This inspection took place on 14 and 19 March 2018. The first day of the inspection was unannounced. Following our last inspection in February 2017 we rated the service as, ‘Requires Improvement’. We found the service did not have in place accurate and up to date records for people who used the service. We also found regular audits were not being carried out of care records. At this inspection we found improvements had been made. St Andrew’s Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service provides accommodation for up to 45 people across two floors. At the time of our inspection there were 44 people using the service.
There was a registered manager in post. 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.
People lived in an environment where safety checks such as regular fire checks were carried out on a regular basis.
Staffing levels in the home were sufficient to meet people’s needs. We found staff were able to respond quickly if a person needed assistance.
People were supported as appropriate to receive their medicines safely from staff assessed as competent to do so. Arrangements were in place for the safe receipt, storage and disposal of medicines. We found some inconsistent practice in relation to topical medicines. These are creams applied to the skin. The registered manager agreed to improve consistency.
Since our last inspection no one using the service had experienced a serious accident or injury. Accidents and incidents were monitored each month and actions had been taken to prevent injuries occurring.
The service had appropriate systems in place to protect people from harm. Staff had received training in safeguarding and were able to tell us how they protected people and what actions they needed to take if they had any concerns about a person.
People were supported to have maximum 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.
Food served in the home was appetising. Staff provided support and encouragement to people at meal times. We observed staff supporting people to eat and drink with patience and attentiveness. We found people enjoyed their mealtime experience.
Support was provided to staff to enable them to carry out their work in the home. This included induction, training supervision and appraisal.
Staff contacted other professionals and involved them in the service when people’s needs changed or when they had health issues which needed to be addressed. Advice from professionals was included in people’s care plans and passed between staff.
We saw staff knocking before entering people’s rooms, and closing bedroom and bathroom doors before delivering personal care. Staff protected people’s dignity and privacy.
Relatives spoke with us about the kind and caring nature of the staff. This was echoed by visiting professionals.
The registered manager and the staff listened to people who wished to speak up on behalf of themselves. They also listened to relatives as natural advocates for people using the service. An independent advocacy service was available to help people speak up.
Each person had care plans which were person centred and contained relevant guidance to staff to enable them to provide the right care for people. These were regularly reviewed and updated as necessary.
The service had strong links with key partners. Advice from other professionals had been incorporated into people’s care plans.
People were supported to participate in activities of their choice. The activities coordinator arranged for entertainers to visit the home and had also invited a resource to the home that could enable people to look through viewfinders and remember their past history.
Whilst the provider had a complaints process in place there had been no complaints since our last inspection. We observed the registered manager respond to issues raised by relatives. Relatives confirmed with us this was the case and they appreciated the prompt response from the registered manager.
People, their relatives and staff were complimentary about the registered manager. Relatives felt the registered manager was proactive in responding to them and staff felt well supported by them.
The provider and the registered manager had arrangements in place to monitor the quality of the service and make improvements where necessary. For example we saw they carried out regular audits to monitor the effectiveness of the service. Surveys were carried out to seek the views of people who used the service, their relatives and staff.
Records in the home were up to date and accurate.