About the service Anson Court Residential Home is a residential care home providing personal care for up to 33 people across two floors. At the time of the inspection the service was accommodating 21 people, some of whom were aged over 65 and living with dementia.
People’s experience of using this service and what we found
Relatives and all people we spoke with gave positive feedback about the staff and the home. However, we found shortfalls throughout the inspection which impacted on the safety and quality of care for people.
People had been put at risk of potential, avoidable harm. Checks had not always identified significant loss of weight for people, food was unsuitable for one person’s dietary needs and the use of inappropriate moving and transferring techniques by care staff.
The service was not well led. At our last six inspections, we have had continuous concerns the governance systems were ineffective to monitor the quality and safety of the service. This has continued to be a concern at this inspection. The provider had not taken prompt action to make the necessary improvements. The quality assurance systems were significantly lacking and were not robust. The processes had not identified all of the concerns in the service. Records were not always complete. Care plan reviews were of poor quality and ineffective at improving care.
Risks associated with people’s health had been identified. However, there was limited information within people’s care plans for staff to follow to support people, particularly for people who may present with behaviours that could be seen as challenging.
The home had adequate processes in place to monitor infection control. Staff had access to a supply of personal protective equipment (PPE). Carpets and furniture were regularly cleaned. However, this had not prevented an unpleasant odour emanating around the home from a carpet in the main lounge area.
Medicines were overall administered safely. The auditing of medicines required some improvement to prevent the over stocking of some medicines. Protocols required some improvement to give staff the guidance they needed to support people unable to verbally tell people when they were in pain.
Incidents and accidents were being recorded on a regular basis and there was an analysis of the data to identify for trends to support the implementation of improvements to mitigate the risk of reoccurrences. However, not all outcomes were recorded to provide staff with guidance how to support people safely.
Training for staff had not been effectively monitored. We found shortfalls with training for a number of staff, particularly regarding training for first aid, dementia awareness and behaviours that may be seen as challenging.
Some work had started within the home to become more dementia friendly. However, there remained a significant amount of work left to be completed.
The overall dining experience for people required improvement. People who required support from staff to eat did not always receive this.
People and the relatives we spoke with, felt people were treated with dignity and respect. We saw some kind and caring interactions between people and staff. However, we also observed people were left for long periods of time with little or no stimulation or staff engagement.
The service worked with other health and social care agencies to monitor people’s health and wellbeing, although timely intervention had not always been sought.
There were processes in place to safeguard people from abuse. Appropriate recruitment procedures ensured new staff were assessed as suitable to work in the home.
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.
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 requires improvement (published 15 February 2022) and was in breach of regulations. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations. The service has deteriorated to inadequate.
Why we inspected
This inspection was carried out to follow up on action the provider told us they had taken following the last inspection. It was also prompted, in part, due to concerns received about staff training, poor governance and risk. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make further improvements. Please see the safe, effective, caring, responsive and well-led key question sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anson Court Residential Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to the home environment continued to be poor and did not support people’s autonomy. Staff had not recognised some of their actions when supporting people were not always respectful. People not always receiving personalised care and not always being treated with dignity and respect. Some people’s nutritional needs were not being met and had been put at risk of potential avoidable harm. There was a lack of effective and adequate training for staff and inadequate governance.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.