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 int

This inspection took place on 8 February 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

St Andrews Nursing Home provides care and accommodation for up to 45 people with residential and nursing care needs. On the day of our inspection there were 43 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

St Andrews Nursing Home was last inspected by CQC on 29 July 2015 and was rated Good.

Accidents and incidents were appropriately recorded and analysed to identify any trends.

The registered provider had a safeguarding policy in place and the registered manager understood their responsibilities with regard to safeguarding. Staff had been trained in protecting vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at St Andrews Nursing Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care. However, one person who had been admitted to the home for end of life care did not have an end of life care plan in place.

Care records showed that people’s needs were assessed before they started using the service however some care records were incomplete and not regularly reviewed.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs and the service had links with the local community.

The registered provider had a complaints policy in place and people who used the service and family members were aware of how to make a complaint.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

The registered provider had a quality assurance process in place however care records were not regularly audited.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out an unannounced focused inspection of this service on 28 July 2015. A breach of legal requirements was found following the comprehensive inspection on 11 December 2014, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to this requirement. At the last inspection on 11 December 2014, we asked the provider to take action to make improvements. We asked the provider to provide staff with a minimum of six one to one supervision sessions annually.

The inspection was led by an adult social care inspector.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Andrews Nursing Home on our website at www.cqc.org.uk

We inspected the service on 28 May 2013 and found that the service and found that medicines were not being handled safely.

We asked the provider to send us a plan detailing how improvements would be made and we carried out our recent review to ensure standards had improved.

We did not speak with people who used the service during our visit regarding this outcome area but we did speak with nursing staff and senior managers to evaluate the improvements.

We found the service had made improvements and had systems in place for the safe handling and administration of medicines.

We decided to visit the home on an evening to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

We asked staff how they ensured they obtained consent from people. Comments included “I ask what I can do first, how I can help”, “I look in care plans and liaise with relatives too, if someone doesn’t want me there I leave and go back later” and “I ask people what they would like.”

People were happy with the care provided. Comments included “The staff are very good, they’re well trained”, “They look after me well, they couldn’t do better” and “They’re very professional, my (relative) has become a different person since they moved here.”

We checked medicines records and found some stock levels and records were inaccurate.

When we visited there were 31 people accommodated in the home. We when arrived during the afternoon, we looked at the number of staff supporting people at the home. We found there was one nurse and four care staff on duty. The manager showed us the staff rotas for the past two months and they showed similar staffing levels.

The provider had a clear policy on obtaining feedback from people using its services. This included information from sources such as residents and relatives meetings, complaints and survey questionnaires.

A high proportion of people who used the service were unable to express their views to us due to their general medical conditions. In order to determine how care and treatment was provided we spoke with staff, observed their practices and looked at some people's care records. We also spoke to relatives of people who used the service. One person told us "They're very respectful, very caring.” Another person told us “They're all great here.”

We looked closely at the condition of the home, how the provider maintained it and how unforeseen damage was dealt with. We found the building had been properly maintained and when unexpected damage occurred, immediate steps had been taken to ensure the safety of people who lived or worked there. We found the provider had also taken steps to ensure the safety of people who used the service by carrying out regular checks and making improvements based on their findings. We also saw people who used the service, their relatives and other professionals were welcomed to the home and their views were sought on the way the home was run. We found people’s diversity was valued, respected and encouraged.

This inspection took place on 12th and 15th December 2014 and was unannounced. St Andrews Nursing Home provides care and accommodation for up to 44 people. The home specialises in the care of people who have nursing needs including a small separate 14 bed unit for older people living with dementia. On the day of our inspection there were a total of 34 people using the service.

The home 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 and associated Regulations about how the service is run.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff

Interacted with people in a friendly and respectful manner. One person told us, “I feel very safe living here. The staff are wonderful.” One visitor said, “I have no concerns. My wife is very settled here and she receives excellent care.”

Staff and visitors we spoke with described the management of the home as open and approachable.

Throughout the day we saw that people and staff appeared very comfortable and relaxed with the

registered manager on duty.

Staff we spoke with said they received appropriate training. We saw records to support this. Staff had received training in how to recognise and report abuse. We spoke with six staff and all were clear about how to report any concerns. Staff said they were confident that any allegations made would be fully investigated to ensure people were protected.

Throughout the day we saw staff interacting with people in a caring and professional way. We saw a member of staff supporting one person with their mobility. They were interacting happily and laughing together. We saw another member of staff offering to assist a person to go to the toilet. The staff member was gentle and encouraging and the person happily agreed to their support We noted that throughout the day when staff offered support to people they always respected their wishes.

People who were unable to verbally express their views appeared comfortable with the staff that supported them. We saw people smiling and happily engaging with staff when they were approached.

We saw on the dementia care unit there was a weekly activity programme and records showed an activity worker supported people to take part in activities on a one to one basis. In other parts of the home, people were more independent and activities were more personalised and we saw that people made suggestions about activities and outings at regular meetings.

People told us they were treated with respect and privacy was upheld. People received a wholesome and balanced diet in pleasant surroundings and at times convenient to them.

We saw the provider had policies and procedures for dealing with medicines and these were adhered to. The provider had an effective complaints procedure which people felt they were able to use. We saw people who used the service were supported and protected by the provider’s recruitment policy and practices.

The home was very clean and well maintained, and equipment used was regularly serviced.

The provider had a quality assurance system, based on seeking the views of people, their relatives and other health and social care professionals. There was a systematic cycle of planning, action and review, reflecting aims and outcomes for people who used the service.

Staff told us they received regular supervision. However the manager was unable to locate any of these records for the last five months. When we spoke with the area manager, they confirmed that qualified nursing staff had not received any clinical supervision. The area manager said they would rectify this immediately.

This meant staff were not receiving appropriate support, training and professional development to enable them to carry out the duties they are employed to perform. This meant there was a breach of regulation 23 (1) (a) of The Health and Social Care Act 2008 Regulated Activities Regulations 2010. You can see what action we told the provider to take at the back of this report.