Attention: The information on this website is currently out of date and should not be relied upon..

Care Services

carehome, nursing and medical services directory


Andrew Smith House - Nelson, Nelson.

Andrew Smith House - Nelson in Nelson is a Nursing home and Rehabilitation (illness/injury) specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs, caring for adults under 65 yrs, dementia, learning disabilities, physical disabilities and treatment of disease, disorder or injury. The last inspection date here was 14th January 2020

Andrew Smith House - Nelson is managed by Stocks Hall Care Homes Limited who are also responsible for 6 other locations

Contact Details:

Ratings:

For a guide to the ratings, click here.

Safe: Requires Improvement
Effective: Requires Improvement
Caring: Good
Responsive: Requires Improvement
Well-Led: Requires Improvement
Overall:

Further Details:

Important Dates:

    Last Inspection 2020-01-14
    Last Published 2019-03-09

Local Authority:

    Lancashire

Link to this page:

    HTML   BBCode

Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

8th February 2019 - During a routine inspection pdf icon

About the service:

Andrew Smith House is registered to provide nursing and personal care for people living with dementia, older people, physical disability, nursing care and mental health care needs. It is situated in Nelson, Lancashire. Accommodation is provided on four units on two levels, with a lift to both floors and wheelchair access to all parts of the home. The home can accommodate up to 60 people. At the time of this inspection, there were 39 people who lived in the home.

Our last inspection report for this service was published on 30 August 2018 and the rating was 'Requires Improvement’ with the question, is this service safe? rated ‘Inadequate’. There were six breaches of regulations 12,17,18,19 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, good governance, staffing, employment of fit and proper persons and duty of candour.

Following the last inspection, we took enforcement action and issued the registered provider with warning notices in relation to medicines management and good governance. We also asked the registered provider to tell us what actions they would take to comply with these regulations. At this inspection in February 2019, we found that the provider had made some improvements in relation to the management of risks of injury, medicines management, staff training, duty of candour and fit and proper persons. However, we found continuing areas for improvement in relation to governance arrangements, staff training and medicines management. Our findings showed there were areas which required further improvements and improvements made needed to be imbedded.

We found shortfalls in the assessment of people’s mental capacity. The service remains, 'Requires Improvement'.

This was a scheduled inspection based on the service's previous rating.

People’s experience of using this service:

There had been improvements in the management of risks of injury and oversight on accident and incidents. Risk assessments were in place and incidents were analysed and management plans discussed with staff. The frequency of injuries had reduced for certain individuals who had been at high risk during our last inspection.

Improvements had been made to the safe management of medicines. We noted some areas where improvements were necessary and the registered manager took immediate action to rectify them.

While people were assisted to have choice and control of their lives and consent to receive care had been sought, we found people’s mental capacity to make specific decisions was not lawfully assessed and authority to deprive people of their liberties for their safety had not always been sought.

We made a recommendation in relation to the application of mental capacity principles and seeking authorisation to depriving people of their liberties.

People’s records had been checked to make sure they included up to date and accurate information about people's needs. However, the systems for recording care records needed to be improved. We made a recommendation about effective record keeping for care plans.

Staff had been safely recruited

Improvements had been made to ensure staff were providing effective care for people through person-centred care planning, training and supervision. Consideration had been made for the provision of best practice guidance and support to meet people's individual needs.

People were treated with compassion and dignity by care staff.

We observed a homely and friendly atmosphere throughout the inspection.

Staff spoke passionately about their roles and wanting to provide quality care.

There was good evidence that equality and diversity had been considered, in particular around those with protected characteristics such as disability, race, culture and religion.

Improvements had been made to ensure people received personalised care that was responsive to their needs.

Staff had developed good relationships with p

19th July 2018 - During a routine inspection pdf icon

This inspection took place on 19 and 20 July 2018, the first day was unannounced.

Andrew Smith House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Andrew Smith House is registered to provide nursing and personal care for people living with dementia, old people physical disability, nursing care and mental health care needs. It is situated in Nelson, Lancashire. Accommodation is provided on four units on two levels, with a lift to both floors and wheelchair access to all parts of the home. The home can accommodate up to 60 people. At the time of this inspection, there were 44 people who lived in the home.

