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Inspection carried out on 18 April 2019

During a routine inspection

About the service:

Anita Stone is a care home that provides personal care for up to 33 people, some of whom are living with dementia. At the time of the inspection 33 people were living there. The home was established over three floors with communal areas that included a dining area, two lounge spaces and a large garden.

People’s experience of using this service:

At the last inspection, we rated the questions of is the service effective and well-led as ‘Requires Improvement.’ At this inspection, we found there had been improvements made to now rate the service as an overall ‘Good.’ Although the question, is the service effective will remain ‘Requires Improvement.’

People were assisted to have enough to eat and drink and told us the food was good. Although there was some improvement to be made to the dietary needs of people living with diabetes.

Since the last inspection, the registered manager and the head of care quality had started to implement new processes to bring a clear and consistent oversight of operations.

The provider’s governance systems to monitor and check the quality of the service provided for people were consistently effective.

People and relatives told us they felt the service was safe and there were enough numbers of staff to support people. New staff members had completed their induction training.

Risk assessments and care plans were up to date and reflective of people's support needs.

Staff had access to equipment and clothing that protected people from cross infection.

People accessed healthcare services to ensure they received ongoing healthcare support.

People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way. Staff demonstrated an understanding of how to support people to make choices. There had been an improvement in the completion of mental capacity assessments and appropriate deprivation of liberty safeguard applications had been completed which meant the provider was compliant with the law.

People were supported by kind and caring staff that knew them well. Staff encouraged people’s independence, protected their privacy and treated them with dignity. People were supported by staff that knew their preferences.

There was a complaints procedure in place and people and relatives told us their concerns were dealt with positively.

People and their relatives were involved in providing feedback on service provision.

People, their relatives and staff were satisfied with the way the service was managed and the provider worked well with partner organisations to ensure people’s needs were met.

Rating at last inspection:

Requires Improvement (report published 24 May 2018).

Why we inspected:

This was a planned inspection to check on the progress of the service in making the required improvements.

Follow up:

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

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

Inspection carried out on 28 March 2018

During a routine inspection

This unannounced inspection took place on 28 March 2018 with a second day that was announced on 04 April 2018.

We had previously inspected this service on 05, 06 and 11 April 2017. Following that inspection we rated the provider ‘requires improvement’ under is the service ‘effective’, ‘caring’ and ‘well-led’. At this most recent inspection we found the provider had made a number of improvements, however there were some areas that required further improvement.

Anita Stone is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Anita Stone is registered to provide accommodation for up to 33 people, some of whom are living with dementia. On the day of the inspection there were 27 people living at the home.

At the time of our visits, there was no registered manager in post. 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. However, at the time of writing this report, the manager had submitted their application to become the registered manager of the home.

People, relatives and staff felt the home had improved and was well managed. A number of relatives and staff we spoke with told us they would recommend the home to others. The management team had taken on board feedback from the last inspection and had made a number of improvements to the service; although there was further improvement required to ensure quality assurance processes that monitored the service were more robust. Staff felt supported by the management team and that their views were listened to and respected. People and relatives had been asked for their views on the delivery of care.

People received their medicines and systems used to manage and store medicines were safe. Improvement was required when recording the amount of liquid medicines dispensed for audit purposes. These improvements were implemented immediately following the first day of the inspection. People were protected from the risk of infection by a clean home environment and the provider had established systems to monitor the standards of cleanliness throughout the home. Where incidents and events had occurred the provider and management team learned from these and where appropriate, implemented changes to raise standards within the home.

Peoples’ needs and preferences were assessed prior to them moving into the home. People were supported by staff who had received an induction and training for their role and who were supported by the provider and management team. People received food and drink that met their nutrition and hydration needs and where people required specific dietary support, this was provided by staff. Improvements were required to the monitoring and recording of peoples’ weights. The staff team worked well with other agencies to ensure people’s needs were met and referrals to external agencies were made in a timely way.

People were asked for their consent before care was provided and where people’s rights were restricted to protect them from harm, this had been done lawfully. However, where people had been restricted to protect them from harm, the provider had not always ensured this had been done in line with conditions that had been applied

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People were supported by staff who were kind and caring and were supported to make their own decisions, where possible, about their day to day lives. Staff were aware of people’s life histories and individual needs. Some improvement was required to ensure people’s cultural food preferences could be met. Staff treated people as individuals

Inspection carried out on 5 April 2017

During a routine inspection

This inspection took place with an unannounced visit on the night of 05 April 2017 with return announced visits on the 06 and 11 April. This was the home’s first inspection since registration in May 2016.

Anita Stone Court provides accommodation over three floors for up to 33 people who require nursing and/or personal care. Some people have complex medical conditions and some people are living with dementia. At the time of our visit 32 people were living at the home.

Although there was an interim manager providing operational support at Anita Stone, there was no 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. However, the provider had recently appointed a new general manager and explained their intention was to submit an application once they had completed their probationary period.

Risks to people were being monitored with care plans and risk assessments being reviewed monthly, however reviews were not always consistently completed. The interim and deputy managers carried out audits and checks to ensure the home was running properly to meet people's needs and to monitor the quality of the care people received but the audits had not identified some of the issues we had recognised during the inspection.

We saw most of the staff interacting with people in a friendly and considerate way and that staff respected people's choices. People were generally supported by caring and kind staff who demonstrated a positive regard for people’s privacy and treating people with dignity and respect. Although this was not consistently practiced by all staff with some unsuitable comments being made and actions observed.

People living at the home and their relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes.

We saw all staff were busy but were available to provide support to people when needed. There were differences of opinion as to whether there were sufficient numbers of staff employed by the provider with some people, relatives and staff saying there was not enough staff whilst others felt there were sufficient staff numbers to provide support to people. Staff supported people to eat, drink and move around the home safely. We saw that requests for assistance from people were responded to promptly. We found the provider’s recruitment processes ensured suitable staff was safely recruited.

Peoples’ care records contained information relating to their specific needs and there was evidence that the care plans were updated when people's needs changed although there was some inconsistency when reviewing people’s weights. Some people living at the home and their relatives told us they were involved in developing and reviewing their care plans. Staff understood how to seek consent from people.

People received appropriate support to take their prescribed medicines and records were kept of the medicine administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.

People were assisted by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff was knowledgeable on how to support people effectively and that staff possessed the necessary skills.

We found mental capacity asses