CQC report explained · a nursing home
What the CQC found at St Andrew's Nursing and Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were not always protected from avoidable harm. Nutritional risks were not effectively assessed or managed, some environmental risks were not controlled, and recruitment and medicine recording needed improvement.
- Effective?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used in the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used in the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used in the overall rating.
- Well-led?
- Requires improvement
- Management was inconsistent and quality checks had not identified important risks. The home had no registered manager and systems for care records, DoLS, mental capacity decisions and recruitment were not reliable enough.
What inspectors found, October 2022
St Andrew's Nursing and Care Home is rated Requires Improvement; inspectors found risks in nutritional care and weak management oversight.
This was an unannounced focused inspection on 6 July 2022. Two inspectors spoke with one person, four relatives and seven staff. They reviewed care records, medicine records, recruitment files and management documents.
The home was not always safe. Nutritional needs and risks were not recorded or managed well enough. Inspectors also found unlocked laundry areas with hot equipment, gaps in recruitment checks, poor laundry practices and weaknesses in recording medicated creams.
The home was not well-led. Audits had failed to find important problems, there had been several management changes and there was no registered manager. The overall rating remained Requires Improvement, as did Safe and Well-led. Other key questions were not inspected in this visit and their previous ratings were carried forward.
People felt safe
Staff had training to recognise abuse and concerns were reported. People and relatives told inspectors they felt safe.
“People and their families told us they felt safe at the service.” from the report
Safeguarding had improved
The home was no longer in breach of the safeguarding regulation. The interim manager acted quickly when concerns were raised.
“Where concerns had been raised the interim manager acted quickly, to ensure the safety of people at the service.” from the report
Some medicine improvements
Medicine storage and guidance for medicines given when needed had improved since the previous inspection. However, medicated cream records still needed work.
“People who required "As and when" medicines had protocols in place to ensure staff had guidance in how and when to administer the medicines” from the report
Visitors were welcomed
People could receive visitors without restrictions, and inspectors saw family visits taking place in communal areas and private rooms.
“People were able to receive visitors without any restrictions at the service as the service was following government guidance.” from the report
Nutrition risks
seriousCare records did not give staff reliable guidance about people's diets, diabetes or swallowing needs. Weight loss was not always monitored properly or acted on quickly.
“People's nutritional care needs, and risks associated with their nutrition were not effectively assessed or mitigated.” from the report
Weak quality checks
seriousAudits did not identify incorrect nutrition assessments or expired DoLS arrangements. This meant people could be left without timely support or review.
“Quality audits at the service did not always identify areas of concern.” from the report
Unstable management
needs fixingThere had been three managers since the previous inspection, and no registered manager had been in post since August 2021. The report also found a lack of oversight of clinical issues.
“The service has been without a registered manager since August 2021.” from the report
Environmental and laundry risks
seriousLaundry doors were unlocked while hot irons and presses were unattended. Soiled and clean laundry had also been mixed, and laundry equipment problems had caused a backlog.
“We found the doors unlocked and the laundry room unattended where irons and trouser presses were hot to the touch.” from the report
- 01How are you now assessing and recording each resident's nutritional, diabetes, swallowing and weight-loss risks?
- 02Who is currently responsible for the home and when will a registered manager be in post?
- 03How do you check that care plan audits identify errors and that referrals to health professionals happen promptly?
- 04How are DoLS expiry dates and mental capacity best-interest decisions now recorded and reviewed?
- 05What checks do you complete for agency staff, including right-to-work checks and references from their last employer?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive carried over from the previous inspection. This explanation was written from the published report of 20 October 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, February 2022
St Andrew's Nursing and Care Home was rated Requires Improvement; inspectors found risks with medicines, safeguarding, infection control and management oversight.
Inspectors visited on 27 May 2021 after a serious injury and concerns about staffing. They spoke with people living at the home, relatives and staff, and checked care records, medicines, recruitment files and management records.
The home was not always safe. Inspectors found unsecured medicines, incomplete instructions for medicines given when needed, conflicting guidance about modified diets and weak follow-up after falls and accidents. COVID-19 safety procedures and protective clothing rules were not always followed.
Some people said they felt safe and staff were seen giving kind care. However, inspectors found that people were not always protected from undignified or psychologically harmful treatment. Management checks did not reliably find or fix problems, and the overall rating fell from Good at the previous inspection to Requires Improvement.
People said they felt safe
Most people said they were cared for and felt safe living at the home. This was also reflected in relatives' feedback.
“I feel safe. We are like a big family.” from the report
Unhurried medicines support
Although medicines were not always managed safely, inspectors saw staff supporting people to take them at their own pace.
“We observed staff supporting people to take their medicines in their own time, without rushing them.” from the report
Recruitment checks
The provider carried out pre-employment checks, including references and criminal record checks, before staff worked with people.
“The registered provider carried out appropriate pre-employment checks on staff to ensure their suitability to work with people they supported.” from the report
Dignity and safeguarding
seriousA person's care plan limited the number of continence aids available. Inspectors found this could leave the person in an undignified situation and cause psychological harm.
“People were not always protected from derogatory treatment, which meant was is a risk people could be at risk of psychological harm.” from the report
Care risks and medicines
seriousThickening powder was left where people could access it, care guidance about food consistency conflicted, and the clinic room key was not securely controlled. Instructions for medicines given when needed were also incomplete.
“The provider failed to ensure all risks associated with people's care had been assessed and medicines were managed safely.” from the report
Weak management checks
seriousAudits did not identify important problems, including unsafe medicine storage temperatures, incomplete checks and undignified language. Known actions after medicine errors had not been completed.
“Quality assurance audits did not always identify areas of concern.” from the report
Infection control
needs fixingSome COVID-19 procedures were not followed consistently. This included protective clothing practices and missing risk assessments for staff who had not chosen vaccination.
“Staff had access to personal protective equipment. Although, national guidance around donning and doffing were not always followed.” from the report
Mixed experience of respect
needs fixingFeedback about dignity and respect was mixed. One person said they had been shouted at, and another said their mental health needs were not taken into account.
“We received mixed feedback from people and using the service their relatives on how they were treated with dignity and respect, by the staff at the service.” from the report
- 01How are medicines given when needed now supported by clear instructions about symptoms or behaviour?
- 02How is the clinic room kept secure, and what has been done about the medicine fridge temperature checks?
- 03How do you make sure continence care protects people's dignity and does not limit the supplies they need?
- 04What has changed in care plans and staff guidance for people with modified diets or mental health needs?
- 05How are falls, medicine errors, complaints and infection control concerns now reviewed, acted on and checked for improvement?
This focused inspection reported ratings for Safe and Well-led; the report does not give ratings for Effective, Caring or Responsive. This explanation was written from the published report of 11 February 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.
Every inspection of St Andrew's Nursing and Care Home
6 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- October 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at St Andrew's Nursing and Care Home →
- February 2022Requires improvementSafe: Requires improvementWell-led: Requires improvement
Read what inspectors found at St Andrew's Nursing and Care Home →
- January 2021Inspected but not ratedSafe: Inspected but not rated
- January 2020Goodstayed GoodSafe: GoodWell-led: Good
- May 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2016Requires improvementstayed Requires improvementWell-led: Requires improvement
- March 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- October 2012
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 12 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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9 live-in carers within about an hour of Lincolnshire
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.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
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.