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.

We previously inspected this service in June 2016. The registered provider was compliant with all regulations at that time and the service was rated overall ‘good’.

During this inspection we found shortfalls in relation to the management of risks associated to receiving care. This was because risks to people and incidents had not always been analysed to identify patterns and ensure lessons were learnt. People’s medicines had not been safely managed and staff recruitment procedures were not robust to protect people. There were significant shortfalls in staff training. Quality assurance systems were not effective in identifying shortfalls or areas where the service was not meeting regulations and failure to drive improvements. In addition, there was a failure to demonstrate how the provider had promoted a culture that encouraged candour, openness and honesty.

We found there were six breaches of the Regulations. These were breaches of Regulations 12,17,18,19 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Staff had received safeguarding training and knew how to spot abuse and the reporting procedures. Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. However, there had been significant incidents that exposed people to risks. Some significant incidents had been reported to the local authority and the Care Quality Commission however, there was no robust formal system to analyse incidents. Accidents and incidents had been recorded and staff had sought medical advice where required however, there was no evidence of lessons learnt. Improvements were required to demonstrate what support people had received following incidents such as repeated entrapment by bedrails.

Staff had been trained in the safe management of medicines. However, there were some shortfalls in medicine management practices in the home.

Safe recruitment procedures had not always been followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place for training staff however we found significant shortfalls in training. Staffing levels were monitored to ensure sufficient staff were available.

Policies and practices for promoting, honesty, transparency and duty of candour had not been effectively followed when things had gone wrong with people’s care.

There were established governance arrangements and quality assurance processes. The provider had considered best practice and had been involved in the trial of innovative practices in collaboration with other agencies. However, the shortfalls we identified in people’s care sh

1st June 2016 - During a routine inspection pdf icon

This inspection took place on the 1 and 2 June 2016 and was unannounced. The last inspection of this service took place on 15 May 2014 when the service was found to be non-compliant with medicine management, staffing levels and with maintaining records. We visited the service on the 29 September 2014 to check if improvements had been made and found the provider was compliant in all of these areas.

Prior to our inspection we received some concerning information. We brought our inspection forward and looked into the concerns during our visit. During this inspection we found the service was meeting the current regulations.

Andrew Smith House is located in Nelson Lancashire and can accommodate up to 60 people. The service is registered to provide nursing and personal care for people living with dementia, old age, physical disability, nursing care and mental health care needs. Accommodation is provided on four units on two levels, with a lift to both floors and wheelchair access to all parts of the home. There were aids and adaptations to support people to remain independent and outside gardens with car parking for several cars.

The registration requirements for the provider stated the home should have a registered manager in place. There was a registered manager in post on the day of our inspection. 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 and relatives using the service told us they felt safe and well cared for. They considered there were enough staff to support them when they needed any help. The registered manager followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively.

The staff we spoke with were knowledgeable about the individual needs of the people and knew how to recognise signs of abuse. Arrangements were in place to make sure staff were trained and supervised at all times.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained to do this safely.

Risks to people’s health and safety had been identified, assessed and managed safely.

We found the premises to be clean and hygienic and appropriately maintained. Regular health and safety checks were carried out and equipment used was appropriately maintained.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

People using the service had an individual care plan that was sufficiently detailed to ensure people were at the centre of their care. Care files contained a profile of people’s needs that set out what was important to each person.

People’s care and support was kept under review and people were given additional support when they required this. Relevant health and social care professionals provided advice and support when people’s needs had changed.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. Care plans were written with sensitivity to reflect and to ensure basic rights such as dignity, privacy, choice, and rights were considered at all times.

Activities were varied and appropriate to individual needs.

People were provided with a nutritionally balanced diet that provided them with sufficient food and drink

15th May 2014 - During a routine inspection pdf icon

We brought forward our inspection in view of some concerns that had been reported to the Care Quality Commission. We looked at these concerns at our inspection and spoke with the manager. We were satisfied with the evidence provided in relation to these concerns.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This a summary of what we found:

Is the service safe?

