Anson Court Residential Home

Anson Court is a residential care home providing personal and nursing care to up to 33 people. The service provides support to older people and those living with dementia. At the time of our inspection there were 25 people using the service.

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

People told us they felt safe living at the home. There were risk assessments in place to mitigate risks to people’s safety. Staff supported people safely with their medicines and staff understood how to recognise abuse and report this. The home was clean, and staff understood how to prevent the spread of infection. There were enough staff who had been recruited safely.

Staff received training and support in their role and demonstrated a good understanding of peoples assessed needs and care plans which had been completed to guide staff on providing effective care. Staff supported people to maintain a balanced diet and manage health conditions with support from other professionals as needed. The environment had been adapted to meet people’s needs.

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

People, relatives and staff spoke highly of the home and the management team. There were systems in place to ensure people received good quality care. Staff were able to share their views about the service and people and their relatives were also able to five feedback. Feedback was used alongside audits of the service to develop an action plan to make improvements.

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 requires improvement (published 10 January 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to people’s health needs and falls. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-ked sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anson Court Care Hone on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Anson Court is a residential care home providing accommodation and personal care to up to 33 people in one adapted building. The service provides support to older people and people living with dementia. At the time of our inspection there were 17 people using the service.

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

Continued improvements were required to the provider’s audit and governance processes. These included monitoring people’s fluid and nutritional intake, consistency in care plans and risk assessments and accuracy of daily records. There were systems in place to obtain feedback from people, relatives and staff about how the service could be improved.

Risks to people’s safety had been assessed. However, risk related to use of flammable creams had not been considered for one person who smoked. Staff understood their responsibilities to report abuse and protect people. Staff were safely recruited and deployed effectively to support people. Medicines were administered safely and stored securely. Accidents and incidents were investigated and learning shared with staff. There were adequate processes in place to monitor infection control.

Improvements had been made to people's mealtime experiences since the last inspection. Staff training had been reviewed and updated. Work had continued around the home to become more dementia friendly. The service worked with health and social care agencies to monitor people's health and wellbeing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We saw kind and caring interactions between people and staff. Staff had time to sit and engage with people in a meaningful way. People and relatives were happy with the care provided and spoke positively about the staff who supported them. People and the relatives felt people were treated with dignity and respect and supported, as much as possible, to be independent.

People received care and support to their needs. Care plans were clearer with instructions for staff on how to deliver support to people. Care plans were in the process of being reviewed although sometimes contained inconsistent information. People were supported to engage in meaningful activities, although more could be done to support individual hobbies and interests. People and their relatives knew they could speak with the manager or staff with any concerns.

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 15 July 2022) and there were breaches of regulation. The provider and their consultants completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of some of the regulations.

This service has been in Special Measures since May 2022. During this inspection the provider and their consultants demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider still needs to make improvements. Please see the well-led section of this full report.

In response to the issues identified at this inspection, the manager and consultants took immediate action to address them.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified a continued breach in relation to the provider’s governance processes at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Anson Court Residential Home is a residential care home providing personal care for up to 33 people across two floors. At the time of the inspection the service was accommodating 21 people, some of whom were aged over 65 and living with dementia.

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

Relatives and all people we spoke with gave positive feedback about the staff and the home. However, we found shortfalls throughout the inspection which impacted on the safety and quality of care for people.

People had been put at risk of potential, avoidable harm. Checks had not always identified significant loss of weight for people, food was unsuitable for one person’s dietary needs and the use of inappropriate moving and transferring techniques by care staff.

The service was not well led. At our last six inspections, we have had continuous concerns the governance systems were ineffective to monitor the quality and safety of the service. This has continued to be a concern at this inspection. The provider had not taken prompt action to make the necessary improvements. The quality assurance systems were significantly lacking and were not robust. The processes had not identified all of the concerns in the service. Records were not always complete. Care plan reviews were of poor quality and ineffective at improving care.

