We carried out a review of the data available to us about Aniska Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Aniska Lodge, you can give feedback on this service.
Aniska Lodge is a care home registered to provide nursing and residential care and accommodation for 49 people with various health conditions, including dementia and sensory impairment. There were 41 people living at the service on the day of our inspection. Aniska Lodge is a large converted property located in Warninglid, West Sussex.
People’s experience of using this service:
The service did not have a manager who was registered with the Care Quality Commission. Registered managers and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. Day to day management of the service was carried out by an interim manager. A new manager had been employed, but had been in post a very short time and had not yet commenced their application to register with the CQC.
People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.
Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “The staff are amazing and they love my [relative]”.
People enjoyed an independent lifestyle and told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. One person told us, “The quality of food is good”. A relative added, “They have so many outside entertainers who come in, animals, musicians, pet therapy as well as parties regularly which relatives are invited to”.
People felt their healthcare needs were met and they had access to professionals should this be required. A relative told us, “[My relative] was not in a good state when she came here after a long period in hospital. They are excellent at getting the right resources for her. She was under weight on admission and the home makes fortified milk shakes which she loves, and she now sees a member of the SALT (Speech and Language Therapy) team about a throat problem. This now means that she has the right medication which has rectified her not wanting to eat due to discomfort”.
People felt the service was homely and welcoming to them and their visitors. A relative told us, “I do feel [my relative] is safe, and I am always made welcome. They know her likes and dislikes”. People told us they thought the service was well managed and they enjoyed living there. One person told us, “This place is like a hotel, everything is done for me”.
Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “We get regular training”.
The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care from dedicated and enthusiastic staff that met their needs and improved their wellbeing. A member of staff said, “The managers are very supportive and we work well together. We do the best we can for the residents”.
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 14 May 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected: The inspection was prompted in part due to concerns received regarding service delivery and an ongoing safeguarding investigation. A decision was made for us to inspect and examine those risks.
Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good. If we receive any concerning information we may inspect sooner.
At this inspection we found the service had not been maintained at the rating of Good overall but deteriorated to Requires Improvement overall. For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People’s experience of using this service:
¿ The service did not have a registered manager. The new manager and senior staff had undertaken audits in the service. Action plans were in place where areas had been identified as not fully maintained or were in need of improvement. For example, at the last inspection we were told guidance and support was being sourced for the redecoration of the ‘Willows’ unit. This was to improve the environment for people living with dementia. However, this had not been fully completed and was still ongoing.
¿ Although systems were in place to ensure there were sufficient staff to meet people’s individual needs: The deployment of the staff had continued to not ensure the service was always responsive.
¿Although checks had been made to ensure mattresses for people at higher risk of skin breakdown were set at the correct settings, we found two which were not. This was highlighted to staff and rectified on the day. However, this had not ensured people were fully protected.
¿There was a plan in place for the redecoration and replacing of furnishings where identified. For example, beds were being replaced and new carpeting laid. However, two areas of flooring were identified as potential trip hazards.
¿ The service provided a variety of activities in line with people's interests and encouraged people's involvement. However, although activities had been identified for people who remained in their own room. On the day of the inspection not everyone who wished to be had been engaged in meaningful activities.
¿People and their relatives told us people were safe. There were safeguarding systems and processes that protected people from harm. Staff knew the signs of abuse and what to do if they suspected it.
¿ There were systems in place to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, these incidents and accidents were recorded and lessons were learned.
¿ Medicines were managed safely. Medicine documentation and relevant policies followed best practice guidelines to ensure people received their medicines safely.
¿ Staff received appropriate training and support to enable them to perform their roles effectively.
¿ People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food.
¿ People and relatives told us staff were ‘kind’ and ‘caring’. They could express their views about the service and provide feedback.
¿ People's care was personalised to their individual needs. There was sufficient detail in people's care documentation that enabled staff to provide responsive care.
¿ Management and staff demonstrated a good understanding of and response to people's diverse needs.
