Anne Residential Homes - 74 Coombe

Anne Residential is a residential care home providing personal care to older people, in a single story building in a residential area. The home is registered for four people and two were receiving care on the day of the inspection.

People’s experience of using this service:

The provider continued to deliver a good service that met the needs of the people they cared for.

People we spoke with were happy with the care they received and with the staff who assisted them.

People received care from staff who were suitably trained and supported to meet their personal care needs.

Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met. People were protected from avoidable harm, discrimination and abuse.

Appropriate recruitment checks took place before staff started working for the service.

The home had procedures in place to reduce the risk of the spread of infection.

Medicines were administered, stored and disposed of safely.

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.

People were supported to maintain a healthy balanced diet that met their needs.

People received the support they needed to stay healthy and to access health care services as and when required.

People received support from staff who were kind and compassionate. Staff treated people with dignity and respect and ensured people's privacy was always maintained.

People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

The provider had effective systems in place to deal with concerns and complaints and to assess and monitor the quality of the service people received.

The service was well-led; there was an open, transparent and person-centred culture.

People, their relatives and staff were all asked to share their feedback about the service in an informal way.

The provider worked in partnership with other health and social care professionals and agencies to plan and deliver an effective service that met the needs of the people they supported.

Rating at last inspection:

At our last inspection, the service was rated Good overall and in all five questions. Our last report was published on 22 December 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

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.

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

74, Coombe provides care and accommodation for up to four older people, some of whom are living with dementia. On the day of the inspection three people lived at the home.

The service had a registered manager. 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.

People told us they felt safe. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

Our inspection of care records showed risks to people were assessed and there was guidance for staff as to how those risks should be managed to reduce the likelihood of harm.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

People received their medicines safely from appropriately trained staff.

Staff received training and support they said helped them with their role of providing good, effective care to people in the home. Staff communicated with people effectively and they received support from staff as necessary in a careful and, dignified manner.

The registered manager took appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

People were supported to maintain a healthy balanced diet and adequate hydration. People told us they enjoyed their meals, there was plenty of food and we observed people were not rushed.

People had access to health care services to ensure their health care needs were met.

People and their relatives said that staff were kind, caring and compassionate. Staff knew people well and were able to provide care in the way they needed and wanted. Staff also recognised people's right to privacy, promoted their dignity and respected their wishes.

People's care was planned with them and their relatives so they were able to say how they wanted their needs met. Their care records were personalised and reviewed regularly or as their needs changed. People's care records detailed people's preferences.

Where possible people had choice and control over their lives and were supported to engage in various activities within the home and in the community.

People, relatives and staff were positive in their comments about the registered manager. They said they promoted an open and positive working environment that they felt able to contribute positively to the development of the service.

We saw there were informal quality assurance audits in place. However the registered manager recognised that this needed to be more formalised and told us they planned to implement a monthly written report that would provide valuable information to develop and improve the service.

Where suggestions or comments were received the registered manager used the information to develop and improve the service.

Following that inspection we asked the provider to send us an action plan setting out the steps they had taken to achieve compliance, which they did on 9 July 2014. During this visit we checked these actions had been completed.

This visit was carried out by a single inspector who helped answer two of our five questions: Is the service safe? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with the provider, who was also the registered manager.

Is the service safe?

We found at this visit the provider had taken appropriate steps to protect people from abuse and prevent the risk of this occurring. Training in safeguarding of vulnerable adults for staff had been planned. Staff had also received one to one support from the provider to check their current understanding and awareness of their responsibilities for identifying abuse, what this constituted and what actions they must take to protect people, if they suspected they were at risk.

We were assured of the provider's understanding of their role to ensure that proper authorisation was sought to deprive people using the service of their liberty in a safe, correct way and where this was in their best interests to do so. People's care records showed applications had been made, where this was appropriate.

People's care records had been reviewed and now contained accurate information about their current care and support needs. Risk assessments had also been reviewed regularly which meant there was up to date information about how to protect people from known risks to their health, safety and welfare.

