to analyse incidents. Accidents and incidents had been recorded and staff had sought medical advice where required however, there was no evidence of lessons learnt. Improvements were required to demonstrate what support people had received following incidents such as repeated entrapment by bedrails.
Staff had been trained in the safe management of medicines. However, there were some shortfalls in medicine management practices in the home.
Safe recruitment procedures had not always been followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place for training staff however we found significant shortfalls in training. Staffing levels were monitored to ensure sufficient staff were available.
Policies and practices for promoting, honesty, transparency and duty of candour had not been effectively followed when things had gone wrong with people’s care.
There were established governance arrangements and quality assurance processes. The provider had considered best practice and had been involved in the trial of innovative practices in collaboration with other agencies. However, the shortfalls we identified in people’s care showed the quality assurance processes were not robust and needed to be improved to ensure they identified where the service was not compliant with regulations.
Feedback from people and their relatives regarding the care quality was positive. People who lived at the home told us that they felt safe. Visitors, people who lived at the home and care staff spoke highly of the registered manager.
People were happy with the care and support they received and made positive comments about the staff. They told us they felt safe and happy in the home and staff were caring. People were comfortable in the company of staff and it was clear they had developed positive trusting relationships with them. However, our records showed that there were incidents in the home which had compromised people's safety.
The staff who worked in this service made sure that people had choice and control over their lives and supported them in the least restrictive way possible. However, some improvements were required to ensure records of people’s consent were kept.
The information in people's care plans was detailed to ensure they were at the centre of their care. Majority of people's care and support were kept under review however this was not consistent throughout the records we checked. Relevant health and social care professionals provided advice and support when people's needs changed. People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored.
The home was clean, and comfortable for people to live in. The environment was dementia friendly and the home had adaptations designed to suit the needs of people living at Andrew Smith House.
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. Staff respected people's diversity and promoted people's right to be free from discrimination.
There was a strong drive to facilitate community and social inclusion. People had access to a range of appropriate activities both inside the home and in the local community.
People were supported to maintain and develop their independence. The provider had sought people’s opinions on the quality of care provided.
People who used the service knew how to raise a concern or to make a complaint. The complaints procedure was available, and people said they were encouraged to raise concerns and were confident they would be listened to.
The registered manager and staff co-operated with the inspection and were keen to rectify all the shortfalls we identified. They took corrective measures to rectify a significant amount of the concerns during the inspection and soon after. However, we would have expected these issues to have been identified by the provider and rectified without our intervention.