¿ The service had processes in place to measure, document, improve and evaluate the quality of care.
¿ Referrals were made appropriately to outside agencies when required. For example, GP visits, community nurses and speech and language therapists (SaLT). Notifications had been completed to inform CQC and other outside organisations when events occurred.
Rating at last inspection: Good. (Report published 14 September 2016).
Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had been without a registered manager in post. The last registered manager had deregistered in September 2017.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
Aniska Lodge is a nursing home for up to 49 people. It provides care and support to adults but predominantly older people with residential or nursing care needs, and people living with dementia or a physical disability. At the time of our inspection there were 44 people living at the service. The service is purpose built, arranged over three floors accessed by two passenger lifts, and situated in the village of Warninglid just off the A23. The ground and top floor was used to provide people with residential and nursing care, support and treatment while the middle floor was used to provide care for people living with dementia. Long term care and respite care was provided.
There was a registered manager for the service. 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.
The last inspection was carried out on 12 and 14 May 2015. We found a number of breaches to the Regulations. This was in relation to safe care and treatment, staff awareness about the care provided to people who did not have capacity to make decisions about their care and treatment, the environment people lived in and recruitment practices. We also found areas which needed improvement in relation to the quality assurance processes in place, the environment and medicines administration guidance and recording. The provider provided the CQC with an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection. At this inspection we found the provider had followed their action plan, improvements had been made and the regulations were now being met.
Feedback from visiting health and social care professionals was that there had been significant improvements to the care provided. Staff told us there had been significant improvements made to the service provided since the last inspection. One member of staff told us, “There have been a lot of changes since (registered manager’s name) started. Paperwork has improved. Staff are more relaxed. I consider her (the registered manager) not like a friend, but we communicate very well. The door is always open we can go to her office anytime. The building has changed a lot. There is the quiet room now and the building all-over looks so much better now than before.”
People were cared for by staff who had been through safe procedures. Recruitment checks such as a criminal records check and two written references had been received prior to new staff working in the service. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff. Senior staff monitored peoples dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. However, on the day of the inspection we observed the deployment of staff during the day did not ensure all people’s care and support needs identified were fully met. Care staff were very busy meant areas of the service did not did not ensure people had access to care staff when needed. This is an area in need of improvement.
There was a maintenance programme in place which ensured equipment and service were regularly checked, and repairs were carried out in a timely way. There were areas where the décor and furnishings was still in need of updating to improve the environment people lived in. However, the provider had an action plan to address this which they were working through. This had ensured that there had been improvements to the environment since our last inspection. For example, there was a programme for replacing the beds, floor coverings, external decoration and repair and internal decoration. Following feedback from people a new hairdressing salon had been created. On the middle floor there was a new quiet lounge where people could go if they wanted to be away from the larger busier lounge.
People felt safe in the service. One person told us, “Yes, very safe. There is always someone around.” Another person told us, “I do. It’s really good here. They really look after me.” A visitor told us, “It’s very safe and very good. I took care of him for a good while and am happy to think he is well cared for. He is very happy here.” People were supported by care staff who were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. People knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.
Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop and increase their independence. People’s care and support plans had been reviewed and updated and were detailed. People felt involved in making decisions about their care and treatment and listened to. People’s healthcare needs were monitored and they had access to health care professionals when they needed to. Detailed risk assessments were in place to ensure people were safe when they received care and support. Where people had been assessed at risk or developing pressure sores, or from falling out of bed, the equipment identified to be used had been regularly checked to ensure it remained suitable for individual peoples use.
People told us they got their medicines on time. One person told us,” I would forget so it’s good that they look after my medication.” There were systems in place to ensure that medicines were ordered, stored, administered and reviewed appropriately. Where medicines were administered on an ‘as and when’ basis (PRN) such as pain relief there was detailed guidance in place to direct staff on its administration. Records completed such as the medicines administration records (MAR) and where creams had been applied had been fully completed.
