Archived: Anchor Lodge Retirement Home

We found the following examples of good practice.

The service was working closely with the local authority, Public Health England, and Clinical Commissioning Group (CCG) infection control team to ensure their infection control practice was safe.

Staff had been trained and were following safe practice in the wearing of personal protective equipment (PPE).

Relatives who had attended garden visits in the summer told us it had been conducted in a safe manner with staff wearing PPE. One told us, “Infection control was done right, and it gives you confidence.”

The management had systems in place, to overcome environmental issues to support social distancing. Where the small dining room would not support this, arrangements were in place to serve people their meals in their bedroom, communal lounge or dining room.

People and staff were accessing regular testing for COVID-19, and results were acted on.

Systems were in place to support people needing to self-isolate. The service was not taking new admissions at the time of our visit. The registered manager confirmed they were following government guidance regarding new admissions and all new admissions were isolated in their bedroom for the first 14 days.

Relatives praised the ‘friendly’ management who kept them updated on what was happening in the service and their relatives welfare. Comments included, “They have been very good, excellent and outstanding,” and “I speak every second day and I am kept well informed.”

Anchor Lodge Retirement Home accommodates up to 14 people in one adapted building. On the day of our inspection there were ten people living at the service. Anchor Lodge is a detached building situated on the sea front in Walton on the Naze. The premises is set out on three floors with each person using the service having their own individual bedroom. The service has a communal lounge and dining area.

Rating at last inspection: At our last inspection, the service was rated ‘Inadequate’. Our last report was published on 25 July 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection. Following our last inspection, the provider sent out an action plan setting out the actions that they intended to take to address the shortfalls that we found.

People’s experience of using this service:

At our last inspection we found that there had been a deterioration in the quality of care provided at Anchor Lodge Retirement Home. There were breaches of Regulations 9,11,12,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service was placed in in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. We found that while there was still some work to do, the service met the characteristics of Requires Improvement.

People received care from staff who knew them well. People told us they were happy living in the service and staff were kind and caring.

Improvements had been made to staffing and a new activities member of staff had been appointed. However, we were not assured that there were always sufficient numbers of staff available. Several of the people living in the service had a diagnosis of dementia and other health conditions which meant that their needs were complex. The layout of the building meant that staff did not always have oversight of the communal areas which presented some risks. We have asked the provider to take action on this.

The environment was better maintained.

There were systems in place to reduce the risk of cross infection.

Medicines were better managed and while we found some shortfalls, practice largely followed professional guidance.

There were improved systems in place to recruit staff and ensure their suitability before they started work at the service.

Staff received training to develop their skills.

People told us they enjoyed the food.

People were referred for specialist health care support when needed.

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.

Care plans were in place but were not always sufficiently detailed.

People had better access to activities to enhance their wellbeing.

The manager had started the process of developing oversight systems, but these had not identified some of the areas that we identified at the inspection such as gaps in documentation and safety shortfalls.

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

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

Anchor Lodge retirement 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.

Anchor Lodge retirement home accommodates up to 14 people in one adapted building. On the day of our inspection there were nine people living at the service.

Anchor Lodge is a large detached building situated on the sea front in Walton on the Naze. The premises is set out on three floors with each person using the service having their own individual bedroom. The service has a communal lounge and dining area.

The service 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 our previous inspection in September 2015, we rated the service as ‘Good’ overall but improvements were required to ensure that the service was responsive and that people were engaged and had enough stimulation on a day to day basis.

At this inspection, we found that the service was no longer Good. We found that significant improvements were needed and we found breaches of legal requirements under the Health and Social Care Act, 2008; 2014

People’s safety and welfare were compromised because the owner did not have in place robust and effective quality monitoring and assurance processes to identify issues that presented a potential risk to people. Thorough risk assessments had not been carried out particularly in relation to individual’s pressure care needs, risk of falls and to risks within the physical environment. Improvements were required in the monitoring of fluid intake.

