Archived: Anchorage Nursing Home

Anchorage Nursing Home is a 'care home' providing accommodation, nursing and personal care for up to 40 older people; some of whom lived with dementia. At the time of the inspection 34 people were living at the home.

People's experience of using this service and what we found

The provider and staff worked together to help ensure people received a good service. However, on our first day of inspection we found issues of concern with COVID 19 weekly testing regimes that did not fall in line with government guidance. We also had concerns regarding the cleanliness and some aspects of the condition of the environment.

People told us they were happy with the care they received and said they felt safe living there. One person said; "It’s a nice place and I like it." We saw that people living at the service were relaxed and comfortable with staff. We observed staff spent time chatting with them and supporting them when they became distressed or anxious.

People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. People received their medicines as prescribed and staff had clear information about how people liked to be supported with their medicines. Staff were knowledgeable about people's health needs and the provider had sought support from other health professionals as appropriate to support people's needs.

Care records were individualised and reflected each person's needs and preferences. Risks were assessed and identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. We did however see missing entries in the daily records and some key information in people’s care records that we looked at. The provider addressed these concerns immediately and made appropriate changes and updates to care records.

Staffing levels were appropriate, and we found that due to several permanent members of staff being off long term, the home used a high volume of agency staff. The provider assured us that they were continuously working to recruit more staff. Staff received training and support to enable them to effectively meet the needs of the people they supported.

People were supported to maintain good health and nutrition. Staff worked closely with professionals such as speech and language therapists, GP's, commissioners and other health professional.

The provider had addressed issues identified from the last inspection relating to the environment and had implemented changes to the building that made it safer.

Rating at last inspection

The last rating for this service was requires Improvement (published 26 January 2021). This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 7 October 2021 following a number of concerns relating to staffing numbers and intelligence gathered through various sources and our system. This report only covers our findings in relation to the Key Questions of Safe and Well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the caring, effective and responsive key questions were not looked at during this visit. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

The overall rating for the service has remained 'requires improvement'. This is based on the findings at this inspection. We found evidence that the provider still needs to make improvements.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we have identified breaches in relation to safe care. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Anchorage Nursing Home is a ‘care home’ providing accommodation, nursing and personal care for up to 40 older people; some of whom lived with dementia. At the time of the inspection 37 people were living at the home.

People’s experience of using this service and what we found

We were not always assured that infection prevention and control (IPC) measures were appropriately followed. We identified some areas that were unkempt and not well-maintained. We have made a recommendation regarding this area of safe care.

Management of risk and safety monitoring had improved since the last inspection. People’s needs were appropriately assessed, and the relevant support measures were put in place as a way of keeping people safe.

People’s overall health and well-being was closely assessed, and appropriate referrals were made to other healthcare professionals as and when needed.

People's care plans and risk assessments were up to date, contained relevant information and were regularly reviewed. We saw a variety of different monitoring tools such as diet / fluid and weight charts; these helped to ensure that people’s level of risk was appropriately monitored.

Improved medication systems and procedures had been implemented. Trained staff administered medicines to people who required support, people received their medicines as prescribed and improved recording, storage and disposal processes were in place.

The provider increased staffing levels since the last inspection to ensure people received safe, timely and effective support. Staff told us that the improved staffing levels had made a positive difference.

Safe recruitment processes ensured that people were supported by staff who had been safely recruited and able to work in health and social care environments.

Staff were effectively supported by the management team. They received regular supervisions, annual appraisals and completed the relevant training courses as a way of developing and enhancing their skills and abilities.

People were supported to maintain maximum choice and control of their lives; staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider confirmed that although structural changes could not be made to the communal areas, alternative dining options were being explored to improve the dining experience of people living at the home.

Rating at last inspection and update

The last rating for this service was ‘requires improvement’ (published 17 March 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection, which identified the improvements they would make and when actions would be completed. At this inspection the provider was no longer in breach of regulations, but improvements are still required.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they were now meeting legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the caring and responsive key questions were not looked at during this visit. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively

The overall rating for the service has remained ‘requires improvement’. This is based on the findings at this inspection. We found evidence that the provider still needs to make improvements.

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

Follow up

We will continue to monitor information we receive about the service until we return to our inspection programme. If we receive any concerning information we may inspect sooner.

Anchorage Nursing Home provides accommodation with nursing or personal care for up to 40 people. There were 36 people living in the home at the time of our visit.

