We carried out an inspection at St Andrews House on 5 and 6 February 2019. The first day was unannounced.

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

Andrew's House provides accommodation and both nursing and personal care for 24 people, including younger people who have a physical disability. It is an extended, detached older property located in the town centre of Barnoldswick. Accommodation was provided on two floors with a passenger lift. There were 19 people living in the home at the time of the inspection.

The service was managed by a registered manager. 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.

At the last inspection, carried out on 16 and 17 January 2018, the service was rated as ‘Requires Improvement’. Whilst we found improvements had been made, our findings demonstrated there was a continued breach of the regulations in respect of effective quality assurance systems.

During this inspection, we found improvements had been made in all areas. However, our findings indicated a breach of regulations in relation to recruitment processes. The rating was Required Improvement.

A safe and robust recruitment procedure had not always been followed. Improvements were needed to the recruitment process to ensure staff were properly checked before working at the service. Appropriate action was taken to address this following the inspection to prevent any re-occurrence.

The management team were committed to the continuous improvement of the service and to improving people’s care. People, staff and visitors to the home were happy with improvements made and considered the service was managed well. The registered manager collaborated with others to develop the service, improve practice and to attain better outcomes for people living at the home.

Further developments were underway to ensure quality assurance systems were robust and fully embedded into the day to day management of the home. People had opportunities to provide feedback on the care provided; improvements were underway to ensure people were more involved and kept up to date.

People told us they felt safe living in the home. Staff knew what to do if they suspected or witnessed abusive practices. There had been a number of changes to the staff team; staff told us they had a good team that worked well together. There were enough numbers of staff on duty to meet people’s needs, meet their preferences and promote their independence. Arrangements were in place to manage any shortfalls in the provision of training, support and supervision.

People were happy with the care and support they received and made positive comments about the staff and about their willingness to help them. They said staff were kind and caring and respected their right to be treated with dignity and respect. We observed caring and friendly interactions between staff and people living in the home; it was clear they had developed positive trusting relationships with them. All staff told us they enjoyed working at St Andrews House and were happy with the improvements made.

People were supported to have 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. Staff understood the importance of acknowledging people’s diversity, treating people equally and ensured they promoted people’s rights.

Care plans and risk assessments were person centred and provided

We carried out an inspection of St Andrews House on 16 and 17 January 2018. The first day was

unannounced.

St Andrew's House provides accommodation and both nursing and personal care for 24 people who have a physical disability. It is an extended, detached older property located in the town centre of Barnoldswick. Accommodation was provided on two floors with a passenger lift. There were 13 people accommodated in the home at the time of the inspection.

St Andrews 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.

The service was managed by a registered manager who had been in post since September 2017 and registered with CQC in December 2017. A registered manager is a person who has registered with the 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.

At the last inspection on 1, 2 and 11 August 2017 we found seven breaches of regulation in respect of infection control, recruitment processes, maintaining the environment, medicines management, care planning and risk assessment and quality assurance systems. The overall rating for this service was ‘Inadequate’ and the service was placed in special measures. This meant the service was kept under review and an inspection would be undertaken within six months to ensure significant improvements have been made. At that time we asked the provider to complete an action plan to show what they would do to improve the service and by when.

Following the last inspection regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. Admissions to the home were suspended until commissioners and CQC were satisfied that significant improvements had been made. The medicines management team, infection control team and local commissioners worked with the provider, registered manager and staff to support them with improvements. Recent feedback from other agencies was positive regarding the improvements made and an action plan was available to support further improvements. The local authority suspension on admissions was lifted.

During this inspection we found new quality assurance and auditing processes had been introduced to help the provider and the registered manager to effectively identify and respond to matters needing attention. However some of these improvements had been introduced over a short period of time and were in their infancy; further work was needed to embed these processes into the day to day practice at the home. Therefore our findings demonstrated there was a continued breach of the regulations in respect of effective quality assurance systems. You can see what action we told the provider to take at the back of the full version of the report. We will check this during our next planned comprehensive inspection.

Since the concerns raised at the last inspection the registered manager, directors and staff had worked hard as a team to introduce much needed changes and improvements. People and staff were happy with the improvements that had been made and considered the service was managed well. Communication had improved and people felt they had been involved in decisions and consulted about any changes.

People were happy with the personal care and support they received and made positive comments about the staff and about their willingness to help them. They also made positive comments about the registered manager and the directors. The registered manager, directors and staff were observed to have positive relationships with people living in the home and people were relaxed in t

We carried out an inspection of St Andrews House on 1, 2 and 11 August 2017. The first day was unannounced.

