The Care Quality Commission
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Archived: Anglesea Heights Care Home

Overall: Requires improvement read more about inspection ratings

Anglesea Road, Ipswich, Suffolk, IP1 3NG

Provided and run by:
Bupa Care Homes (CFHCare) Limited

All Inspections

19 January 2017

During a routine inspection

This unannounced inspection took place on 19 January 2017. This was to follow up the previous inspection completed on 1 and 2 June 2016. We had given an overall rating of requires improvement and found that it required improvement in every domain. We had found three breaches in regulation. These related to; medicines not being safely managed, a lack of sufficient suitably qualified nurses and a lack of responsiveness to emerging health conditions to ensure people’s health needs were met in a timely way. We had placed positive conditions on the provider to ensure compliance with regulation. We had restricted admissions to the service. We had met with the provider to ensure they understood our concerns and to develop a plan for compliance. At this inspection we found steady progress overall, but with some concerns remaining about Gippeswyk House and medicines management.

Anglesea Heights is nursing home and they are registered to accommodate up to 120 people. They also have the regulated activities of treatment of disease, disorder or injury. On the day of our inspection visit there were 50 people resident. 18 people resided on Alexandra. This house is for people with high nursing needs and end of life care. 18 people resided on Christchurch. This is for people with some degree of nursing needs and some people living with dementia. There were 14 people on Gippeswyk. This house is for people living with dementia with lower nursing needs.

Bourne house remained empty.

The service requires a registered manager. We at CQC had received an application and are in the process of determining the outcome of registration of the applicant. 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 at this service were confident and happy with the service that they were provided with. Relatives told us that they had seen improvements and any concerns they raised had been addressed. People had care plans in place, but these were not as individualised as they could have been, along with known risks not being effectively and consistently mitigated. There were a variety of activities on offer for people to participate in, but these could have been developed further based upon the known likes and preferences of the people living at the service.

The number of staff had increased since our last visit. Recruitment was ongoing. We were given assurances that this would continue before the service was expanded into four houses again. Bourne House remained closed to admissions. CQC have given permission for planned incremental admissions to two houses, but that no admissions were in place for Gippeswyk. This was because we found a lack of stable management and oversight on this particular house. The thread of inconsistencies showed us that Gippeswyk was the weakest house with Alexandra and Christchurch providing an acceptable level of care and support to people. Despite having good staffing levels at lunchtime on Gippeswyk the mealtime was not well managed and staff understanding and implementation of their dementia training needed further monitoring and development. Mealtimes had systems in place to provide people with the food they required and needed, but the lack of staff organisation and knowledge led to inconsistencies in the service provided.

At this inspection we found one on going breach in medicines management. There were issues found on each unit, but in particular with Gippeswyk where covert and crushed medicines were not as safely managed as should be. There were missed signatures and one person missed their medicines. In other units creams were not safely managed and records were not consistently accurately kept.

You can see what action we told the provider to take at the back of the full version of the report.

1 June 2016

During a routine inspection

This unannounced inspection took place on 1 and 2 June 2016. This was to follow up on the previous comprehensive inspection on 5 and 19 November 2015 where we had identified seven breaches in regulation and had placed this service in to special measures. At this inspection we found improvements and the safety of people at this service has improved. We have seen a reduction in breaches in regulation and have reported on three breaches ongoing. CQC had placed three positive conditions on the registration of Anglesea Heights. We found that two conditions relating to management and nursing were being complied with. There were further improvements to be made to comply with the condition relating to medicines management. However, due to an administration error at CQC, this condition had not been correctly applied. This condition is now in place and going forward we will continue to monitor the compliance with these positive conditions to ensure people are safe at this service.

Anglesea Heights Nursing Home is a care home with 120 beds divided into four separate buildings with 30 beds in each building: Alexandra House, Gippswyck House, Christchurch House and Bourne House. Each house provides nursing care. At the time of our inspection Bourne House was due to close the next day and people who had resided there had moved into other parts of the service or to different care homes that could meet their needs. There were 68 people resident.

This service requires a registered manager. A new manager had been appointed and had been at the service for five weeks on the day of our visit. They had applied to be registered. 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 this inspection of the service we found matters had improved from our last visit but still needed to develop further. We were not assured of consistency in terms of staffing being appropriately trained and deployed. We found people in need of support and unable to summon assistance. We were also concerned that agency nurses were used in large numbers particularly at night and did not know people they were caring for. The number of care staff had increased as had their training in dementia care.