People’s experience of using this service

At this inspection we identified serious concerns with regards to the management of medication. Medication management failed to adhere to best practice guidelines published by the National Institute of Social Care (NICE) with regards to the storage, administration and management of medicines. This meant it was unsafe and placed people at risk of avoidable harm.

People’s care plan did not always contain sufficient or accurate information about their needs and risks or the care they required. This placed people at risk of receiving unsafe or inappropriate care. People’s daily records did not always demonstrate they received the support they needed. Records in relation to people’s care were not always accurate or properly completed. This made it difficult to keep track of the support they received.

Staffing levels were not always sufficient to meet people’s needs or to ensure staff were able to evacuate people to a place of safety in the event of an emergency such as a fire.

People’s legal right to consent to their care was not supported in accordance with the Mental Capacity Act 2005. This meant people were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible and in their best interests.

Some of the communal areas in the home such as the dining room was not big enough to accommodate everyone's dining needs at the same time. The two quiet lounges were very small and were next to other communal areas which experienced heavy traffic from people, staff and visitors and were noisy. We have recommended the provider reviews the communal spaces within the home to ensure they accessible, suitable for purpose and of sufficient size. We also recommended that they review best practice guidance on creating dementia friendly environments to support people living in the home with dementia.

The service was not consistently well-led. Managerial and provider oversight of the service was also not robust and the systems in place to monitor the quality and safety of the service were not always effective in identifying and driving up improvements.

People and the relatives we spoke with all told us staff were kind and caring. They said they were treated with dignity and respect and felt. Staff knew people well and spoke with genuine warmth about the people they cared for. People had access to a range of recreational activities and social pursuits to occupy and interest them.

Rating at last inspection and why we inspected

At the last inspection the rating of the service was good (published 02 September 2017). At this inspection the rating has not been maintained. At this inspection, the service has been rated 'Requires Improvement'. This is because the provider has failed to ensure that regulations 11 (Need for consent), 12 (Safe care and treatment), 17 (Good governance) and 18 (Staffing) were met.

Follow up

Immediately after the inspection we requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor their progress with regards to this. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

At our last inspection in March 2016, we found a breach of Regulation 9 of the Health and Social Care Act because not all of the people who lived in the home had a plan of care that was appropriate and met their needs. Since that inspection, care plans had been moved to an electronic system. We found the electronic records were easy to read and reflected a person-centred approach to people’s care. Care staff recorded the personal care they had provided for people in their daily records.

The home was required to have 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. The home had a registered manager who had been in post for two years.

All of the relatives we spoke with were happy that their family member was in a safe environment and people who lived at the home said they felt safe at all times. Policies and procedures were in place to manage safeguarding concerns. The manager had reported safeguarding incidents to the Local Authority and Care Quality Commission appropriately and promptly. Staff had attended safeguarding training and those we spoke with were aware of their responsibilities regarding safeguarding. People’s medicines were managed safely.

There were enough staff to ensure that people received the support they needed in a timely way. Staff had regular training and supervision. We looked at the staff files for four new members of staff. Appropriate recruitment procedures had been followed to ensure that staff were safe and suitable to work with vulnerable people.

People we spoke with were happy with their meals and said they had plenty of choices.

The service was compliant with the Mental Capacity Act 2005. The manager had made relevant Deprivation of Liberty Safeguard applications to the local authority. The care plans we looked at detailed people’s capacity to give consent and, where appropriate, relatives had been involved in making decisions about people’s care.

People told us that the staff were kind and caring and respected their privacy and dignity. Throughout the inspection we observed that staff interacted with people in a friendly and caring way.

The home’s complaints policy was displayed in the entrance hall and gave details of who people could contact if they wished to make a complaint. The manager maintained records of complaints she had dealt with and the action taken.

Everyone we met spoke highly of the home’s activities coordinator. Activities planned for the week were shown on a notice-board. They included puzzles and board games; armchair exercises; arts and crafts; gardening; one to one chats and singalongs.

All of the people we spoke with said they knew the manager because she came round and chatted to them. All said she was approachable and all felt she would act if they made a complaint. Staff we spoke with also considered that the manager was approachable and listened to them.

The manager shared with us the plans and ideas she had for further improvement of the home and it was evident that she was continuously looking for ways to take the service forward.

Records showed that regular meetings were held for all staff, and for specific groups of staff such as nurses, senior carers, kitchen staff. There were also relatives and residents meetings and all of the visitors we met said that they had attended a relatives meeting and had felt able to contribute. We looked at the minutes of meetings which showed that those attending had felt able to express their views and raise any concerns they had.

