We carried out a review of the data available to us about Anastasia Lodge Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Anastasia Lodge Care Home, you can give feedback on this service.
Anastasia Lodge is a residential care home providing accommodation and personal care to 28 people at the time of the inspection. The service can support up to 29 people. The service supports older people, primarily of Greek origin, some of whom were living with dementia.
The care home is two houses joined together and has been adapted to meet people’s needs. The home offers single occupancy and shared occupancy bedrooms.
People’s experience of using this service and what we found
People told us that they were happy living at Anastasia Lodge and felt safe with the care and support that they received from care staff.
People knew care staff well and staff also knew people, their likes and dislikes and how they wished to be supported. Some care staff spoke in people’s native language which enabled effective and responsive communication.
Care staff knew how to recognise possible abuse and explained the steps they would take to report their concerns and protect people from potential abuse.
People told us that staff were kind and caring and supported them in ways which respected their privacy and dignity but also promoted their independence.
Care plans were person centred, detailed and listed people’s support needs and how they wished to be cared for in response to those needs.
Risks associated with people’s health and care needs were assessed, giving guidance to staff on how to manage and minimise risks to keep people safe from harm.
Medicines were administered and managed safely, ensuring people received their medicines on time and as prescribed.
There were sufficient numbers of staff available at the home to ensure people’s safety and that care needs were appropriately met.
Recruitment processes followed by the service ensured that only those staff assessed as safe to work with vulnerable adults were employed.
People were seen to eat and drink well. People always had access to drinks and snacks. Where required, people received appropriate support and assistance with their meals.
People’s healthcare needs were monitored and were supported to access health and care services where specific needs and concerns had been identified.
Staff had access to training, further development and appropriate support to enable them to deliver care and support to people effectively.
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 and relatives knew who to speak with if they had any concerns or complaints and were confident these would be addressed immediately.
The registered manager and senior managers regularly monitored the quality of care people received and where issues were identified actions were taken to make the required improvements and promote learning to prevent re-occurrence.
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 Good (published 22 June 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
On 5 April 2016, we undertook a focused inspection of the service, following some concerns that we had received about staffing levels, especially during the evenings, and the management of complaints and concerns. We found that although the provider was not in breach of any of the regulations, we made recommendations around the setting of staffing levels according to people’s needs as well as ensuring that complaints and concerns raised were dealt with in a professional manner. At this inspection we found that the provider had responded to our recommendations in order to make improvements in those areas.
Anastasia Lodge Care Home provides residential accommodation for up to 29 people primarily from Greek origins. On the day of our inspection 27 people were using the service. The home covered three floors. There were two lounges and one dining room situated on the ground floor and 27 bedrooms over all three floors. Lift access was available to the first and second floor.
A registered manager was available at the time of the inspection. 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 and relatives told us that they felt safe at Anastasia Lodge and were happy with the care and support that they received. Staff were able to demonstrate a good understanding of safeguarding vulnerable adults and whistleblowing and the actions they would take if abuse was suspected.
Issues that we had identified at the last inspection on October 2015, around safe management of medicines with the focus on record keeping, had been addressed. The provider had made appropriate improvements in order to ensure that people’s medicines were managed and administered safely.
People, relatives and staff confirmed that overall staffing levels were appropriate to meet the needs of the people living at Anastasia Lodge. Where concerns had been noted at the last focused inspection on April 2016, the provider had consistently monitored staffing levels to ensure that where people’s needs were seen to change reasonable adjustments of staffing levels had been made to respond to those changing needs.
Relatives feedback during the last focused inspection on April 2016, was found to be consistently negative around the way in which a relatives meeting held in March 2016 had been conducted by the provider. Comments were made about the way in which relatives were spoken to when clarification around the care and support people received was raised and that this was noted as unprofessional. At this inspection we found that the provider had undertaken appropriate training on how to manage difficult situations and relatives told us that they had since not had any further concerns in approaching senior managers and the provider with any concerns.
During this inspection we were informed by the registered manager that people’s bedrooms were locked once people had retired to bed. This was so that, people who had a tendency to walk around the home and into other people’s room, were stopped from doing so, so that other people who had experienced this occurrence in the past felt safe in their own rooms and did not get disturbed. Consideration had not been given to the principles of the Mental Capacity Act 2005 (MCA) and to the implications of imposing this form of control which could be interpreted as a form of restraint. As a result of our feedback the provider and registered manager assured us that they would stop locking people’s bedroom and implement other appropriate systems to manage this situation safely.
On speaking with the operations manager, registered manager and care staff, they were able to describe and explain the key principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how this impacted on the care and support people received. Where people had been assessed to lack capacity this had been documented appropriately and best interest decisions had been made to reflect the reasons why the decisions needed to be made. However, where the service was locking people in their rooms during the night, this had not been given the appropriate consideration under the directive of the MCA 2005.
