Archived: Anchorstone Nursing Home

Anchorstone Nursing Home is situated in a residential street in Farnham, Surrey. The home is registered to provide care and nursing for up to 40 people. The people accommodated at the home are elderly and have a variety of care and mobility needs. All of the people are living with the experience of dementia. At the time of our visit 23 people were living in the home.

The home had been scheduled to close in January 2019, but this was postponed due to additional funding being made available to keep the home open. At the time of our inspection the provider was still looking to sell the home as an ongoing business. This did not impact the level of care and support that people received. It did however impact the provider’s expenditure on the fabric of the building, with maintenance and building work being placed on hold until the future of the home was known.

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

Despite the issues with the building, people, relatives and healthcare professionals overwhelmingly said they would rate the care given at the home as exceeding their expectations. Care staff were focussed on getting to know people and their families and did everything they could to provide an excellent standard of care. Staff knew people as individuals and were able to communicate with them in a way they could understand. The exceptional levels of care and compassion were displayed by staff during and after a person’s life. Families who had lost people while they lived at Anchorstone were thankful for the level of support they had received both during the end of life journey, and afterwards when their loved one had passed away.

The caring nature of staff was obvious in the processes they used to keep people safe. Nursing staff had detailed knowledge of dementia and ensured use of medicines to manage behaviours or sedate people were kept to a minimum. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this.

Staff understood their roles and responsibilities around keeping people safe, including the identification and reporting process if abuse was suspected. Staffing levels were kept at safe numbers to ensure peoples support needs could be met. These levels were increased when needed, for example when new people came to the home, to ensure the outstanding level of care was maintained. Hazards to people’s health and safety had been identified and well managed to reduce the risk of harm.

Staff received training and supervision which ensured they had the skills necessary to provide care and support that people needed. Nursing staff were given appropriate support and supervision to enable them to maintain their registration with the nursing and midwifery council. Feedback from health care professionals such as doctors and social workers was very positive. They commented on the competence and knowledge of the nursing and care staff which met people’s needs.

People had enough to eat and drink, and the staff kept up to date with best practice. Involvement in hydration projects and use of adaptive equipment such as coloured cups and plates encouraged people living with dementia to eat and drink. This minimised the risk of dehydration and malnutrition.

People were involved in assessments of their needs to make sure the staff could meet those needs in a way people preferred. People had care plans that detailed their care and support needs. We noted that the care records had become very large and would benefit having the old information within them being archived so staff only had access to the most up to date records. Wherever possible people or their relatives were involved in reviews of their care. People had access to indoor activities to help keep them active and stop them being bored.

People and their relatives confirmed the home was well managed. There was a calm and relaxed family atmosphere at the home with people and staff enjoying each other’s company. People, their relatives and staff were all involved in giving feedback about the home, and any areas that may need to be improved. The registered manager listened to feedback and complaints and made changes where they could.

Rating at last inspection:

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why we inspected:

This was a planned inspection based on the previous rating.

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 we receive any concerning information we may inspect sooner.

The home made up of two buildings joined by a central corridor. Communal areas, for the use of people from both buildings, include a large dining area, conservatory and secure gardens.

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.

The inspection took place on 15 November 2016 and was unannounced. At our last inspection in July 2015 we identified two breaches in the regulations. These were around the safety and cleanliness of the environment (specifically the kitchen), and that the requirements of the Mental Capacity Act had not always been followed. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that all the areas of concern had been addressed, and people had a positive experience living at Anchorstone. There was positive feedback about the home and caring nature of staff from people who live here.

People told us they were happy living here. One person said, “I really like it here, and since I’ve been here I’ve made lots of friends.” A relative said, “We wouldn’t change a thing here, they’re very good. No one shouts at the residents, staff are so calm and patient.” Staff were happy and confident in their work and proud of the job they do.

People were safe at Anchorstone because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks.

Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them.

Staff received comprehensive training, to ensure they could meet and understand the care needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health improved due to the care and support staff gave. People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.

The staff were kind and caring and treated people with dignity and respect. The staff knew the people they cared for as individuals. People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical needs. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs. People had access to a wide range of activities that met their needs. Activities were based on individual interests and people were supported to continue with hobbies.

Feedback was sought from people, and complaints and compliments were reviewed to improve the service. When complaints were received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how to respond to a complaint should one be received.

The service was well led. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. The provider had effective systems in place to monitor the quality of care and support that people received.

People benefitted from living in a home with good leadership and a stable staff team, so they knew the people who looked after them. Staff were very focused on ensuring that people received person centred care. A person said, “Yes the staff are good here and when I feel down they talk to me and make me feel better.” A relative said, “I think the home is superb, there are better looking homes, but not one as caring as this one.”

We looked at consent to care and treatment and found that people were being asked for their permission to have care and treatment provided to them, and had the right to refuse care and treatment. We also found that staff had a proper understanding of mental capacity issues.

We looked at the care and welfare of people who used the service and found they and their relatives were happy with the level of care they were receiving. We also found that a proper system of care planning and management was in place.

We looked at the premises and its grounds and found that it was suitable for its purporse, and that regular maintenance and refurbishment was being carried out.

We looked at staffing and found that there were appropriate staffing levels in the service, and that care and nursing staff were experienced and qualified to fulfil their roles.

We looked at how the provider ensured a high quality of service, and found that they regularly sought feedback from people who used the service and from staff. We also found they conducted regularly reviews and audits on all aspects of the service. However, we found that the provider had failed to carry out regular checks on the employment status of its staff.

Many of the people at this home were unable to verbally express their views, so we used the Short Observational Framework for Inspection

(SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

These observations demonstrated that the staff knew each person really well; they treated people with respect, dignity and kindness.