Consent was sought from people with regard to the care and treatment that was delivered. Care staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation. Where people were unable to make decisions for themselves, staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests. Referrals had been made for Deprivation of Liberty Safeguards (DoLS) and we could see that staff understood how these were implemented. The majority of people told us staff always asked their consent before helping with any care or treatment. One person told us, “Oh yes they always ask before they come in and tell me what they want and ask if it’s ok.” Another person told us, “Yes always.” Another person told us, “Always, they explain everything they do.”
People were supported by kind and caring staff. One person told us, “Kind and considerate, always available if I need them. Another person told us, “They are very good. Another person told us, “They are yes. They take time to chat and we have a laugh.” Another person told us, “Very much so. When I was poorly they kept checking on me and make sure I did my hair and makeup.” People were treated with respect and had their privacy and dignity maintained by the staff. They were spoken with and supported in a sensitive, respectful and professional manner. One person told us, “They always keep bathroom door closed when assisting me.”
People told us the food was good and plentiful. One person told us, “It’s good and plentiful. There are always drinks available. Another person told us, “Can’t fault the food. We have drinks all day.” Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences.
People told us they thought the service was well led. One person told us, “I am very happy here.” Another person told us, “It’s very good.” Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable.
People and their representatives were asked to complete a satisfaction questionnaire, and people had the opportunity to attend residents meetings. They knew who to talk with if they had any concerns. We could see the actions which had been completed following the comments received. The registered manager told us that senior staff carried out a range of internal audits, and records confirmed this. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.
This inspection took place on 12 and 14 May 2015 and was unannounced.
Aniska Lodge is a nursing home for up to 49 people. It provides care and support to adults but predominantly older people with nursing care needs, dementia or a physical disability. At the time of our inspection there were 39 people living at the service. The service is purpose built , arranged over three floors accessed by two passenger lifts, and situated in the village of Warninglid just off the A23. The ground and top floor was used to provide people with nursing care, support and treatment while the middle floor was used to provide care for people living with dementia. Long term care and respite care was provided.
There was a registered manager for the service. There was a new registered manager since the last inspection who had commenced working in the service in August 2014. 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.
The last inspection was carried out on 30 April 2014. We found a number of breaches to the Regulations. This was in relation to personalised care, privacy and dignity, people not being able to participate fully in the decisions about their care and treatment, the design of the building and the completion of records. The provider provided the CQC with an action plan as to they would address these issues. We looked at the improvements made as part of this inspection.
People were cared for by staff who had not been recruited through safe procedures. Recruitment checks such as a criminal records check and two written references had not always been received prior to new staff working in the service. This is an area of practice which requires improvement.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Staff had policies and procedures to follow and demonstrated an awareness of where to get support and guidance when making a DoLS application. Although a number of applications had been made we found that people could not all freely move around the service when they wished to. They were reliant on care staff to support them around the service. For example people living with dementia were restricted how freely they could move around the middle floor due to the physical layout of the building. Individuals had not had a risk assessment completed to look at if they could safely use the stairs independently, and people’s rights had not been considered as to if this was a deprivation of individual peoples liberty. This is an area of practice which requires improvement.
Medicines were stored correctly and there were systems to manage medicine safely regular audits and stock checks were completed to ensure people received their medicines as prescribed. However, where PRN ‘as and when’ medicines were given guidance was not fully in place to protect people and ensure safe administration. Records did not in all instances fully detail the stock levels in the service. The instructions for where topical creams should be applied had not all been completed. This is an area of practice which requires improvement.
Where people had been assessed at risk or developing pressure sores, or from falling out of bed, the equipment identified to be used had not been regularly checked to ensure it remained suitable for individual peoples use, and for bedrails the covering in some instances it was not being used to fully protect people. This as an area of practice that requires improvement.
There was a maintenance programme in place which ensured repairs were carried out in a timely way. However, there were areas where the décor was in need of updating to improve the environment people lived in.