Is the service well led?

The provider had taken appropriate action following our last inspection to make improvements that were needed, and in a timely manner. This included undertaking a review and update of care records and staff files, introducing more training and support for staff and improving work practices in relation to staff recruitment. The provider had also put in place arrangements to regularly check the quality of the service provided.

We carried out this visit to check the provider had taken appropriate steps to comply with the warning notice. We found there had been improvements.

This visit was carried out by a single inspector who helped answer one of our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with the provider. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had ensured appropriate checks had been undertaken of staff employed by the service to ensure they were of good character, physically and mentally fit to perform the work and had the necessary qualifications, skills and experience to care for people using the service. We saw new recruitment processes had been introduced to ensure that appropriate checks were undertaken before people were able to start work at the home.

At our previous inspection on 2 August 2013 we asked the provider to make improvements in relation to the recruitment checks of new employees and record keeping to demonstrate that people were receiving safe and appropriate care. During this inspection we checked whether the provider had made the necessary improvements.

The focus of the inspection was also to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for and supported in a clean and tidy environment, and relatives we spoke with told us this was always the case.

People could be placed at risk of poor care and support because the home did not carry out recruitment checks on all new staff to ensure they were suitable for the role. Staff were allowed to start work without a criminal records check, a full and satisfactory employment history and checks to ensure that they were physically and mentally fit to work at the service. Qualifications and experience, as well as skills such as English language ability, were not assessed during recruitment. This meant that some staff were unable to communicate with people in English. We have asked the provider to tell us how they plan to improve their recruitment practices.

The commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found that staff and management did not fully understand their responsibilities under this act and therefore might not be ensuring the safety of people. There was no evidence that some decisions were made in people's best interests, involving the right people and at the right level. Staff did not have a good knowledge of safeguarding adults and their responsibilities in relation to this. We have asked the provider to tell us how they plan to improve this.

Whilst, people and relatives were satisfied with many aspects of the service, we found that the provider did not operate safe staff recruitment processes to make sure that only suitable staff were chosen to work with people using the service.

Is the service effective?

Records of care showed that the service was delivered in line with people's care plans, which meant that most needs people were assessed as having were being met. We saw that the service was meeting people's needs, and one person told us, '[The manager] gets to know your likes and dislikes.'

Is the service caring?

People using the service and relatives all commented that the staff were very caring and we saw many interactions between staff and people using the service where staff showed warmth and kindness. We heard how the manager went to great lengths to care for people, making fresh fruit and vegetable juices daily for people every day, and staying with people for long periods while at hospital.

Is the service responsive to people's needs?

Staffing levels were appropriate to meet people's needs. The manager was familiar with people and was able to demonstrated they knew the needs of people using the service well. We heard examples of how the manager had noticed early signs of ill health and supported people to seek medical attention quickly. However, the provider did not always respond appropriately to peoples changing needs in relation to deteriorating mobility.

Is the service well-led?

The home had an experienced registered manager in post who had run the service for around 30 years. People using the service and relatives spoke highly of the manager and commented that they provided a high level of care and attention to people. Relatives felt well listened to, and told us they had not had reason to complain but felt that they would be listened to if they needed to.

The system in place to regularly assess and monitor the quality of the service provided to people, was not always effective to make sure people were protected from the risks of poor and inappropriate care and support. During this inspection we found a number of areas where the provider needed to make improvements. These included improving the arrangements in place to protect people from abuse, having appropriate recruitment processes in place and keeping accurate and appropriate records.

People we spoke with were very pleased with the quality and choice of food provided at the home. "The food is excellent", one person told us. Another told us: "The food is always hot and beautifully served".

We saw that there were policies and procedures in place to protect people who use the service and staff from the risk of infection.

We saw that all areas of the home were clean, well-decorated and free from hazards. People were able to move safely and freely from house to gardens and had easy access to their rooms at all times. The manager had ensured that rooms were aired and kept cool during the hot weather.