An activity timetable was on display and people were able to access a variety of activities if they wanted to. However, relatives feedback was that people were not sufficiently stimulated and that more could be done to enhance the provision of activities.
The service implemented a number of systems and processes to ensure that people were kept safe and free from harm. Detailed risk assessments had been completed which identified generic risks as well as individual risks associated with people’s health and care needs. Detailed guidance was provided to staff on how to manage or reduce identified risks in order to keep people safe.
The provider ensured that care staff received regular training to ensure that they held the appropriate skills and knowledge in order to support people effectively. Care staff told us and records confirmed that they received mandatory training which was refreshed on an annual basis and additional non-mandatory training as and when required.
Care staff told us and records confirmed that they received regular supervision and an annual appraisal and felt appropriately supported in their role. Robust systems were in place to ensure that all staff recruited were assessed as safe to work with vulnerable adults.
We observed caring and positive interactions between people and care staff. Care staff were observed to communicate with people in Greek even though this was not their first language. This meant that people whose first language was Greek were able to communicate effectively their needs and requirements and care staff were able to understand and respond accordingly.
Care plans were person centred and detailed and focused on people’s needs and requirements as per their choices and wishes. Care plans were reviewed on a monthly basis and involved people and their relatives.
The registered manager and operations manager implemented a number of checks and audits in order to monitor the quality of care provision. This included health and safety checks, medicine audits, environmental checks and care plan checks. Records confirmed that action plans were then developed as a result of the quality check to ensure that improvements were made and where further learning was identified this was provided.
People and relatives told us that meals provided at the home were of a good standard. People were observed to enjoy their meals and always had access to drinks and snacks throughout the day. However, we noted that some care staff did not always engage and interact appropriately with people when supporting them with their meal. This included lack of conversation and on occasions the use of inappropriate methods when supporting people with their meal.
We saw records detailing complaints that had been received and how this had been dealt with. A complaints policy was clearly on display in the entrance of the home and had also been translated in Greek for those who were unable to read English. People and relatives told us that they knew who to complain to if they had any concerns or issues and were confident that their concerns would be addressed appropriately.
Anastasia Lodge Care Home provides residential accommodation for up to 29 people, the majority of whom originally come from Greece. On the day of our inspection 28 people were using the service. The home covers three floors. There are two lounges and one dining room situated on the ground floor and 27 bedrooms over all three floors. There is a lift for access to the first and second floor.
At the time of our inspection there was a registered manager in post. 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 were happy with the care that their relatives received. However, out of the ten relatives that we spoke with, five of them made a comment about there being fewer staff in the evenings compared to the day. They also stated that care workers were rushed and did not spend the appropriate required time with their relative.
One staff member also told us that possibly an additional one staff member in the evening until 8pm would be beneficial. However, they also said that if the shift was organised appropriately the work could be completed with the current level of staffing.
The service completed level of needs assessments for each person living at the service. These were regularly reviewed and updated. However, the service did not carry out a collective review of those assessments to assist with determining staffing levels within the home.
Most relatives felt confident to highlight any issues and concerns with the registered manager and senior management. However, one relative told us they felt some apprehension about reporting concerns out of fear of negative repercussions in relation to the person potentially being issued notice to leave because they had complained.
The provider held six-monthly resident and relatives meetings. The last one was held in March 2016 and certain relatives had been quite vocal at the meeting regarding certain issues relating to the care of their relative. Relatives commented that the meeting did become quite volatile and that the provider and senior managers did not deal with the situation in a professional manner.
We have made two recommendations in relation to staffing levels and how the provider and senior managers respond to complaints in a professional manner. At the last inspection the service was rated as ‘good’, however, as a result of this focused inspection the overall rating for this service is now as ‘requires improvement’.
We will undertake another unannounced inspection to check on all other outstanding breaches of regulations identified for this service.
We inspected the service on 15 October 2015. The inspection was unannounced. At our previous inspection in May 2014 the service was meeting the regulations we looked at.
Anastasia Lodge Care Home provides residential accommodation for up to 29 people, the majority of whom originally come from Greece. On the day of our inspection 28 people were using the service. The home covers three floors. There are two lounges and one dining room situated on the ground floor and 27 bedrooms over all three floors. There is a lift for access to the first and second floor.
At the time of our inspection there was a registered manager in post. 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 that we spoke with were positive about the service that they received and about the staff who supported them. People told use that they were treated with warmth and kindness. Staff were aware of people’s individual needs and how they were to meet those needs. People were encouraged to build and retain their independent living skills. Relatives, friends and care professionals told us they felt people were safe in the home. There were systems and processes in place to protect people from the risk of harm. These included robust staff recruitment, staff training and risk assessments that considered the individual potential risks for each person using the service.
