CQC report explained · a nursing home
What the CQC found at Andrew Smith House - Nelson
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2022
Andrew Smith House - Nelson was rated Good; inspectors found kind, person-centred care but concerns about staffing, communication and complaints.
This was an unannounced inspection on 8, 11 and 14 July 2022. Inspectors spoke with people living in the home, relatives and staff. They looked at care records, medicines, staff files, training, audits, the building and infection control.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were generally treated with kindness and dignity. Medicines were managed safely, activities were available, and people were supported to access the community and health services.
There were still areas needing improvement. Staffing numbers were not always sufficient, some relatives were not kept informed about care and professional reviews, and some concerns and complaints were not dealt with well. Inspectors made recommendations about these issues, but the report records no breaches of regulations.
Kind and respectful care
Inspectors observed staff treating people with kindness, respect and attention to their individual needs.
“We observed kind, caring interactions between staff and people, with consideration and respect for their individual needs.” from the report
Safe medicines
Medicines were administered as prescribed, with trained staff and clear instructions for medicines that were needed only occasionally or given covertly.
“Records showed that medicines were administered as prescribed and counts of medicines confirmed this.” from the report
Activities and community access
People were offered activities of their choice and were supported to access the community safely.
“We saw people accessing the community safely, as they wished.” from the report
Positive staff culture
Inspectors found staff who were engaged with the inspection and a culture that supported person-centred care and improvement.
“There was an open and approachable culture, and all staff appeared engaged with the high quality of care philosophy of the organisation.” from the report
Staffing levels and experience
needs fixingStaffing numbers were not always sufficient, including on one shift affected by sickness. Inspectors also noted many new staff and stressed the need for enough experienced staff to support them.
“We recommend the provider consider current guidance to ensure sufficient, experienced skilled staff were available to deliver people's care” from the report
Keeping families informed
needs fixingSome people and relatives said they were not kept updated about health conditions, assessed needs and professional reviews.
“No, I don't feel I am kept informed about my [person's] condition.” from the report
Complaints and concerns
needs fixingAlthough a complaints system and log were in place, some people felt their concerns were not listened to or answered.
“Not at all do I feel listened to. I don't have a problem asking questions, but I have not been getting any answers.” from the report
Care records not always up to date
needs fixingSome records had not been reviewed when required, so they might not have reflected people's current needs. The managers said they would address this.
“Whilst information was recorded, not all records had been reviewed as required to ensure they reflected people's current needs.” from the report
Infection control practice
needs fixingSome staff were not always wearing masks in line with the guidance in force at the time. The manager said immediate action would be taken.
“We observed some staff not always wearing masks in line with guidance.” from the report
- 01How many experienced permanent staff will be on each shift, and how will new or agency staff be supported?
- 02How will relatives be kept informed about changes in health, assessed needs and professional reviews?
- 03How are care plans checked and updated when people's needs change?
- 04How are complaints recorded, investigated and answered, and how can families check what action was taken?
- 05What action was taken after inspectors found that some staff were not wearing masks in line with guidance?
This was an unannounced inspection that assessed all five key questions and included infection prevention and control checks; the previous overall rating was Good, published on 2 October 2020. This explanation was written from the published report of 31 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2020
Rated Requires Improvement overall; inspectors found good safety, effective care and leadership, but Caring and Responsive were not reassessed and still carried older Requires Improvement ratings.
This was a focused inspection on 17 September 2020. Inspectors looked at Safe, Effective and Well-led. They spoke with people, relatives, staff, managers and community professionals, and checked care, medicine, recruitment, training and management records.
The inspectors found good standards in all three areas they checked. People said they felt safe. Staffing, medicines, infection control and risk checks had improved. Staff had better training, people received support with food and healthcare, and the home had improved its management checks.
The overall rating was Requires Improvement. This was because Caring and Responsive were not looked at during this inspection and kept their previous Requires Improvement ratings. The home had previously been rated Inadequate and placed in special measures, but it was no longer in special measures and was no longer breaching regulations at this inspection.
Safer staffing
Inspectors found enough staff to respond quickly. The number of agency staff had fallen, and further nurses had been recruited.
“Sufficient numbers of staff were available to meet people's needs safely.” from the report
Medicines and infection control
Medicines records, storage and checks were safe. The home was clean, staff used protective equipment properly and infection controls were in place.
“Infection control practices at the home were effective.” from the report
Staff training
Staff completed a thorough induction and training programme. Records showed that 98% had completed all mandatory training.
“Records showed that 98% of staff had completed all of their mandatory training.” from the report
Improved leadership
The inspectors found major improvements in management, care standards and quality checks since the earlier inspection.
“Management and oversight of the service had improved significantly since our last inspection.” from the report
Choice and individual support
People were offered choices about food and care. The home was adapted for people's mobility, communication, dementia and independence needs.
“The home had been adapted to meet people's needs and enable them to maintain their independence.” from the report
Overall rating remains Requires Improvement
needs fixingThe overall rating did not reach Good because Caring and Responsive were not checked during this visit. Their previous Requires Improvement ratings were carried forward.
“Although we did not look at the key questions of Caring and Responsive at this inspection, the ratings for those key questions from the last inspection, were used in calculating the overall rating at this inspection.” from the report
Manager not yet registered
minorThere was no manager registered with CQC at the time of the inspection. An application had been made and was waiting to be processed.
“The service did not have a manager registered with the Care Quality Commission.” from the report
- 01What has been done to improve the Caring and Responsive areas that still carried Requires Improvement ratings?
- 02How do you check that care is respectful, personalised and responsive to each person's changing needs?
- 03Has the home manager's application to register with CQC now been completed?
- 04How do you keep families informed about changes in a person's risks, needs, care or treatment?
- 05How do you make sure the remaining staff complete the mandatory training that was still outstanding at the inspection?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not examined and their previous Requires Improvement ratings carried over. This explanation was written from the published report of 2 October 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Andrew Smith House - Nelson
6 rated inspections over 6 years: the service has held its Good rating throughout.
- August 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2020Requires improvementup from InadequateSafe: GoodEffective: GoodWell-led: Good
- January 2020Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- March 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2018Requires improvementdown from GoodSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- June 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 21 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.