We observed some very caring interactions between people living at the service and staff. Staff were warm in their interactions, communicated well. Some helped out with shopping for people and planted flowers for people to enjoy. Relatives had seen improvements and expressed their views positively with us. People had prompt access to healthcare professionals and relatives were pleased that changes in people’s wellbeing was communicated well. Care and support was effective on the whole, but there were inconsistencies in approach. We found that not all changes in a person’s care was communicated effectively and may have been slow to have been responded to except for our intervention on the day. Examples included a person who had developed a sore heel, a person feeling cold and call bells to summon staff being out of reach, also some people were at risk of dehydration as they were not monitored effectively.

People generally enjoyed access to a varied choice of foods and said how this had improved. Some people said how they enjoyed the variety of activities and choices of how to spend their day. Some people living with dementia did not have such a positive experience.

Since the last inspection a new management team has been put in place. Systems of evaluation and auditing have begun, but needed time to embed. Unit managers had their already limited time to manage compromised due to being drawn into leading nursing shifts because of the high usage of agency nurses.

You can see what action we told the provider to take at the back of the full version of the report.

05 and 19 November 2015

During a routine inspection

This unannounced inspection took place on 05 and 19 November 2015. The overall rating for this service is ‘Inadequate’ and the service is therefore 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 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The last comprehensive inspection was 29, 30 October and 6 November 2014. The overall rating was Requires Improvement. The one domain of ‘Effective’ was rated as Inadequate. We found two breaches of legal requirements at the last inspection. At this inspection we found some, but not enough improvements have been made to meet the relevant requirements.

Anglesea Heights Nursing Home is a care home with 120 beds divided into four separate buildings with 30 beds in each building: Alexander House, Gyppswyck House, Christchurch House and Bourne House. Each house provides nursing care. There is a registered manager in place they had been appointed in June 2015 and had recently become registered with us. A registered manager is a person who has registered with the Care Quality Commission [CQC]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.

A local manager with a good track record for managing services well was appointed to bring this service up to standard. We found that they had a good grasp of the issues needing to change and were working well with other outside agencies within health and social care. However, they were not appropriately supported by BUPA to bring about change. The manager has resigned from their post with other managers and key positions within the home also being vacant, suspended or resigning. This has led to concerns being expressed by the local authority and CQC. The main concerns focus mainly on Bourne House.

The manager had been recruiting staff to various positions within the service, including nurses, carers and housekeeping and catering. However, the high usage of agency still impacts upon the experience of people using this service. We also found that though well recruited staff did not always have the training to fulfil their roles nor the supervision and guidance to meet people’s needs.

People, dependant on where they lived within the service, experienced differing care and support. Some experiences were positive and others were not. Access to health care was not consistent and people were placed at risk of not having healthcare provided. Medicines management was not robust and some people were at risk. There was a high number of covert and crushed medicines being used and this was not always with the appropriate consent. Consent to care was for some people not obtained and people were at risk of having their liberty and rights infringed on a day to day basis because some people were placed in box chairs, bedroom doors routinely locked to prevent people from using their rooms or people were isolated in their rooms with no staff supporting them who spoke their language. Some people had good care with risk assessments in place to minimise harm, whereas other people either did not have risk assessments in place or staff were not aware and following plans in place. The premises were not routinely kept clean and hygienic and therefore people were laced at risk through cross infection.

Managers in BUPA external to the home were visiting and were aware of a limited number of issues within this service, but had not grasped the impact and were not taking action to support and change matters within this service. Some of the concerns we have found are repeat matters relating back to our inspection last October 2014 and February 2013.

You can see what action we told the provider to take at the back of the full version of the report.

29, 30 October and 6 November 2014

During a routine inspection

This was an unannounced inspection carried out on 29 and 30 October and 6 November 2014. At the last inspection on 16 February 2014 we found a breach of legal requirements as staffing levels were insufficient and people’s dignity was not always respected. An action plan was received from the provider which stated they would meet the legal requirements by April 2014. At this inspection we found that action had been taken with regard to these breaches but further improvement was still required.

Anglesea Heights provides accommodation, personal care and nursing for up to 120 people. The service mainly provides care to people who are living with dementia, and/or require nursing and palliative care. There was a total of 115 people living in the service at the time of our inspection. There are four bungalows; Alexander House, Gyppswick House, Christchurch House and Bourne House, each provides single bedrooms with ensuite facilities for up to 30 people. Staff refer to these as “bungalows” or “units”.

