Archived: Annandale Rest Home

We found the following examples of good practice.

The service followed safe visiting procedures. Visits were restricted to essential visitors only. However, there were safe measures in place to facilitate visits for people receiving end of life care and where it had been assessed as being in the persons best interest due to their wellbeing. All visits were to be conducted in the persons own room and visitors were required to wear full personal protective equipment (PPE).

There was a procedure that accommodated people should they develop COVID-19 or show symptoms. Stocks of the right standard of PPE were well maintained and staff used and disposed of it correctly. Guidance on the use of PPE and current infection prevention control (IPC) procedures were available.

People and staff had access to regular testing.

Staff reassured people throughout the pandemic and provided them with the support they needed to maintain regular contact with their family and friends through the use technology, this was facilitated by the acting deputy manager.

Further information is in the detailed findings below.

Annandale Rest Home is a residential care service that provides accommodation and personal care for up to ten people. The care home provides accommodation across two floors. At the time of our inspection, there were nine people living at the service.

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

People using this service benefitted from a caring and warm service. People truly felt that Annandale was their home. We received positive feedback on how staff were passionate about providing individualised care for people.

People and their relatives had confidence in the staff who took care of them. Staff had formed genuine relationships with the people they were caring for. Staff were kind and patient and knew people's individual needs, routines and preferences well.

People were supported in such a way that allowed them 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 were treated with great dignity and respect. Staff provided support where required but took care to encourage and maintain people’s independence.

Staff were supported in their role with appropriate training and supervision. Most staff had received additional training to meet the specific needs of the people they were caring for.

Regular checks and audits were carried out to determine the quality and safety of the environment and the care being provided. Risk to people was appropriately assessed and measures were put in place to support people safely, whilst still respecting their freedom.

People and staff spoke highly of the registered manager. They adopted a hands on approach to the deliverance of care in addition to managing the home. It was evident the registered manager promoted a person centred culture to create a 'home from home' for people.

The registered manager and registered provider had met their legal requirements with the Care Quality Commission (CQC).

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

Rating at last inspection

At our last inspection, the service was rated "Good." (Report published March 2017).

Why we inspected

This was a planned inspection based on the rating of the last inspection.

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.

Annandale Rest Home provides accommodation and support for up to ten people. It is situated in a residential street, close to bus routes and shops. The building is a converted Victorian property with steps to the front and rear entrance. Communal areas include a large lounge and a separate dining room. There is a chair lift to the upper floor. The accommodation consists of one double and eight single bedrooms.

The home was last inspected in December 2015. During this inspection we identified a breach in relation to assessing people’s capacity to consent to care and treatment. This was because some people were being deprived of their liberty without appropriate referrals being in place also the registered manager was not confident in accessing mental capacity or the process for acting in people’s best interest. The ‘effective’ domain of our report was rated as ‘requires improvement.’ Following this inspection the provider wrote to us to tell us what action they were going to take to ensure this breach was met. We checked this as part of this inspection.

On this inspection we found that improvements had been made and people living at the home had had their capacity re-assessed for individual decision and applications to the local authority had been when needed. In addition, the registered manager and the staff team had familiarised themselves with the Mental Capacity Act (MCA) 2005 by attending additional training. The MCA is the legislation that underpins mental capacity and how it is applied in care settings. The service was no longer in breach of regulation.

A registered manager in place. 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.

There were safe practices in place to ensure people received their medications safely and on time. Medications were stored in a designated area of the home and were only given out to people by staff who were training to do so.

There were recruitment checks in place to ensure that staff were safe to work with vulnerable people. There had been no new staff recruited to work at the home since our last inspection, and the staff that worked at the home had done so for a long time.

Staff were able to describe the course of action they would take if they felt someone was being harmed or abused in any way. This included raising and reporting safeguarding concerns. Staff also said the home’s whistle blowing procedure was discussed regularly with them, and they would not hesitate to enforce this procedure if need be.

Risk assessments were up to date and contained good information for staff to follow to minimise any risks to people’s safety. Risk assessments were reviewed every month or when people’s needs changed as a result of a medical condition or diagnosis.

Incidents and accidents were recorded and analysed monthly for any emerging patterns or trends.

Rotas showed there were enough staff on duty at any one time to keep people safe. We observed a calm, relaxed environment.

Staff had the correct skills and training to support them in their role, which included a range of courses in mandatory subjects as well as access to external qualifications. Staff were supervised in line with the providers policy, and had an annual appraisal.

Meals were served in the dining room, and people were provided with a menu which showed meal choices for a week based on a four weekly programme. Meals were home cooked and people said they enjoyed the food.