Medicines were administered safely and staff had received appropriate training. However, some concerns were raised in relation to record keeping of medicines.
We found the premises to be clean and tidy. There was a record of inspections and maintenance checks that had been carried out. The service had an infection control policy and staff had a good understanding on how to follow this effectively.
People told us that the food was good at the home. The chef was aware of any special diets people required either as a result of medical need or a cultural preference. People and relatives were positive about the food.
People received personalised care that was responsive to their individual needs. A one page preference list was available in each person’s room and care plans were person-centred with details specific to each person and their needs.
Staff had the appropriate knowledge and skills to carry out their role effectively. All staff received regular supervision and had the opportunity to discuss strengths, their performance and training needs. Staff were positive about working at the home and with the registered manager.
All staff had received training in the Mental Capacity Act 2005 and were able to demonstrate a good understanding on how to obtain consent from people and were able to provide examples. They understood the need to respect a person’s choice and decision if they had the capacity to do so.
We saw evidence that the home had applied for Deprivation of Liberty Safeguards (DoLS) where appropriate. DoLS are required to be in place to ensure that where an individual is being deprived of their liberty that this is done in the least restrictive way and reviewed regularly to ensure that it continues to be in the best interest of the individual to whom it applies.
There was an activity co-ordinator in post who we met on the day of the inspection. The home held resident’s and relatives meetings where a variety of topics were discussed and people were encouraged to express their views about the service and make suggestions for any potential improvements.
People using the service, their relatives, friends and staff were positive about the registered manager, the operations director and the owners of the service. The service had an open, transparent and family orientated culture where people were encouraged to have their say and staff were supported to improve their practice.
At this inspection there was one breach of Regulation 12(2)(g) which was in relation to proper and safe management of medicines. Please refer to the “Safe” section of this report for details. You can see what action we told the provider to take at the back of the full version of the report.
During this inspection we spoke with four people who used the service and three relatives of people who used the service. We also spoke with five members of staff who included the Registered Manager, care staff and domestic staff.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
Four people who used the service told us that they felt safe in the home and that staff treated people with respect and dignity. One person told us, 'Staff are respectful and my privacy is respected'. Another person told us, 'Staff talk to me politely and respectfully. They listen to me and ask what I would like'.
Relatives of people told us that they were confident that people living in the home were safe. One relative told us, 'I trust the staff very much. The home is very safe'.
Safeguarding procedures were comprehensive. We saw evidence that the majority of staff had received safeguarding training. When we discussed safeguarding with staff, they were aware of the signs of abuse and the action to take when responding to allegations or incidents of abuse. Staff were also aware that they could report allegations to the local authority, police and the Care Quality Commission.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been submitted, appropriate policies and procedures were in place.
Staff were well supported by management so that they delivered care and treatment safely to people to an appropriate standard.
The service had systems in place to identify assess and manage risks related to health welfare and safety of people who used the service. Care records contained risk assessments which provided guidance to staff on actions to take to keep people safe.
Is the service effective?
People we spoke with said that they were satisfied with the care provided in the home and felt that people's needs had been met. One person said, 'I am well looked after here' and another said, 'It's good here. It is a good place'.
Relatives were positive about staff and said that they were helpful and listened to them. One relative told us, "The care is fantastic' and another relative said, 'I am impressed with the care'.
We looked at four care files and saw that people's care needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments had been carried out where necessary. Care plans included information about people's preferred routines and healthcare needs.
All the staff we spoke with told us that they were well supported by the Registered Manager and that there was good communication amongst staff. This enabled them to carry out their roles effectively, which in turn had an impact on the quality of care people received.
Staff had received appropriate training to meet the needs of the people living in the home.
Staff, family members, healthcare and social care professionals were involved in decisions about people's care and we saw evidence of this. Relatives of people who used the service told us that they were kept informed about people's progress.
Is the service caring?
People we spoke with were positive about the staff at the home. They told us that staff treated them with respect and dignity.
During our inspection we spent a significant amount of time observing people and staff. We found that people who used the service approached staff without hesitation and people appeared comfortable around members of staff. There was good interaction between staff and people. People looked well cared for and we saw that the atmosphere was relaxed in the home. We saw that care staff were patient and supported people to meet their needs.
Staff we spoke with said that they were aware that they should treat all people with respect and dignity and were able to give us examples to demonstrate how they ensured this.
Is the service responsive?
People who used the service and relatives we spoke with told us that if they had any concerns or complaints, they would feel comfortable raising them with staff or the management at the home.
We saw that the home had a complaints policy and procedure. We looked at the results of a quality assurance survey that had been carried out in 2013. The results indicated that people were satisfied with the care provided.
People's care and health progress was monitored closely. People's care plans and their health needs were regularly reviewed.
Is the service well-led?
The home had quality assurance processes in place to help ensure that people received a good quality service.
People who used the service told us that staff and the Registered Manager listened to them.
