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 and recognised that each person’s needs were different. People’s privacy and dignity was maintained by staff and family members and friends felt welcomed when they visited the home.
People told us they felt safe. Staff received training in protecting people from harm and knew how to escalate any concerns for people’s safety and well-being. Risks were assessed and managed to reduce the risk of harm and there were sufficient numbers of staff to respond to people’s care and support needs. Checks had been undertaken on new staff to ensure they were suitable for their roles.
People and relatives were involved in the assessment, planning and review of their care and support. Where people’s needs changed the care provided by staff was responsive to the changes and was reviewed and planned to reflect any additional needs. A range of activities were available that took into account people’s interests and hobbies. The environment was well maintained and appropriate for the needs of people living at the home.
People knew how to make a complaint if they were unhappy about the care they received and the provider had systems in place to ensure people’s views were listened to. Complaints were investigated by the management team and, where appropriate, any improvements would be made.
The management team demonstrated a good understanding of the responsibilities of their role and staff described the management team as approachable and supportive.