People were supported to access medical treatment when they required it. The home was taking part in a pilot scheme which involved them being able to access support from the community matron when required.

We observed staff delivering support and they were kind and compassionate when working with people. They knew people well and were aware of their history, preferences and dislikes.

Care plans, with regard to people’s preferred routines and personal preferences were well documented and plainly written to enable staff to gain a good understanding of the person they were supporting. Care plans contained a high level of person centred information. By ’person centred’ we mean the service was tailored to meet the needs of the person, and not the service.

Complaints had been responded to by the registered manager and appropriately dealt with including any changes which needed to be implemented because of the complaint. There were no new complaints since our last inspection.

Quality assurance procedures were robust and identified when actions needed to be implemented to drive improvements. We saw that quality assurance procedures were organised and adopted an honest approach to identifying shortfalls in service provision.

Feedback had been gathered from people who used the service in the form of questionnaires. This was presented in a way people understood, containing a mixture of words and pictures. There was a poor return with this; however, the service gathered feedback informally most of the time from people and relatives.

We received positive feedback about the registered manager and the home in general.

' 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, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

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

Is the service safe?

People told us they received good support and attention at Annandale Rest Home. Their comments included, "I get all the help I need" and "I only have to ask and the girls make sure I am alright."

We found the home to be clean and odour free. Measures were in place to ensure the environment was safe and suitable for the people who were living there. We did, however, find that some improvements were needed for the control of Legionella and also fitting window restrictors to ensure people's safety. On the second day of the inspection the manager informed us that window restrictors were being fitted. This helped to ensure people lived in a safe environment.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act [2005]. At the time of the inspection there was no person subject to a Deprivation of Liberty Safeguard [DoLS] application. DoLS is part of the Mental Capacity Act [2005] and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People's health and care needs were assessed with them and/or with a family member and/or health professional. People told us the staff talked with them about the support they needed and wished to receive. Care plans recorded people's care needs though not all documents seen had been updated to reflect a change in care provision. Our observations and discussions with staff did however confirm their knowledge of the support people needed and received.

Where specialist support was needed, for example, the use of equipment, this had been sought in a timely manner to help improve people's health, well-being and comfort.

Is the service caring?

The people we spoke with told us the staff were considerate and helpful. People's comments included, "I am well looked after" and "The staff are marvellous.". Throughout the inspection we observed staff prompting and encouraging people in a kind, thoughtful and respectful way. Care and support was given when people requested and needed it. The staff ensured people's comfort and dignity at all times.

People's dietary needs and preferences were taken into account when planning meals. People reported the food was very good and there was plenty of choice. Staff offered support and encouragement to people with their meals and made sure food served was to their liking.

Is the service responsive?

People who lived at the home were listened to and their views were acted upon. People told us they were asked if they were happy with the service they received. We saw that people were given satisfaction surveys to enable them to give feedback about living at the home. People's feedback was then used to make improvements to the service.

Care documents showed medical intervention had been sought at the appropriate time to help monitor people's health and well-being. Staff told us they worked closely with external health professionals, such as GPs and district nurses. A person told us the staff were prompt in arranging a doctor's appointment for them if this was needed.

People who lived at the home and family members knew how raise a concern if they were dissatisfied with something. A relative said they knew if they had concerns they could go straight to the staff and/or manager and they would be listened to.

Is the service well led?

We saw a number of internal and external audits which helped to demonstrate how the service was operating. However, we found it was not easy to track monitoring arrangements in the home as some records were not readily located. Some recommendations made from external agencies to improve the service had not all been actioned. We raised this with the manager who confirmed that monitoring systems would be reviewed and recommended actions would be taken to improve the service. We could see where improvements had been made, for example, in respect of infection control standards and actions taken had been recorded in the most recent audit [check].

People we spoke with were complimentary regarding the manager and staff. People told us the enjoyed living at the home and that it was 'well run' by everyone.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

We spoke with a relative of a person who was about to move into the home for a period of respite care. They told us they had thought the home would be a good choice as it felt homely and they had found the manager and staff helpful and friendly.

The manager told us that activities take place at the home such as board games, quizzes, reminiscence boxes and beauty treatments. There were no external trips planned although some people, did on occasion, go out with their families. One person told us that the home suited them as they could take part in what they wanted to but could also go and read in their bedroom if they preferred. Another person said they would like access to more recreational activities.

We found improvements had been made since our last inspection in June 2012 where we had concerns relating to the storage of medication and staff not having adequate access to records.