This inspection took place on 14 June 2017 and was unannounced. At the last inspection, the home was rated ‘Good’ overall. At this inspection we found the home remained ‘Good’ overall, but continued to require improvements in the key question of ‘Effective’.

St Andrew’s House is a residential care home for 35 older people. It provides both permanent and respite care. At the time of our visit 33 people were living in the home. The provider is a charity ran by the Coventry and District Free Church Homes for the Elderly and the home works within a Christian ethos.

The home had a registered manager. 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.

At the time of our inspection visit the registered manager was on a leave of absence. Their duties were being covered by two deputy managers.

During our last visit the registered manager had not made applications for people who were being deprived of their liberty. During this visit we found an application had been made for one person but there were others in the home who met the conditions for an application to be made. After our visit, the registered manager confirmed to us they had made the relevant applications.

The home undertook general assessments of people’s mental capacity but these were not decision specific as determined in the Mental Capacity Act.

People felt safe living at St Andrews House. Staff understood how to protect people from harm, and provided good support to reduce identified risks. Medicines were managed safely.

There were enough staff available to meet people's needs, and staff recruitment procedures meant staff did not work at the home unless robust checks had been undertaken.

People and relatives thought staff were very supportive and caring. People's privacy and dignity was upheld, and staff respected people's wishes. Family and friends were welcomed to visit the home at any time.

People and their relatives were involved in planning their care, and people decided how they wanted to live their lives on a day to day basis. Staff supported people's choices.

People enjoyed their meals and the choices available to them. They were supported to access healthcare professionals when needed.

People, relatives and staff thought the management of the home were approachable and responsive to their needs. They could informally or formally approach management with concerns or issues for discussion. No formal complaints had been made.

There were effective management systems to assure people were safe and quality care was provided.

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We carried out this inspection on 8 January 2015. The inspection was unannounced.

St Andrews House is registered for a maximum of 35 people offering accommodation for people who require nursing or personal care. At the time of our inspection there were 31 people living at St Andrews House.

The service has a registered manager. The 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 a legal responsibility for meeting the requirements

in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection on 30 September 2013 the home was found to be meeting the required standards in the areas we inspected.

People, relatives and staff told us people were safe. There were systems in place to protect people from the risk of harm. These included comprehensive staff recruitment and training practices. Procedures were in place to effectively protect people against the risk of abuse. Staff were able to tell us about safeguarding people and knew what to do if they had any concerns and how to report these. There was a system in place for managing and storing people’s medicines safely.

Staff were respectful in their approach to people and were caring. They understood the need to ensure privacy and dignity when providing care and could give examples of how they did this.

People told us there were enough staff to look after them and we saw the registered manager ensured there were enough staff to meet people’s needs.

Records showed health and social care needs had been appropriately assessed. Care plans provided detailed information for staff to help them provide the individual care people required. There was some information regarding people’s backgrounds, interests and preferences but these were not comprehensive. Risks to people’s health and welfare had been identified and these were monitored with plans in place to minimise the risks.

The registered manager told us she had an understanding of the Mental Capacity Act, but that improvements were required. We saw on three care records there were no capacity assessments, one person had dementia. Staff had differing views about people’s capacity levels and whether people could make decisions for themselves. They were not following the principles of the Mental Capacity Act. We have made a recommendation about assessing mental capacity and ensuring consent of people using the service.

The provider was meeting the requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, no applications had been authorised under DoLS for people’s freedoms and liberties to be restricted. The manager was aware of recent changes in legislation.

People told us that they enjoyed living at the home and we saw varied activities for them to join in with if they chose to. The food at the home was good and there was a choice offered.

People using the service and the staff told us the manager was approachable and listened if they had any concerns. They were positive about the management and felt that the home was well-led.

We visited on a weekday morning and spoke with the manager, the administrator, three care staff and six people who people who lived at St Andrews. We looked at a sample of care records, and observed interactions in the home.

Throughout our visit we saw people being responded to promptly and positively. Everyone we spoke with who lived at the home was positive about the quality of care, the environment and the choices. The only critical comments we noted were in the most recent survey and in a comment by one person regarding activities. This reflected the desire for more ‘hands on’ and individually tailored activities. The manager was aware of this and was able to assure us this was in the process of being addressed.

We saw people being supported in being as independent as possible. In the morning, people came to the front of the building to collect newspapers that the home had delivered for them.

We spoke with two people who were at the home for a short period. They told us the home was “fabulous” and “wonderful.”

We spoke with two visitors who told us, “We’re pleased with it.” They said, “St Andrews had improved over the years. If we ever had to move to a home, we’d be happy to come here.”

We visited the home without telling anyone in advance. We spoke with the administrator and five care staff. This included the supervisor who led the shift. The manager was not present. We spoke with six people who lived at the home as well as relatives of three people there. We observed interactions and care as well as activities in the home. We looked at a sample of care records.

We saw people were comfortable in spacious, bright and clean surroundings. The home had been refurbished and extended to a high standard. There was still some work to be completed. The home had ample storage space so wheelchairs and hoists were all safely stored.

Staff were attentive and polite. We saw people being supported and moved appropriately.

We had very positive responses from relatives and people at the home we spoke with. “Always made welcome” “Happy atmosphere” “Very satisfied with everything” “Won’t find anywhere better” were typical responses.

We noted some small discrepancies in two boxed medications that regular auditing by the service should have picked up.

The manager had been absent from the home for five months. This had been longer than expected. Some staff expressed concern about this. Relatives and people at the home we spoke with about this felt that the home was continuing to run well.

The home has recently been extended, with some new larger bedrooms. People were pleased with the improvements, especially the new dining room, commenting on how nice it was. Most people spent a lot of time in the large communal lounge, chatting to their near neighbour, dozing, watching television, with many reading the newspaper which they had, in many instances, collected from the office. We saw people going out locally for coffee with the activities organiser, who also organised events such as poetry sessions for interested people in the room adjacent to the main lounge.

Staff were attentive to people’s needs, providing care and help in appropriate ways and giving reassurance.

We spoke with approximately half the residents at the home at some point during our visit, and the overwhelming response was that people were very happy at the home. Typical comments included: “we’re looked after well here,” “nothing’s ever a problem,” “lovely here,” and “very good here.”

We spoke with two relatives who visited, as well as two visiting health professionals, and their views were similarly positive. “No problems” “Look after her well” were typical remarks, with one person being sufficiently impressed to comment that if they ever needed care in a residential home, then they would happily choose St. Andrews.

All those currently living at the home are female. The manager advised that that there have been male residents, but they tend to be fewer, and, at present, there are none.