Risks associated with people’s health had been identified. However, there was limited information within people’s care plans for staff to follow to support people, particularly for people who may present with behaviours that could be seen as challenging.

The home had adequate processes in place to monitor infection control. Staff had access to a supply of personal protective equipment (PPE). Carpets and furniture were regularly cleaned. However, this had not prevented an unpleasant odour emanating around the home from a carpet in the main lounge area.

Medicines were overall administered safely. The auditing of medicines required some improvement to prevent the over stocking of some medicines. Protocols required some improvement to give staff the guidance they needed to support people unable to verbally tell people when they were in pain.

Incidents and accidents were being recorded on a regular basis and there was an analysis of the data to identify for trends to support the implementation of improvements to mitigate the risk of reoccurrences. However, not all outcomes were recorded to provide staff with guidance how to support people safely.

Training for staff had not been effectively monitored. We found shortfalls with training for a number of staff, particularly regarding training for first aid, dementia awareness and behaviours that may be seen as challenging.

Some work had started within the home to become more dementia friendly. However, there remained a significant amount of work left to be completed.

The overall dining experience for people required improvement. People who required support from staff to eat did not always receive this.

People and the relatives we spoke with, felt people were treated with dignity and respect. We saw some kind and caring interactions between people and staff. However, we also observed people were left for long periods of time with little or no stimulation or staff engagement.

The service worked with other health and social care agencies to monitor people’s health and wellbeing, although timely intervention had not always been sought.

There were processes in place to safeguard people from abuse. Appropriate recruitment procedures ensured new staff were assessed as suitable to work in the home.

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

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

Rating at last inspection

The last rating for this service was requires improvement (published 15 February 2022) and was in breach of regulations. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations. The service has deteriorated to inadequate.

Why we inspected

This inspection was carried out to follow up on action the provider told us they had taken following the last inspection. It was also prompted, in part, due to concerns received about staff training, poor governance and risk. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make further improvements. Please see the safe, effective, caring, responsive and well-led key question sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anson Court Residential 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 monitor the service and will take further action if needed.

We have identified breaches in relation to the home environment continued to be poor and did not support people’s autonomy. Staff had not recognised some of their actions when supporting people were not always respectful. People not always receiving personalised care and not always being treated with dignity and respect. Some people’s nutritional needs were not being met and had been put at risk of potential avoidable harm. There was a lack of effective and adequate training for staff and inadequate governance.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 six 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.

About the service

Anson Court Residential Home is a residential care home providing personal care for up to 33 people across two floors. At the time of the inspection the service was accommodating 25 people, some of whom were aged over 65 and living with dementia.

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

Most relatives and all people we spoke with gave positive feedback about the staff and the home. However, we found shortfalls throughout the inspection which impacted on the safety and quality of care for people.

The quality assurance checks in place to drive improvement were not robust. The provider had not ensured the maintenance and upkeep of the home environment and safety of care was sufficiently monitored. At our last five inspections, we have had continuous concerns the governance systems were not effective to ensure the delivery and monitoring the quality of the service. This has continued to be a concern at this inspection and the provider had not taken enough action to make improvements.

Risks associated with people’s health had been identified. However, there was inconsistent information in people’s care plans for staff to follow to support people living with diabetes safely.

The home had adequate processes in place to monitor infection control. Staff had access to an adequate supply of personal protective equipment (PPE). However, we found some staff did not always wear their face coverings in line with government guidance. Checks to monitor the cleanliness of carpets and furnishings required improvement.

Medicines were administered safely, although the auditing of medicines that required additional checks required some improvement.

Incidents and accidents were being recorded on a regular basis. However, there was no analysis of the data that would help to identify for trends to support the implementation of improvements to mitigate the risk of reoccurrences.

Care plans had not been consistently reviewed to ensure all the information reflected people's needs. However, the new manager had started to review all care plans and make referrals to health care agencies for some people to have their needs reassessed.