Resident's meetings took place quarterly and enabled people to discuss issues regarding the running of the home. This encouraged people to raise queries and concerns with management and members of staff.
Staff told us that staff meetings took place every two months and we saw evidence that staff received regular supervisions from management. This enabled staff to raise queries and concerns and discuss their progress.
All staff we spoke with told us that they felt able to consult the Registered Manager if they had concerns or queries and said that they felt supported. Staff were positive about working at the home. One member of staff told us, 'Everybody is very supportive. I can ask lots of questions. Everyone is very approachable'. Another member of staff said 'I am very happy here. The manager is very good and supportive.' Staff training and supervision records showed that staff received appropriate training and support.
At this inspection we found that people were now being protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
Staff understood the importance of obtaining the consent of the person before any care or treatment took place. People we spoke with confirmed that staff communicated well with them and asked for their permission before they offered any assistance. One person commented 'they come up and ask us.' They told us that staff would always respect their wishes and preferences.
We observed staff supporting people in a friendly, patient and professional manner. Staff had a good understanding of the needs of the people they supported and the potential risks they faced.
People told us they had good access to health care professionals such as doctors, dentists and chiropodists. Relatives told us that the home kept them updated about people's health issues and healthcare input from other healthcare professionals.
People were not always being protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.
Effective recruitment and selection processes where in place and appropriate checks were undertaken before staff began work.
People told us they had no complaints about the service but knew how to make a complaint if they needed to.
People's needs were assessed and individualized care and treatment was planned and delivered. Person-centred care plans were up to date and reviewed monthly. Risk assessments and monitoring charts were in place and informed people's care. A relative told us 'they look after her very well.'
People who use the service were protected from the risk of abuse, because of the steps the provider had taken. A relative said people were 'definitely safe here.' Staff were aware of the home's safeguarding and whistleblowing policies and relatives told us they knew how to make a complaint.
Staff received appropriate professional development with monthly supervisions, supportive managers and up to date training. A relative's 2012 questionnaire response described staff as 'upbeat and joyful.' An effective system was in place to take account of feedback and other learning to improve the service.
These people were not able to fully communicate with us, however, they did smile or nod when we asked them if they were being looked after properly. Everyone appeared well cared for and comfortable.
Since our last inspection the service has developed monitoring forms in relation to pressure care management, food and fluid intake and continence monitoring.
Staff told us they were confident to be able to complete these records properly and they had undertaken training in the use of these forms.
We saw written evidence that people had access to other health care professionals including doctors, district nurses and speech and language therapists.
They said that staff do what they ask for and that personal care is given sensitively and in private. This was further confirmed by observing staff providing support to people throughout our visit. Staff were friendly and responsive to people's requests for assistance and the staff we spoke with had a good understanding of the needs of people who use the service.
We asked people who use the service what they thought about the care and treatment they receive at the service.
They all responded positively and one person commented, 'It's very good'. Another person said, 'I've no complaints'. One relative we spoke with said, 'My Mum is in safe hands'.
People said they felt supported by the staff team and that they were included in decisions about their care as far as possible.
The service provides organised activities to promote the wellbeing of people who live in the home.
We spoke with the home's activities co-ordinator and observed some of the group activities taking place during our visit.
We saw that people were enjoying the activities and there was a lively atmosphere at the home. We also met with a number of people who, due to their high level of needs, spend a lot of time in bed. These people appeared relaxed and staff were observed attending to their needs in a caring and sensitive manner.
However we noted that written records in relation to the care of people with higher needs were not always being completed in sufficient detail.
Both people who use the service and visitors we spoke with said that there was an open visiting policy at the home and that visitors were made welcome and offered a cup of tea when they visited.
People told us they were happy with the food at the home and that they were given a choice of menu. Comments about the food included, 'There's lots of Greek food, its fantastic', 'Very nice' and 'I've no complaints'.
People told us the portion sizes were satisfactory and that staff knew their likes and dislikes. The meals we saw looked and smelt appetising and lunch was a social and unhurried experience.
People who use the service told us they felt safe at the home and that they had no concerns about the way they were treated by staff.
A relative told us that the staff were, 'Very patient' and added, 'The staff are brilliant'. We saw that the staff had developed good relationships with the people they support and interactions were polite and friendly.
People told us the manager was very approachable and they had confidence that she would take any concerns seriously and take action to resolve any problems.
People we spoke to confirmed that they attend regular meetings to discuss the quality of service provision.
Visitors to the home told us they receive a quality monitoring questionnaire every year. People said the manager listened to their views about the service. One visitor told us that, 'The manager always listens'.
We asked people if they felt able to voice concerns or complaints about the service and they told us they felt they would be able to and that management would take these concerns seriously. People said they had a good relationship with the manager and they felt the manager listened to their comments and concerns.