People's individual care and support needs were assessed before they moved into the service. Care and support provided was personalised and based on the identified needs of each individual. People’s care and support plans and risk assessments were detailed and reviewed regularly giving clear guidance for care staff to follow. People told us they had felt involved in making decisions about their care and treatment and felt listened to. Peoples healthcare needs were monitored and they had access to health care professionals when they needed to.
People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner.
People told us they felt safe. They knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to.
People said the food was good and plentiful. Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences.
Senior staff monitored peoples dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff.
Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable.
People and their representatives were asked to complete a satisfaction questionnaire, and people had the opportunity to attend residents meetings. We could see the actions which had been completed following the comments received. The registered manager told us that senior staff carried out a range of internal audits, and records confirmed this. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we have asked the provider to take at the back of this report.
Aniska Lodge is a care home for up to 49 people. It provides care and support to older people with nursing care needs, dementia or physical disability. At the time of our inspection there were 40 people living at the service. People we spoke with spoke positively of the service. One person told us, “It’s lovely here.”
The service was spread over three floors. The ground and top floor provided nursing care support and treatment while the middle floor was for people living with dementia. We spent time observing the delivery of care and treatment for people receiving nursing and dementia care.
The service had a registered manager in place and they provided good leadership and support to the staff. Throughout our inspection, staff spoke positively about the service and commented that they felt supported in their role.
People looked happy and content. People spoke positively of the service and the registered manager. A relative told us, “It’s like a hotel here.”
Although some people spoke positively about the range of activities in the home, not all the activities met everyone’s individual needs and preferences. We brought this to the attention of the registered manager and found that the service needed to make improvements in this area.
During the course of the inspection we found that staff treated people with dignity, kindness and compassion. However, we observed one staff interaction which was undignified and was reported to the registered manager immediately. The registered manager informed us this would be addressed immediately with the care staff involved. We found the service needed to make improvements in this area.
We found that, for people living with dementia, staff did not always enable them to make choices about day to day decisions. We found the service needed to make improvements in this area.
For people living with dementia, we found that the design and layout of the service did not enable people’s wellbeing and independence. People could not freely access their bedrooms and were dependent upon care staff to assist them when needed. We found the service needed to make improvements in this area.
The delivery of care and treatment was recorded and each person had an individual care plan which detailed the support required to maintain their health and wellbeing. Risk assessments were reviewed on a monthly basis but did not always reflect the current situation and the support required to minimise the risk of harm. We found that care plans were not always being followed which therefore placed people at risk of harm and meant that their needs were not always met effectively. We found the service needed to make improvements in this area and we informed the local authority of our findings.
We found that not all people were safely supported to transfer from a chair to a wheelchair. We observed one transfer where inappropriate equipment was used. This placed the person at risk of harm. The registered manager was informed immediately. We found the service needed to make improvements in this area and we informed the local authority of our findings.
People received care from a consistent team of care staff who were clear about their roles and knew people well. Staff received appropriate training which was continually on-going.
We observed staff interaction throughout the course of the inspection. Staff respected the individuality of the people using the service. For people receiving nursing care, staff enabled them to make day to day decisions.
People looked content and happy in the company of care staff. We observed that people were dressed in accordance with their lifestyle choice. For example, one person was seen wearing smart clothes. Documentation we reviewed recorded that this person had always dressed smartly and this had been an important aspect of their life. People were wearing their glasses and hearing aids.
Emergency plans were in place and understood by staff. These included personal evacuation plans for all people, to ensure they would be safe in the event of an emergency.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found that people living with dementia could not freely move around the service when they wished to. We found the service needed to make improvements in this area.
People told us that they were treated with respect and that their dignity was maintained. For example, one person told us, "When they are changing me or helping me they include me in the conversation'no they don't talk over me as though I'm not here'.
In the main, people told us that they were happy with the care and support they received. For example one person told us, 'They are wonderful. They know I'm struggling to write so they are helping me do my Christmas cards'. Another person said, 'I stay in my room and that's my choice but I have everything here I need. They make sure I do. You can see I've got my crocheting, telly, loads of books and my door is always open and they say hello as they pass by'.