Necessary health and safety precautions had not been taken within the home to protect people from risk of harm. The cleanliness of the service had been neglected and improvements were required regarding infection prevention.

Staffing levels at the service were not adequate to ensure that people’s needs were met, and they received a good quality of care.

Some staff had not received training, and where staff had received training this had not been effective in ensuring that they had the necessary skills and knowledge to carry out their roles. The requirements of the Mental Capacity Act (MCA) were not fully understood.

Improvements were required to ensure that peoples’ choices were not restricted and that independence was promoted to ensure that people maintained their daily living skills.

People’s choices, needs and wishes were not always recorded and language used in care records was not always respectful and did not demonstrate an understanding of the needs of people living with Dementia.

Although some auditing and monitoring systems were in place to ensure that the quality of care was consistently assessed, they had failed to identify the issues we found during our inspection.

There had been a lack of oversight of the service by the owner and the registered manager to ensure the service delivered was of a good quality, was safe and strived to continuously improve.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. The service 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.

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.

Below is a summary of what we found. The summary is based on our conversations with the manager, one staff, two people who used the service, three relatives and from looking at records. Where it was not possible to communicate with people who used the service we used our observations to gather information.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs. Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

The provider had clear policies and procedures regarding medication, we saw that medication was stored, administered and disposed of in line with their policies and procedures. Staff received annual refresher training in administering medication. The provider carried out weekly audits of medication.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One person said, "I am happy here." A relative said, 'My relative is safe here, the staff are very kind and caring.'

Is the service effective?

It was clear from what we saw, and from speaking with staff, that they understood people's care and support needs and that they knew the people well. A person who used the service told us, "The staff were friendly, polite and caring.'

People's health and care needs were assessed with them, and they were involved in writing their plans of care, where they were unable to do so staff had spoken to their relatives or friends to gain their views. Specialist dietary needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People's preferences, interests, religious and faith needs had been recorded and care and support had been provided in accordance with people's wishes.

We observed people who lived in the home enjoying a laugh and joke with the staff. One person told us, "The staff are friendly; I enjoy a laugh and joke with them."

Is the service responsive?

Where people's care needs had changed appropriate referrals to the doctor, district nurse and dentist had been made and any recommendations had been acted on. The manager had regular contact with the relatives of people who used the service and health care professionals.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Relatives we spoke with told us the staff had kept them informed of people's changing health needs.

We saw the responses from the stakeholder survey. People had commented positively about the quality of the care provided to the people who lived in the home. The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

The member of staff we spoke with told us they were clear about their roles and responsibilities and they received regular refresher training, support and supervision from the manager. They told us that this enabled them to provide excellent care and support to people who used the service. We saw that staff had a good understanding of the aims of the service. This helped to ensure that people received a good quality service at all times.

We received some very positive comments from people living at the home. One person told us: "We're very lucky to live here; we couldn't wish for better treatment, the staff are all really lovely."

We checked that people had given their consent before receiving care or support with personal care. We saw that staff spoke kindly to people living at the home and there was a calm, happy and relaxed atmosphere.

A relative we spoke with told us: 'It's such a lovely homely atmosphere, the staff know the people living at the home really well and know just how to manage and support them.'

Safeguarding procedures were in place to ensure people were safe, and we found the staff members were supported in their roles to provide appropriate and safe care for people.

We saw the home had an effective system to assess the quality of the service they provided.

We spoke with four members of care staff. Staff spoken with told us they felt they were provided with the training that they needed to meet the needs of the people who used the service.

We observed the care provided to people and saw that staff interacted with people in a caring manner. However, we were concerned with the manner in which people were supported with their meals.

There were shortfalls in the management of risk to people who used the service. The provider had not taken proper steps to ensure people were protected against the risk of fire and ensure general fire precautions implemented in response to requirements made following an inspection carried out by Essex County Fire Service.