The manager told us there had been no application for Deprivations of Liberties Safeguards (DoLS). (The Mental Capacity Act 2005 provides a legal framework to protect people who need to be deprived of their liberty for their own safety).

The Care Quality Commission (CQC) had been made aware of some safeguarding referrals which had been reported to the local authority. We discussed these concerns with the manager and asked to look at the evidence of the investigation that had taken place. We were satisfied with the evidence provided in relation to these concerns.

We asked about the use of agency staff in the home. The manager told us agency staff were used to cover sickness of holidays. We were shown evidence of the checks that had taken place for these staff to ensure they had the appropriate qualifications in place.

We saw that medications for people living in the home were not administered safely. We saw gaps in medication charts and we could not see evidence of referral to the GP when medication was being refused by people living in the home.

We saw in one care file there was a care plan in place in relation to safeguarding. However we noted the current risk assessment for them was not in their care file.

Is the service caring?

We spoke with one person living in the home. They told us, “I am happy, cared for and looked after”. Relatives of people living in the home all told us they were happy with the care they received in the home.

We undertook two Short Observational Framework Interventions (SOFI) on the day of our inspection. We saw staff were attentive to the needs of people they were in direct care intervention with however; we saw little conversation with the other people in the lounge on one of the SOFIs we under took. The SOFI we carried out in a second lounge in the home identified staff were speaking kindly to people living in the home and were observed to be attentive to people’s needs and responding to people in a positive way.

Is the service responsive?

We asked the manager about how they ensured there were enough staff to meet people’s needs. We were shown the duty rota and saw there were staff in place to cover all areas of the home. We were told any gaps in cover would be addressed using either bank or agency staff.

Relatives of people living in the home told us there was plenty of staff in the home and they saw regular staff on duty. We were told, “On the whole there is the same staff. There is always staff milling around and they are always in the lounge” and, “Sometimes there can be no one in the lounge”. The person we spoke with confirmed that this was not for long periods of time.

We saw details of an upcoming date for relative meetings in the home, and relatives we spoke with confirmed meetings were taking place in the home and they were able to attend if they wanted to.

Is the service effective?

We spoke with two visiting health professionals on the day of our inspection. We received some positive feedback. We were told, “The home is willing to work with us, and all suggestions we make are taken up”.

In two of the care files we saw that there were care plans in place however, we noted these had not been reviewed for several months. We could not be confident these records reflected people’s current needs. In one person’s file we could not see a care plan or risk assessment relating to their needs in communication.

We saw there was an activities coordinator in the home. We saw evidence of a comprehensive activities programme in place. People living in the home we spoke with confirmed they were able to take part in activities if they wanted to and we saw activities taking place on the day of our inspection.

Is the service well led?

The manager is registered with the Care Quality Commission and we saw copies of their certificate on display in the entrance hall of the home. We received positive feedback about the manager. We were told, “(Named manager) is the best boss I have ever had. She listens to any problems and would bust a gut to help you. She is approachable and understanding. The staff are much happier since she came here”, "(Named manager) is supportive” and, “(Named manager) is okay, supportive, I am able to go to her with concerns”.

We asked about audits taking place in the home. The manager showed us copies of regular internal audits taking place. We saw evidence of audits taking place for example; pressure sores and care plans. We saw details of investigations into incidents taking place with actions and outcomes noted in them.

We saw evidence of staff meetings taking place and staff we spoke with confirmed they were taking place and that they were able to discuss their views

2nd December 2013 - During a routine inspection pdf icon

We looked at the care files for four people who used the service. We saw evidence that people who used the service or their representative had signed the files and agreed to care. An example of this was, ‘A person centred support plan’. This held personal information about peope who used the service.

We spoke with three people who used the service all were complimentary about the care they received. Comments made were, “I have signed my paperwork. I know my key worker”, “The staff are always around”, and “The staff are lovely I am quite happy, the staff look after me”.

We spoke with three members of staff who confirmed they had received training in the protection of vulnerable adults (POVA). All staff we spoke with were able to identify signs of abuse and appropriate procedure to follow if they suspected abuse had occurred.

