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Inspection carried out on 29 August 2017

During a routine inspection

Anjulita Court is a residential care home with nursing for up to 62 older people. Some people may be living with dementia. At the time of our inspection there were 61 people using the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed. Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professionals when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

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.

Further information is in the detailed findings below.

Inspection carried out on 8 and 9 July 2015

During a routine inspection

Anjulita Court is a care home providing nursing, personal care and support for up to 62 people with a range of social, physical and dementia needs. It is situated in a suburb of Bedford. On the day of our inspection there were 61 people living at the service.

The inspection took place on 8 and 9 July 2015.

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.

People felt safe and secure within the environment because of the care and support they received from staff.

Staff had a good understanding of how to protect people from harm. They were knowledgeable of safeguarding vulnerable adults recording and reporting procedures.

People had risk assessments which identified hazards they may face and provided guidance to staff on how to manage any risk of harm.

People were cared for by sufficient numbers of well trained staff who were only employed after all essential safety checks had been satisfactorily completed.

Medicines were stored and administered safely. Staff had been trained in medicines administration and had their competency regularly assessed.

Staff attended a variety of training to ensure they were able to provide care based on best practice when supporting people.

Staff had obtained a valid consent from each person before any care or support was provided. We found that people who had their capacity to make day-to-day decisions formally assessed. When people had been assessed as being unable to make complex decisions, there were records of meetings with family and other professionals involved in their care.

Mealtimes were relaxed and people had a variety of choice and were given support when required.

People were supported to see healthcare professionals in order to ensure their general health was well maintained.

People were happy with the care they received and confirmed that staff were kind, caring and courteous.

Staff understood people’s privacy and dignity needs. They knocked on people’s doors before entering rooms and asked people discreetly if they needed to go to the bathroom.

Members of staff were able to describe the individual needs of people in their care, and worked hard to ensure they received their preferences, choices and wellbeing.

People’s care plans were based upon their individual needs and wishes. Care plans contained detailed information on people’s health needs, preferences and personal history.

People told us they had no reason to complain about the home but felt able to do so if necessary. The provider had a complaints procedure in place which people had access to, including advocacy support if this was required.

The service was well organised which enabled staff to respond to people’s needs in a proactive way. Staff worked well as a team and received good leadership from the registered manager.

We saw that effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvements.

Inspection carried out on 4 September 2014

During an inspection in response to concerns

Before this inspection the Care Quality Commission (CQC) received some information of concern regarding people�s care and welfare. It was alleged that people living at Anjulita Court were not safeguarded through the provision of effective care, and that staff did not always treat people with respect and dignity. This inspection was carried out in response to these concerns.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People�s needs had been assessed on admission to the home and risk assessments were in place.

People who lived at the home told us they felt safe. They said that staff were kind and friendly towards them and delivered the care and support they needed. One person said, �I feel safe, I know that staff look after me.� We saw people were treated with respect and dignity by staff.

We found that the service had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). These policies provided staff with information about how to support people who lacked capacity to consent to decisions about their care and treatment. The interim manager had recently been in contact with the local authority in respect of possible referrals to be made for DOLS.

Is the service effective?

People's care needs had been assessed prior to their admission, to determine their needs and make sure the service could meet them effectively. We saw from information detailed within care files that people had been involved in decisions about how their care was delivered.

It was clear from our observations that staff had a good understanding of the needs of the people who used the service. We found that care plans were written in a �person centred� style which reflected people�s personal needs and preferences. We saw that arrangements were in place for care plans to be reviewed regularly to make sure information about people�s care and support needs remained appropriate and accurate. We found that reviews were up to date and included people and their relatives, where appropriate.

Is the service caring?

We observed that staff were very attentive to people's needs throughout our inspection. Staff engaged positively with people and gave people time to respond. We found staff showed patience and respect when communicating with people who lived at Anjulita Court.

People told us they enjoyed the range of activities offered within the home and we observed that people were encouraged to join in, either on a group or individual basis. People expressed their enjoyment and we observed that people were laughing and joking with staff.

Is the service responsive?

People�s care plans were reviewed and updated monthly or more regularly if required.

Records confirmed that people had access to a GP, who regularly visited the home to treat people and respond to health concerns. We found that people were also able to access help and support from other health professionals such as dentists, physiotherapists and dieticians.

Is the service well led?

The home did not have a registered manager in post but this post was being covered by an interim manager and recruitment was taking place to employ a new registered manager.

We saw evidence of quality assurance processes in place, including regular audits. The interim manager told us of their plans to make further improvements to the service.

Inspection carried out on 14 January 2014

During an inspection looking at part of the service

We visited Anjulita Court on 14 January 2014, to ensure that the compliance action which was made when we visited the service on 8 October 2013 had been achieved. We did not speak to people on this occasion.

We found that the service had reviewed its quality monitoring processes. For example, arrangements had been made for meetings to be held with people and staff. People�s views had been sought. This meant that they were now able to influence how care should be delivered.

Records relating to people�s care, support and treatment were now effectively monitored to ensure that the care they received was safe and effective. Records relating to complaints investigated now provided a clear audit trail of the outcome of the investigation. This demonstrated that people�s complaints were listened to and acted on appropriately.

Inspection carried out on 8 October 2013

During a routine inspection

We spoke with four people who used the service, four relatives, a visitor to the home, a health care professional and six staff.

We found that people�s needs were assessed and their care plans were regularly updated to reflect changes. One person said, �My key worker reviews my care plan regularly and gives it to me to read and sign.�

We found that people were protected from the risks of inadequate nutrition and dehydration. A person who used the service said, �The food is delicious. It is very well cooked, lovely variety. I enjoy everything.�

The home had procedures in place to ensure that incidents and allegations of abuse were responded to appropriately.

We found that rotas were maintained with staff cover 24 hour a day. There were enough qualified skilled and experienced staff to meet people�s identified needs.

The provider�s quality monitoring processes were not effective to ensure the care provided was safe and effective.

Inspection carried out on 29 November 2012

During a routine inspection

During our visit to Anjulita Court on 29 November 2012, we found the home to be a spacious, relaxed and happy environment. The home operates over four separate units dependent on people�s needs although people can move freely around the home independently or with staff support as necessary.

We were shown the various facilities available to people, including a hydrotherapy pool, sensory room, chapel, hairdressers and cinema room. The home also had a coffee shop area which we were told anyone was able to use, including people from the local community. The deputy manager told us the home was developing close links with local people and now provided an area for groups to meet: this included the local mother and baby group and also the parish council. We observed people from the local community meeting with residents from the home in the coffee area.

We spoke with eight out of 59 people who lived in the home and also seven members of staff. Everyone we spoke with said they were happy, and that staff looked after them well. One person said �the carers� are excellent� and another said �the staff are wonderful�very caring and attentive to my needs�.

We saw the home offered a range of activities for people on a daily basis to meet the diverse needs and interests of people: we were told the home had just celebrated Diwali and three people we spoke with told us how much they had enjoyed this and eating Asian foods they had not had previously.

Inspection carried out on 25 October 2011

During a routine inspection

People we spoke with during our visit to Anjulita Court 25 October 2011 told us that they were very happy at this home. One person said, �It�s very comfortable and we�re very well cared for. I�ve absolutely no complaints�. Another said �I can�t fault this place at all � I�m over the moon with it�. A family member said their relative was looked after well and the care was very good.

People said they felt safe here and were able to make choices about their lives. They told us they got on well with the staff and felt they were treated well and with respect. One person said, �The staff are very kind and considerate and they treat us with dignity�.

Reports under our old system of regulation (including those from before CQC was created)