Staff confirmed they had received training to support them in their role. Although some staff had not always followed their infection control training in relation to the wearing of face coverings. Most staff had completed their training through a virtual and on-line programme.

The home environment was not dementia friendly. Repairs to parts of the home had not been completed.

People and most of the relatives felt people were treated with dignity and respect. Although we observed occasions when this was not always the case. We saw kind and caring interactions between people and staff, however we also observed people were left for long periods of time with little or no stimulation or staff engagement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were being supported to get up very early in the mornings and it could not be evidenced this was always by choice.

There were processes in place to safeguard people from abuse. Appropriate recruitment procedures ensured new staff were assessed as suitable to work in the home. The overall dining experience for people was a calm experience. People’s dietary needs were appropriately assessed. The service worked with other health and social care agencies to monitor people’s health and wellbeing.

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

Rating at last inspection: The last rating for this service was requires improvement (published 05 November 2020) and was in breach of regulations. The provider had completed monthly reports after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anson Court Residential 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.

We have identified breaches in relation to people not always receiving personalised care, some poor infection control practices and inadequate governance.

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Anson Court Residential Home is a residential care home providing personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

Incidents had occurred at the service where people may have required safeguarding. These incidents had not always been reported to the relevant agencies. Notifications of incidents had not been submitted to CQC as required by law.

Key risks to people’s safety had not always been assessed, although staff were aware of how to manage these. Following the inspection, the provider sent evidence that they implemented risk assessments to cover the areas identified as missing.

Quality assurances systems were in place but were ineffective at identifying some of the areas for improvement found at this inspection.

There were sufficient numbers of staff to support people safely. Medicines were managed safely and the provider had implemented additional infection control measures in light of COVID-19.

People, staff and external professionals spoke positively about leadership at the service and felt the home was well led. People were given opportunity to feedback on their experience of the service and the provider worked effectively with other agencies to improve the quality of care provided.

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

Rating at last inspection

The last rating for this service was Requires Improvement (Published 07 January 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the management of falls and monitoring of health conditions. As a result, we undertook a focused inspection to review the key questions of Safe and well-led only.

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 in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anson Court Residential 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 visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Anson Court is a residential care home providing personal care to 26 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

Safe medicines practices were not always followed, and it was not always clear if medicines had been given as prescribed. Although people told us there were enough staff to meet their needs, staff availability to support people was stretched at busy periods, such as mealtimes.

The design and décor of the service did not always meet the needs of people living with Dementia.

We found instances of uncaring practice and incidents where people’s dignity had not been respected. Although staff knew people well, there was a lack of personalisation in people’s care records.

The systems implemented to monitor quality at the service had been ineffective in identifying areas for improvement.

People were kept safe by staff who knew how to identify, and report concerns of abuse. Risks to people’s safety was being well managed and there were effective infection control procedures in place.

People were supported by staff who had received an induction and ongoing training relevant to their role. People had access to healthcare services where required and were supported to maintain a healthy, balanced diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Where people had made complaints, these were investigated. People had been asked about their wishes at the end of life so the service could ensure these were met.

People and staff spoke positively about the changes in leadership at the service. People were given opportunity to feedback on the quality of the service and the manager displayed a commitment to improving care.

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 27 June 2019). At this inspection, although improvements had been made in some areas and breaches of regulation met, enough improvement had not been made in other areas and the provider was still in breach of some regulations.

This service has been in Special Measures since 27 June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to ensuring people are treated with dignity and respect, and management oversight of quality. Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

We found that care and support was not always provided in a safe way. Risks to people were not effectively assessed to ensure peoples safety. There was a lack of governance systems and oversight which caused audits and checks to be ineffective. This led to people being at risk from multiple falls. The administration of medications and moving and handling practices were not consistently safe.

People were supported by staff who knew how to report concerns of abuse.