We spoke with staff who told us they received regular supervision and annual reviews of their performance. We saw evidence of this in some of the staff files we looked at.

The staff we spoke with were complimentary about the manager. Some comments received were, “The home is a lot calmer now this manager is here. X is very approachable” and, “X is very good, any issues there are she is quick in bringing them up, she is very approachable”.

We saw the staff had access to an in house policy on complaints for them to follow. There was guidance about the complaints procedure in all people who used the service on display in their bedrooms.

3rd January 2013 - During a routine inspection pdf icon

We spoke with six people who used the service. They told us they were happy with their care and accommodation and said they were treated well by the staff at the home.

We found that suitable arrangements were in place to manage an effective complaints process for identifying, receiving and handling complaints for people living at Andrew Smith House.

We found care plans and risk assessments had been completed for the people living in the home with regular reviews of people’s care and nursing needs in place.

5th July 2011 - During a routine inspection pdf icon

People spoken to made positive comments about the service provided. They told us that staff were kind, approachable and listened to their opinions.

During our visit we saw staff talking to people with respect and always in a polite manner. It was evident that individuals were being supported to maintain their independence, although assistance was consistently provided when required. One resident, who required a high level of nursing intervention told us, “I have no complaints. The staff are very good. The only problem I have is that I sometimes have to wait a long time for my call bell to be answered because staff are busy attending to other people. It is a big home so I cannot expect anything else”. This issue was discussed with the manager of the home. It was established that due to poor dexterity the call bell was not always successfully activated by this individual.

We saw that people living at the home were being supported to make informed choices, such as what to eat and what to do, as part of day to day life at Andrew Smith House. One person living at the home told us, “We get well looked after here. I am very comfortable” and another commented, “I cannot complain. I am lucky to have found this place”.

There was a lot of evidence available to show that support and advice was being sought from external professionals when needed and that people’s wishes were taken into consideration when making decisions about any health care issues.

Most of the people we spoke to told us that they enjoyed the meals provided. During our visit we saw lunch being served, One person said, “The food is very good. I enjoy it more often than not”.

1st January 1970 - During an inspection to make sure that the improvements required had been made pdf icon

We looked at the information we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This a summary of what we found:

Is the service safe?

There was evidence of effective risk assessment in place in the care files we looked at. These had been updated and reviewed recently. Example of risk assessments seen were; falls and bed rails.

We spoke with people who used the service about their medication. They told us they were happy with their medication. One person said, “I am happy with my medication. I get them every day and the staff stay with me whilst I take them”.

Is the service effective?

We looked at staff files for three currently recruited staff members. We saw evidence of supervision taking place including competency assessments, supervision agreements and appraisals, these had been completed recently.

We were shown evidence that staff who were responsible for medication administration had received up to date training and had also completed competency checks when carrying out medication administration

Is the service caring?

The care plans we looked at had been personalised with people's specific needs and contained detailed information to aid staff to care for them safely and effectively. Example of care plans were, personal care, mental health dependency and pressure care. We noted care plans had been reviewed recently to ensure people were cared for by staff who had the up to date knowledge about them.

Is the service responsive?

We asked people who used the service and their family about the staffing numbers and consistency of the staff team. We were told, “There are always staff around. When I press my buzzer someone always comes. There is enough people [staff]. There are two staff always around”, “Sometimes you have to wait for some time for a staff member to come”

The registered manager told us they recently introduced a computer based care file for each person who used the service. We were told that there were plans for all related documentation such as letters and referrals to be scanned into this system to ensure all records relating to people who used the service were stored centrally.

Is the service well led?

We discussed how the registered manger ensured there were adequate staffing numbers on duty to meet people’s needs. The registered manager told us a dependency assessment tool was not in place. However they confirmed they would look into introducing a dependency assessment to ensure there were sufficient numbers of staff to care for people who used the service.

We discussed with the registered manager what systems were in place to monitor and audit medications. We were shown a medication audit form that had been completed recently. There was evidence of notes seen with actions including a summary of the audit.

 

 

Latest Additions: