Anjulita Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. We checked to see if: There were effective systems, processes and practices in place to make sure people are protected from abuse and neglect. That risks were assessed, and mitigating actions put in place. There were appropriate staffing levels and skill mix to make sure people receive consistently safe, good quality care that meets their needs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People confirmed they felt safe and were supported to understand and manage any risks. One person told us, “Yes, it’s just a safe environment, lovely staff, you can lock your door.” A relative added, “I have a job so when I am at work, I have to be sure [relative] is safe and well. And this place provides that.” Everyone felt able to speak with a member of staff if they did have any concerns. Everyone we spoke with confirmed they were asked for their consent before care and support was provided. One person said, “They (staff) ask all the way through. They say are you alright? And explain what they are doing.” Another person said, “I am glad of their help.”

Staff confirmed they had received training on how to recognise and report abuse and knew how to apply it. They told us they had access to safeguarding policies and procedures and felt confident to speak up if they had any concerns. Staff respected people’s rights, including their rights under the Mental Capacity Act 2005. They understood how to support someone if they refused care and support, and how to escalate this if the person’s safety and wellbeing was at risk.

People were safeguarded from harm and abuse. The provider had systems in place to report, record and review any concerns raised. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguarding (DoLS). The provider was working in line with The MCA. Care plans and risk assessments contained evidence of decision specific assessments being carried out, involving people and their relatives where appropriate to do so. DoLS authorisations had also been applied for, where required. We found one example where conditions had been attached to an authorisation but not all had been carried out. Swift action was taken to correct this oversight during the inspection.

Generally the home was observed to be clean and fresh; to minimise the risks to people from infection. We did find some areas requiring more regular cleaning, such as extractor fans. In addition, one person living at the service had shingles. This posed a risk to people coming into close contact with this person of catching chickenpox if they had not had chickenpox before. Arrangements had not been put in place to manage this risk. The registered manager took swift action to address both these areas based on our feedback. Similarly, staff were observed using equipment, such as hoists, safely most of the time. We did observe one staff member pushing someone in a wheelchair without first fixing the footplates in place. This meant the person’s feet were dragged along the floor for a short distance, placing the person at risk of injury. Once again the registered manager took action to address this once we pointed this out to them. Call bells were in place and operational. These were observed to be within reach of people. Photographic signage was in place to assist people to navigate the building safely. There was no evidence of restrictive practices in place.

People and their relatives, where appropriate, were involved in making risk decisions. Nursing staff captured information about people’s assessed risks within their care records, with guidance for staff on how to manage these safely. Daily handovers enabled staff to pass on key messages about any changes in peoples’ needs, and records were updated accordingly. Where required people had specialist equipment in place. Staff spoke confidently about the use of equipment such as moving and handling equipment and sensor mats; to minimise the risk from falls. They had received training and refresher training on how to operate equipment required to meet people’s assessed needs. Staff understood how to support people if they became distressed and expressed their feelings through an emotional reaction. One staff member said, “People are not aggressive. When they are displaying changes in behaviour this should be referred to as frustration and a method of communication.”

Staff supported people to manage risks associated with their ongoing and changing health conditions. For example, to reduce the risk of developing a pressure injury one person told us, “Since I am in bed now, staff come and reposition me regularly.” A relative provided feedback about staff using a hoist to transfer their family member from one position to another. They said staff had been careful and, “It was done well.” Risks were assessed and staff understood how to manage these. Where needed, staff sought advice from relevant external professionals; to manage identified risks following best practice. Everyone provided positive feedback about the cleanliness of the home, which minimised the risks to people from infection.

Care records demonstrated that risks to people were assessed to ensure their safety and wellbeing, with appropriate actions taken to mitigate these risks. Staff liaised with relevant external professionals to ensure changes in people’s needs, such as health or behavioural, were reviewed and supported appropriately too.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Anjulita Court consists of 4 units providing different levels of care and support to people with nursing and / or dementia care needs. Staff were allocated to one of the units for the duration of their shift. They were visible in all units of the home and provided care and support in a patient and unhurried way. Staff did not appear to be rushed on the 3 residential units however, whilst not seen to be rushing on the nursing (higher dependency) unit, staff were observed to be busy responding and providing care to people. On the day of our visit call bells were not heard left unanswered and in the main, were not heard sounding for an excessive time. Staff spent time chatting with people, as well as encouraging them to participate in activities and mealtimes. All of the staff we observed appeared to be happy in their roles and worked cohesively together as one team. As a result, the atmosphere in the home was relaxed and friendly.

A dependency tool was used to ensure adequate numbers of qualified, skilled and experienced staff were employed to meet people’s needs safely and appropriately. We shared feedback about staffing levels on the nursing unit with the management team who took immediate action to review staffing levels on this unit. This included detailed audits of call bell response times across the whole service and organising for the deputy manager to work as an additional person on the unit; to provide support and assistance each morning, whilst also monitoring and reviewing staff allocation, deployment and interactions with people. Staff received training to ensure they felt suitably confident and skilled to carry out their roles without supervision. The registered manager carried out a daily walk round the home to monitor staff skill and practise. They shared their findings with staff through supervisions, team meetings and huddles; to discuss how to make improvements to people’s experience of care and support. Staff turnover at the service was low. When new staff were recruited, the provider carried out checks to make sure they were safe to work at the service. Required checks were in place for the staff records we looked at including a DBS check. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. A process was in place to assure agency staff were suitable to work at the service too, which was carried out by the provider’s quality and compliance team.

Staff and visitors told us people in one of the units, which accommodated people with higher dependency needs, sometimes needed to wait for staff to attend. They advised there were periods of time which were very busy on the unit and whilst care was provided appropriately the staff team did not always have time to complete written notes in full and felt rushed. In other units, staff felt staffing levels were adequate to meet the needs of people living there, due to them being able to complete some tasks more independently. Agency staff were used to cover staff absence. However, agency staff would work alongside a permanent staff member to promote consistency of care for people. Staff were encouraged to complete training relevant to their roles, including vocational training and training to meet people’s specific needs. They told us they were able to ask for more if needed and had done so in past. In one case a staff member said their knowledge and confidence in managing catheter care needs had improved as a result. Another staff member added, “There is lots of training available…I am encouraged to develop in my role.” Staff commented on the support they received from the provider and management team. Most staff felt confident to raise issues and concerns and said they would be listened to. One staff member said, “The manager is very friendly and approachable. They make me feel valued and listened to. I am still in my job after all these years as management are good.” Another added, “The manager is approachable and makes time for people and staff. They will come in at weekends to ensure staff are supported and to be available for people and families.”

People provided mixed feedback about staffing. They felt staff had the right training to carry out their roles, and in general were happy with the staff team and the support they received. One person explained, “From my point, staff are truly trying to look after us the best they can. They are kind, patient and so hard working.” But they went on to say they were often left waiting for help when they rang their call bells for assistance. A key point of frustration was during shift handovers. One person told us, “When staff are having a change of shift, which is around 7pm that is a bad time to ring because they are all busy. If I need to go to toilet at that time, I can wait maybe an hour so I try to avoid ringing around that time.” Another person added, “When I ring the bell, it’s sometimes a long wait but the way I see it is that staff can be awfully busy with other residents here…Staff basically juggle every single moment of who is in higher priority need. Yesterday I had one of the best carers. She started helping me, doing an excellent job but halfway through the process had to rush off as she was needed somewhere else." Other people commented on the use of agency staff, One person said, “It’s hard if I have to explain every step to a new person. Sometimes I don’t think I can relax and be helped by them…if we can avoid having agency staff this would be pretty much perfect place.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.