Care plans were task orientated and did not reflect people’s choices or how to help them to make choices in how they were supported. The service relied on people’s relatives to deal with cultural needs.

The dining experience was not positive. People did not receive effective support to eat their meals with people’s meals being removed before they had finished. People’s nutritional requirements were not met.

Improvements had been made to the environment. The provider had put in place a new wet floor shower room and had created a conservatory area that led to the enclosed garden. This enabled people to independently access the enclosed garden.

People were not consistently supported to access specialist health care services, such as dieticians, when they needed to. This meant that people’s needs were not always met in a safe way.

Rating at last inspection: Rated Requires Improvement. (Report Published 7 March 2018)

• Why we inspected: This was a planned inspection based on the ratings at the last inspection. The inspection took place on 19 and 20 March 2019.

• At the previous inspection in October 2017, it was identified people’s health and safety was not managed in a consistent way and records lacked detail, quality assurance processes did not effectively identify issues. At this inspection we found that this had not improved.

This is the third consecutive inspection where the provider has failed to achieve an overall “Good” rating.

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

Enforcement: Full information about The Care Quality Commission’s (CQC) regulatory response to more serious concerns found in inspections and appeals, is added to reports after any representation and appeals have been concluded.

Follow up: As we have rated the service as inadequate, the service will be placed 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 providers registration of the service, we will inspect again within six months. The expectation is that providers found to be providing inadequate care should have made significant improvements within this time frame.

If not, enough improvement is made within this time frame, so that there is still a rating of inadequate for any key question or overall, we will act 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 twelve 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.

During this inspection we identified two breaches of the Health and Social Care Act 2008 relating to governance systems and failing to notify us of certain events. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection there was a registered manager in place. 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 told us they felt safe living at Anson Court. However, we found the system operated by the registered manager did not always demonstrate people got their medicines as prescribed. Risks to people’s health and safety were not always managed in a consistent way. Staff had received training in how to protect people from the risk of harm and knew what to do should they suspect any abuse had taken place. People told us and we saw there were sufficient staff to meet people’s needs.

Staff told us they had received training to help them meet people’s needs. People’s rights were upheld through effective use of the Mental Capacity Act 2008. People told us they enjoyed the food at Anson Court and they received sufficient nutrition to remain healthy. When people’s health needs changed or required reviewing we saw they had access to other healthcare professionals to support them.

People told us and we saw staff treated them with kindness and compassion. We saw people’s privacy and dignity was upheld by staff. Staff understood the need and we saw they promoted people’s independence. We saw people were encouraged to maintain relationships that were important to them.

People and their relatives told us they were happy with the care they received. Staff knew people’s individual needs well and therefore people received care that was responsive to their individual needs. There were activities available should people wish to join in. The provider operated a complaints system which meant people could complain should they wish to.

The provider had failed to notify us when people were being deprived of their liberty in line with their legal duty. The quality assurance system operated by the provider was not effective at identifying the areas our inspection highlighted where improvements were required. People and their relatives told us the home was well led and they were happy living there. Staff told us they were supported by the registered manager and were involved in the running of the home.

At our inspection of 20 February 2014, we found that the provider was not meeting Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 because they were not involving people in decisions and choices about their care. We found that people were woken very early by staff and there was no evidence to state that this was their choice. We asked the provider to send us an action plan of how they were going to meet this regulation which they did. Since our previous inspection the law has changed and the regulation is now Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found on this inspection that the provider was now meeting the requirements of the law.

We also found during our last inspection the provider was not meeting the requirements of Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010. This was because records did not always reflect people’s choices and preferences. We found on this inspection they had met the requirements of the law. The law which replaces this regulation is now Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The administration and recording of medicines given to people was not always done safely. Medicines were not always stored at the correct temperature required to keep the medicine at its best. Although criminal records checks were undertaken before staff were able to begin their role, where disclosures had been raised on these checks, risk assessments were not in place to ensure that people were not at risk. A full work history for staff had also not always been obtained. Staff supported people in a way that made them feel safe. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed.

