St Andrew's Nursing and Care Home

Updated 20 October 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

The inspection was carried out by two inspectors.

Service and service type

St Andrew's Nursing and Care Home 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. St Andrew's Nursing and Care Home 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used information the provider sent us. We used all of this information to plan out inspection.

During the inspection

We spoke with one person who used the service and four relatives about their experience of the care provided. We spoke with seven staff members including the interim manager, deputy manager, nurses, carers, cook and housekeeper.

We reviewed a range of records. This included four people's care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 20 October 2022

About the service

St Andrew's Nursing and Care Home is situated in Ewerby near Sleaford, providing accommodation for people who require residential and nursing care. The service can support up to 45 older and younger adults, some of whom may experience memory loss. There were 33 people living in the service at the time of inspection.

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

There were quality assurance processes in place. However, audits continued to be ineffective and had not identified shortfalls in the service.

People’s care records were not always accurate or effective in order to give staff guidance on how to meet the nutritional needs of people.

People were not always supported to have maximum choice and control of their lives and staff did not 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.

Systems and processes around safe recruitment needed improvement. Checks had not consistently been carried out in respect of some staff’s right to work in the UK. The provider had not always assured themselves of gaps in employment and had not always ensured references were sought from staff’s last employer when staff were recruited by a recruitment agency.

Medicines management at the service had improved. There was guidance for staff to follow on how to safely administer “As and when medicines.” However, the service would benefit from improvements in the recording of medicated creams.

There had been an inconsistency in management at the service since the last inspection. Managers at the service have been interim, with no registered manager since August 2021.

Staff had received training in order to recognise how to protect people from abuse. People and their families told us they felt safe at the service.

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 09 August 2021) and there were breaches of regulation 12 and 17. CQC issued the provider with a warning notice in relation to Regulation 17 (Good governance).

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 regulation 17 (Good governance.)

Why we inspected

We carried out an unannounced focused inspection of this service on 27 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they 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 and Well-led which contain those requirements.

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.

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 remains requires improvement. 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 Andrew's Nursing and 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 monitor the service and will take further action if needed.

We have identified breaches in relation to the safety of people's care and good governance at the service.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.