Anchorage Nursing Home

Updated 12 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Anchorage Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Anchorage Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. Although there was a manager registered with the Commission, they were no longer in post. An interim manager had been in post for 5 months and a new manager had been recruited and was waiting to commence.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and other professionals who work with the service, such as the infection control and end of life care teams. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with the regional manager, manager, director of quality, clinical nurse, as well as other members of the staff team including nurses, senior care workers, care workers, a domestic, chef and administrator. We also spoke with 12 people who used the service and 4 relatives, about their experience of the care provided.

We reviewed a range of records. This included 7 people's care records and a range of people’s medication records. We looked at 4 staff files in relation to safe recruitment. A variety of records relating to the management of the service, including audits, were also reviewed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 12 December 2023

About the service

Anchorage Nursing Home is a 'care home' providing accommodation, nursing and personal care for up to 40 older people. At the time of the inspection 23 people were living at the home, some of whom lived with dementia.

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

Systems in place to monitor the quality and safety of the service were not effective. Although internal and external audits identified areas for improvement, we found that action had not been taken to ensure those improvements were made. There was a lack of management oversight of staff practice to ensure best practice guidance was being adhered, and a lack of systems to ensure records were maintained accurately and stored securely.

Risks to people were not always managed safely, as care plans did not always provide information regarding people's current needs and how risks would be minimised. Identified risks were not robustly mitigated, as records did not evidence that people received planned care that met their needs. People’s nutrition and hydration needs were not always met adequately. The environment posed risks to people as it was not safely maintained. Personal protective equipment was available for use when required. Medicines were not always stored and managed safely, as room and fridge temperatures were not monitored daily, and no action was taken when the temperature was out of recommended ranges. Best practice guidance was not followed, such as for the administration of covert medicines. Not all staff had had their competency assessed to ensure they were safe to administer people’s medicines.

People, relatives and staff told us there were not always enough staff available to support people in a timely way. Our observations during the inspection supported this feedback. Not all safe recruitment practices were evident within staff files, and we made a recommendation about this. Not all staff received the necessary training to enable them to carry out their roles effectively, or relevant support, such as regular supervisions and an appraisal. However, staff told us they were kept updated and could raise any concerns with the management team.

Systems and procedures in place to safeguard people from the risk of abuse were not always effective, as although staff knew how to raise concerns, actions agreed to reduce risks to people were not always followed. Systems had been implemented to manage Deprivation of Liberty Safeguards and we found applications had been made appropriately. However, the principles of the Mental Capacity Act were not always adhered to when seeking and recording people’s consent to their care and treatment, therefore people were not supported to have maximum choice and control of their lives.

Most people told us they were respected and treated well by staff, and staff told us they knew people’s needs and how they wanted to be supported. People told us their family and friends could visit when they chose to, and we observed visitors in the home during the inspection.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 10 July 2023) and there were breaches of regulation identified. At this inspection we found sufficient improvements had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk and medicines, staffing, person-centred care, nutrition and hydration, consent and governance systems at this inspection. We also made a recommendation regarding staff recruitment practices.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.