St Andrew's House provides accommodation and both nursing and personal care for 24 people who have a physical disability. It is an extended, detached older property located in the town centre of Barnoldswick. Accommodation was provided on two floors with a passenger lift. There were 17 people accommodated in the home at the time of the inspection.

At the previous inspection on 13 July 2016 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to infection control practices, safeguarding vulnerable adults, training and induction and quality assurance processes. We also made recommendations about the provision of consistent numbers of staff and improving the recruitment process and medicine management processes. Following the inspection we asked the provider to take action to make improvements and to send us an action plan.

During this inspection we found there had been limited progress made in respect of infection control practices and with quality monitoring systems. We found seven breaches of regulation in respect of infection control, recruitment processes, maintaining the environment, medicines management, care planning and risk assessment and quality assurance systems. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the time of our inspection the service did not have a registered manager in post. A registered manager is a person who has registered with the 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. There had been a change to the registered manager since our last inspection. The previous registered manager had left the service in July 2016. The current manager had been in post since May 2017.

People considered there had been times when there had not been sufficient staff to meet their needs. We found sufficient numbe

We carried out an inspection of St Andrews House on the 13 and 14 July 2016. The first day was unannounced.

St Andrew's House is registered to provide accommodation and both nursing and personal care for twenty-four people who have a physical disability. It is a large detached property located in the town centre of Barnoldswick. Specialist services provided include a physiotherapy room and a hydrotherapy pool. A physiotherapist offers individually tailored treatment programs. There were 19 people accommodated in the home at the time of the inspection.

At the previous inspection on 25 June 2014 we found the service was meeting all the standards assessed.

During this inspection visit we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to infection control practices, safeguarding vulnerable adults, training and induction and quality assurance processes. You can see what action we told the registered provider to take at the back of the full version of the report. We also made recommendations about the provision of consistent numbers of staff and improving the recruitment process and medicine management processes.

At the time of our inspection visit the service was not being managed by a registered manager. The registered manager had left the service two weeks prior to our visit. 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 made positive comments about the service they received and about the staff. We found a relaxed, open and caring atmosphere where people were comfortable and at ease. The number of shortfalls we found indicated quality assurance and auditing processes had not been effective as matters needing attention had not always been recognised or addressed.

People told us they did not have any concerns about the way they or their relatives were cared for. They were happy with the care and support provided and they felt safe. Staff responded to people with care, good humour and consideration. We observed good relationships between people.

Staff spoken with were aware of the action they would take if they witnessed or suspected any abusive or neglectful practice. However all staff needed update training in safeguarding vulnerable adults, the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards to make sure they were able to recognise and respond appropriately to any abusive practice.

People told us they were given their medicines when they needed them. However, we found areas where improvements were needed to ensure people’s medicines were always managed safely.

We found some areas of the home were not clean and hygienic and there were areas in need of attention. We noted improvements had been undertaken with a plan for ongoing development. People told us they were happy with the facilities available and had arranged their bedrooms as they wished.

The service had recruitment and selection policies and procedures and improvements were needed to ensure staff were safely recruited. There were gaps in the provision of training, induction and supervision for staff.

People were happy with the staff team and told us there were enough staff to provide them with the care and support they needed in a safe way. However, whilst staff told us they were happy working in the home the numbers of staff had not been consistent throughout the week and short notice sickness had created ongoing staffing problems.

People told us they enjoyed the meals. We noted the atmosphere was relaxed with friendly chatter throughout the meal. Staff were aware of people’s dietary preferences and professional advice and support had been sought when needed.

People were able to

One adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

During this inspection we spoke with five people using the service. We spoke with three members of staff, the registered manager and the owner. We also made contact with the local authority. We viewed records which included, three care plans and daily care records, policies and procedures, cleaning records and quality assurance information.

We considered the evidence we had gathered under the outcomes. This is a summary of what we found:

Is the service safe?

People told us they were able to make their own choices and decisions. The manager expressed an awareness of the processes to follow if people did not have the capacity to make safe decisions about their care and support.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us no applications have needed to be submitted and that policies and procedures were in place to support staff.

We found all areas of the home we looked at were bright, homely, comfortable and free from offensive odours. Whilst we noted recent improvements had been made to the home we also noted other areas were in need of improvement. However, without a 'development plan' it was unclear how the arrangements for improvements were identified, maintained or prioritised.