Regular audits were carried out covering accidents, environment, medication, kitchen, infection control, meal observation. The manager told us she planned to revamp the audits to ensure that they provided the information she needed to better monitor the quality and effectiveness of the service.

The home required 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. There was a manager in post who received notification of their completed registration on the second day of our visit, and so during the course of our inspection, became a registered manager with the Care Quality Commission.

We spoke with the provider and the registered manager and they were open and honest and told us that they recognised that the home needed to improve and that they were committed to the work required. People we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives also told us they felt people were safe.

We found a breach in relation to care planning. You can see what action we told the provider to take at the back of the full version of this report.

We reviewed peoples care plans, not all people who lived in the home had a plan of care that was appropriate and met their needs and topical medicines are the home were not always managed in a proper or safe way.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The registered manager told us of the people at the home who lacked capacity and that the appropriate number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care.

The staff in the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful.

People who lived at the home and staff told us that the home was well led and staff told us that they felt well supported in their roles. We saw that the registered manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home extremely well.

Staff were recruited safely and there was sufficient evidence that staff had received a proper induction or suitable training to do their job role effectively. The majority of staff had been supervised and appraised. The registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults.

We saw that since the registered manager had been appointed there had been significant improvements in the service and the registered manager had a comprehensive action plan that showed what had been achieved and what was still outstanding.

Below is a summary of what we found.

Is the service safe?

The four staff members we spoke to were all able to confidently and correctly tell us what they would do in an event of a person using the service suffering a fall. We saw for those who were high risk of falls, interventions were in place that minimised their risk of falling and injury for example, specialised equipment such as sensor mats. These interventions were supported by care plans and risk assessments, which were reviewed on a regular basis. We saw staff responding quickly to those people who used the service who were walking around or wandering ensuring they were assisted. We saw staff were able to identify risks and manage them appropriately.

Records showed that staff at the home regularly undertook safeguarding training and the staff we spoke with corroborated this. We spoke to four staff who were able to tell us what abuse was, name the different types and what they would do if they witnessed abuse.

Is the service effective?

We were told by staff and relatives that activities at the home reflected what the person enjoyed doing prior coming to live at the home. One relative told us that they had all sorts of activities, which the person enjoyed such as baking and flower arranging.

We saw nurses kept communication logs of GPs and multi-disciplinary team member visits and advice, which was also reflected in people's care plans. This showed that staff were following specialist advice and ensured continuity of care. We saw evidence of staff discussing these visits with relatives in a separate communication log. The four relatives we spoke to told us staff would always discuss their relative's care with them.

Is the service caring?

We saw staff played black and white films up on a movie projector, which we saw some people with dementia recognised and enjoyed watching. One relative told us that staff would offer people a choice of films to watch, she said her mother really enjoyed picking one she remembered. We also noted that staff were polite when speaking to people who use the services and greeted them in a friendly manner. The four relatives we spoke to corroborated this. We saw staff would sit with the people who lived at the home and talk about their families and social activities. We observed and corroborated that staff gave people choices, were caring and inclusive of people who used the service.

Is the service responsive?

We saw the home had recently undergone refurbishments and had made space for two lounges one 'quiet' lounge and one 'high dependency' lounge. The people in the high dependency lounge were observed by at least one member of staff at all times to ensure their safety. The provider had made sure that sufficient staff with the right skills and knowledge supported people who used the service. We saw evidence in the four care plans we reviewed of the people who used the service had their dependency assessed. The registered manager told us 'We recently increased the staffing level over the year to meet the requirements of the people's needs'.

Is the service well-led?

We asked people who lived at the service, relatives and staff about the registered manager and her ability to deal with concerns. They all felt she dealt with any issues very promptly and all gave positive comments about her management style and personality for example, 'She is very approachable', 'Friendly', 'Very nice and kind' and 'Good leader'.

"Life is easier now I am living here. I know I made the right choice when I made the decision to leave my home.' We spoke with three family members who told us they were very satisfied with the care and support offered to their relative. One comment made was:

'Before my relative moved the manager did a full assessment of their needs including routines, likes and dislikes. This made us as a family feel the staff wanted to get to know our relative and wanted to look after them properly.'

We saw from the care records that there was assessment of people's needs and this was done in consultation with the individual and their family members or representative. Each person had a personalised care plan and risk assessments that were reviewed regularly and showed what their needs and preferences were.

Staff members felt supported and showed that they had a good understanding of the people they were caring for and were able to meet their various needs. Staff confirmed they were provided with safeguarding adults training to make sure they understood how to keep people safe.

There were systems in place to monitor the safety and quality of the service provided.