Where medicines were given without people’s knowledge, there was no evidence that discussions had been made to reach a best interests decision where people did not have the capacity to make decisions for themselves. Staff had the skills and knowledge required to support people effectively. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going training to assist them in their role. Staff could access supervision and felt able to ask for assistance from the registered manager and senior staff, if they should need it. Staff knew how to support people in line with the Mental Capacity Act and gained their consent before assisting or supporting them. Staff assisted people to access food and drink and encouraged people to eat healthily. Staff supported people’s healthcare needs.

Quality assurance audits were not always comprehensive enough to allow patterns and trends to be observed accurately. People were happy with the service they received and felt the service was led in an appropriate way. Staff were supported in their roles. Staff felt that their views or opinions were listened to.

People were involved in making their own decisions about their care and their own specific needs. People felt listened to, had the information they needed and were consulted about their care. Staff treated people with dignity and respect. People were encouraged to retain an appropriate level of independence with staff there ready to support them if they needed help.

People’s preferences for how they wished to receive support were known and considered by the staff. Staff understood people’s needs and provided specific care that met their preferences. People knew how to raise complaints or concerns and felt that they would be listened to and the appropriate action would be taken.

During the inspection we spoke with three people who used the service, three staff, one relative, the provider, the manager from another home and the registered manager who came in whilst on annual leave. We spent time observing the care people received as most people due to their health conditions were unable to speak with us.

One person told us: "The staff are very good". A relative said: "I don't know what I will do without the staff when my mum goes home, everyone has been great".

We found that people who lived in the home or if appropriate their relatives were not fully consulted about their preferences about the care they wanted or needed.

We found that improvement to people's care records was needed, to ensure that people received safe and appropriate care.

The home had appropriate systems in place to enable people to raise concerns. Improvements had been made in the way that complaints were recorded.

All people we spoke with during our inspection told us that they or their relative received good care. One person said: "We are really happy chappies here. They look after me as if I'm their mother. I feel happy and well cared for". Another person said: "The care is wonderful; they look after me very well. We have activities that keep me occupied ". One relative said: "I'm so glad we found this place - it's brilliant. They treat my relative with respect and love, nothing is too much trouble". Two people told us before we visited about their concerns about care provided at Anson Court.

We found that improvement was needed to protect people from the risk of falls and ensure they received safe and appropriate care. Care records were not accurately completed and did not protect people from the risks of inappropriate or unsafe care.

We found that appropriate arrangements were in place to store and manage people's medicines.

The home was a clean and pleasant place for people to live.

People were positive about the staff and told us that staff were caring. Concern had been highlighted about the sufficiency of the staff. We found that there were sufficient staff and arrangements were in place to cover staff absence.

The home had appropriate systems in place to enable people to raise concerns and people said that they were confident that any concerns they had would be addressed. However we were unable to find evidence that concerns were investigated and addressed as no record of complaints made was available.

The inspection included the observation of care experienced by people living at the home, talking to people who were living in the home, talking with the manager and staff on duty, looking in detail at all aspects of care for three people some of whom had complex needs, viewing people's rooms and discussing their care with staff. This process is known as pathway tracking.

People we spoke with were positive about the service provided. One relative told us, " I am very pleased, she always looks clean and well looked after", another relative said "I have no concerns, she is happy here".

People and their relatives were consulted about the care they needed. People were able to choose how they spent their day and when they got up and go to bed. Friends and relatives were made welcome and were able to visit.

The service had appropriate systems in place to protect people from harm. One relative said, "She is happier here and she is safe".

There were sufficient staff to meet people's needs. We were told that staff were caring. One relative said, "Staff are very helpful, they work really hard". Another relative said, "The staff here are first class".

The service had appropriate systems in place to check that people received safe and appropriate care that meets their needs.