A full infection control audit of the home had not yet been completed and we found some shortfalls that had not been identified or acted on. We asked for confirmation when the audit and associated improvements were completed.

People had access to a range of appropriate equipment to safely meet their needs and to promote their independence and comfort. The equipment was regularly serviced and maintained and staff had received training to ensure they were competent to use the equipment safely and properly.

Staff told us they were aware of the procedures for reporting any concerns about poor practice which should help ensure people were protected.

Is the service effective?

Records contained useful information about people's routines and likes and dislikes. The information had been kept under review to make sure it reflected people's current needs and people told us they were involved in discussions about their care. However we noted the records did not always demonstrate people’s involvement. This may result in them not receiving the care and support they needed or wanted.

People told us they had no complaints about the service but would raise their concerns with the staff or manager and would be happy to discuss any concerns with the owner during her visits. Comments from people living in the home included, “I tell them if anything is wrong and they sort it out straight away” and “I don’t think they listen to me sometimes”.

Is the service caring?

People told us they were happy with the care and support they received. Comments included, “It’s alright here; it’s my home”, “Staff are great; I’m looked after” and “I like the place”. Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People told us, “Everyone is very nice” and “Staff are great”.

Is the service responsive?

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. Some of the identified risks had not been kept under regular review which could result in people not getting the support they needed.

A range of appropriate activities and entertainments were available both inside and outside the home. People told us they were able to participate in one to one or group activities that met their diverse needs.

Is the service well-led?

There was a registered manager in post who was responsible for the day to day running of the home. The manager was supported by the owner who regularly spoke with people living in the home and their visitors.

People had been encouraged to express their views and opinions of the service during meetings and day to day discussions with staff and management.

There were systems in place to monitor the quality of the service however improvements were needed to ensure they were effective in identifying any areas for improvement or the risks of non-compliance with the regulations.

We spoke with six people living in the home who said they were happy with the care and support they received. Comments included, “I get the support that I need; it's an excellent place” and "I only have to ask and it's done; no waiting or asking again".

A range of activities were available. People told us they were able to participate in one to one or group activities that met their diverse needs. Some people were able to pursue their own interests and hobbies within the local community.

People told us they enjoyed the food. Comments included, "The food is very good; you can have different things to eat" and "The cook knows what I can eat and what I like".

People were happy with their rooms and most had brought in personal items to make them more homely. Comments included, "The facilities are good; I have my own space" and "The home is always very clean; I can't fault it".

There were enough staff to meet people's needs. Comments included, "All the staff are great; I get on with everyone" and "Staff are ok; you can have a laugh with them". All of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions.

During our visit we spoke with seven people who used the service and one visitor. All of the people we spoke with told us they were happy with the service they received and they were able to make choices and decisions about how they spent their day. Comments included, "I do what I want and staff work around me", "It's alright here; very relaxed" and "I can come and go as I please". People told us they were treated with respect.

People who lived at St Andrews House told us that activities, holidays and day trips were arranged. One person said, "There are different things going on or you can do your own thing". All the people we spoke with told us they were able to express their views and opinions and could influence the way that the home was run.

People were happy with the staff team. They told us, "There are enough staff", "The staff are lovely" and "The staff are nice and friendly". A visitor said, "The staff are very good" and "They do a good job".

We spoke with two staff who told us they were kept up to date and encouraged to share their views and opinions. One member of staff said, "They listen to us and things get sorted". Both staff told us they enjoyed working at St Andrews House.

The people that we spoke with during our visit told us that they were treated well by staff and encouraged to make choices and decisions about how they spent their time. People said, "I do what I want and staff work around me", "It is a good place, very relaxed and friendly, "I can come and go as I please" and "I can join in or spend time on my own".

We were told that different activities, holidays and day trips were available. People told us, "There is plenty going on either as a group or on your own" and "I like the day trips; they cater for what you are interested in".

People told us they were looked after properly and that staff treated them well. They said they would be able to speak to staff or management if they were unhappy and the

manager and staff often asked if they were comfortable and happy. One person said, "It's a good place, everyone seems to get on. I am happy but can tell someone if I wasn't".

People we spoke with told us they were happy with the staff team. They told us, "Staff are great", "Staff are like good mates, they are interested in the things that I like" and "You can have a laugh with them".

People told us they were able to express their views and opinions and were confident they would be listened to. They told us they had not had any meetings recently but were able to discuss their concerns with staff or management. They told us they were kept up to date with any changes that affected them.

Staff told us, "It is a good place, I really enjoy my work" and "It is a really good home, we work around the people who live here".