The service has 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 provider had a range of systems in place to inform them of what was going on in the service however actions to address issues that were identified were not aways taken promptly. There was a lack of managerial oversight of the service as a whole and there was inconsistency in quality across the service. The registered manager was unable to demonstrate how they identified where improvements to the quality of the service was needed.

Staff told us that the culture of the service was not always open and transparent and communication was poor. Key challenges facing the service to those that used it or were involved in it were not discussed with staff. Staff meetings and one to one meetings were not held regularly to inform and support staff in their day to day practice.

Staff training was not monitored and planned effectively and staffs competency and understanding was not assessed regularly . Specific training relevant to people’s needs was not provided to enable staff to have the right knowledge and skills to meet their needs.

The service was experiencing problems in retaining staff and covering staff absence. In response to this temporary agency staff were being employed and new staff were being recruited. Call bells were being responded to promptly however care was mainly centred on providing for people’s immediate and personal care needs. Some people lacked effective social interaction that promoted their wellbeing and gave them a pupose.

Relatives told us that their family members were treated with kindness and respect by staff. Staff understood and described how they could recognise various types of abuse and who to report any concerns to. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Where people lacked capacity it was not evident that decisions had been made in their best interests. Staff had good relationships with people and interacted with people in a caring and respectful manner. At mealtimes people’s dignity was not always maintained and choice was not always promoted. People did not always receive the encouragement they needed to eat and drink well.

There was a system in place to respond to complaints. However relatives told us that concerns raised verbally were not considered seriously and in some cases resolved satisfactory.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.

16 February 2014

During a routine inspection

We spoke with nine people who used the service and six relatives of people who used the service. People told us, 'The staff here are kind to us.' Another person said, 'The student here recently was cheerful. She had a lovely smile ' a smile in a morning means a lot to me when I find things hard to bear. There are a couple of staff here who understand me that I can joke with.' A relative said, 'The person in charge today is marvellous. But some of the others can be a little matter of fact with care, but most of the staff are compassionate when they give care.'

We observed that staff did not interact positively with some people who used the service. Some staff demonstrated a lack of understanding around ensuring the dignity of people was maintained. We saw that people were not always treated respectfully when supported with their meals.

We found that people's individual care needs had been assessed and planned. Each person had a treatment plan in place for their specific health related conditions. Where people were at risk of falls, pressure ulcer development, or malnutrition we found that appropriate assessments to minimise the risk of harm were in place.

We found that the number of staff on duty at the time of our inspection was not sufficient. We observed that people's needs were not always met due to the low numbers of staff. The provider did not have suitable arrangements in place to ensure that staffing levels were safe at all times.

7, 8 January 2013

During a routine inspection

As part of our visit we spoke with two people who used the service and and five relatives.

One person we spoke with told us, "I'm as happy as anything here. Everybody is kind to me. I'm as happy as a bird in the wood." A relative we spoke with said, "There are no problems getting to see a Doctor. They encourage you to be involved in the care if you want to be."

Another person we spoke with said, 'Quite frankly I don't think we could get better care anywhere -they try very hard.' A relative we spoke with said, "Some carers are more caring than others but they are all so dedicated here."

People who used the service received the care, treatment and support that they agreed to because the correct steps were used when taking consent.

People were protected against the risks of receiving unsafe or inappropriate care because the assessment, planning and delivery of care was properly planned.

We saw that medicines were stored, administered and disposed of safely. People received their medicines at the time they needed them and in a safe way.

People who used the service were safe because their welfare needs were met by staff who were fit, appropriately qualified and able to do the job. The service had effective recruitment and selection procedures in place.

We also saw that the service had systems in place to deal with comments and complaints, including providing information for people on how to complain.

14 March 2012

During a routine inspection

We met and spoke with fourteen people who use the service and eight relatives. We met with people during our two day visit to seek their feedback on their experiences of this service. The response we received was positive. Most people we met who lived in Anglesea Heights were not always able to verbally communicate. Therefore we used observational skills and relied on relatives to speak on behalf of their person living at this service.

One person told us that their relative had not looked so good in a long time. Since coming to the service they had their hair dyed, manicure and polish on their nails and overall much better kempt.

One relative told us that when they left the service they had 'Peace of mind' in the knowledge that their next of kin was being looked after. They had confidence that staff would contact them if an incident occurred that affected the person's safety, such as a fall.

We spoke with an individual who spends most of their time in bed. They told us they were comfortable with the air mattress and that they liked the 'bumpers' on the bedrails and that they felt soft.

The feedback from all people and visitors spoken with was positive about the staff at Anglesea Heights. We observed that relationships between staff and people were friendly, warm and appropriate.