People also told us that they were happy with the levels of cleanliness at the service and with staffing levels. Some people did comment that they felt staff at times, were rushed. As one person said, "Sometimes it would feel nice if they did not have to rush so much, if they had the time to just sit and talk to us".
We found that steps had been taken by the provider and previous compliance actions were met in relation to peoples dignity, risks associated with the management of malnutrition, infection control measures and staffing levels.
We found that people had variable experiences depending upon the level of their needs. People who had general nursing needs or who were receiving rehabilitation support consistently told us about their positive experiences. Their comments included 'I am very well looked after as everyone is so kind to me, I have no complaints at all'. A relative told us: 'It is not the nicest decorated place but we cannot fault the care my mother has received'. However for people who lived on the dementia unit practices did not always promote their privacy and dignity during meal times.
People had their medicines administered to them safely. Staff had the guidance they needed to help ensure that people's needs could be addressed. People had access to a range of additional health care professionals. However not all actions taken in response to changes in people's food and fluid intake were recorded in order to evidence if appropriate actions were being taken to improve people's hydration.
People told us of their varying experiences with regard to their welfare and social needs. One person told us there was always lots going on. However a relative referring to the dementia unit told us ' They are just left sitting in the lounge chairs with nothing to do as the staff are too busy doing other things'. We noted there were not always opportunities for people to have their social needs met.
Care and nursing staff were knowledgeable about the individual preferences and needs of people they supported. We saw interactions where care staff reassured and guided people. For example we saw staff holding the hands of people to walk along corridors and chatting and using humour to help motivate and orientate people.
Care staff were described by people and their visitors as: 'Very helpful', 'kind' and 'attentive'. However we received consistent feedback from staff, people and their visitors about how rushed staff were and that there were not always enough staff to be able to meet people's needs in a timely manner at peak times. Care staff told us: 'It's hard physical work nowadays as we have so many people who require a lot of support' and 'Our anxiety rubs off onto residents when we rush, rush, rush all the time, they pick this up and they become aggressive'. Comments from people who lived the service included : 'Sometimes I have to wait 20 minutes for someone to come and that can be too long, so I have managed to find a way of getting myself to the toilet' and 'There's just not enough staff to help everyone they are always rushing. They all work so hard. It's now 11.30am and I'm still waiting for a wash and to get dressed'.
Not all areas and equipment of the service gave the appearance of being clean, and there were strong odours throughout. We received consistent feedback about the poor standards of cleanliness of the premises and furniture. On person told us about their bad experiences with having to use dirty wheelchairs.
Comments included 'we have a good quality of life here', 'the care is excellent' and 'life is very good'.
Relatives told us that the staff were nice and that they were welcome to visit the home at anytime.
People we spoke with told us they felt the staff respected their privacy and dignity. Staff knew the people living at the home and had an understanding of their care needs.
People told us that they had had a very nice lunch, they enjoyed the food and they were happy living at Aniska Lodge.
One person's relative told us that staff were not always visible on each floor and that on a recent occasion when they needed to speak to staff they had had to go and search for them.
We noted that the people who were sat in the communal lounge looked well cared for. We observed that staff spoke to people in a kind and respectful manner. Staff supported the people who ate in the communal dining area appropriately over the lunch time period.
We spoke with a resident who told us that she could not move her legs and had to rely on staff to do everything for her. She told us that most of the staff were kind and patient and tried very hard to make life easier for her. When we saw this person later in the day she was in the communal room and said she had received a very good wash from one of the very caring staff.
We were told that people are fully involved in the life in the service and in their individual care. One person said 'We have choices in everything every day and if we suggest anything they take notice of us'
People told us that there were sufficient staff on duty at all times with one person saying how much the service had changed in the past two years. They said that great improvements in staffing and attitude of staff had taken place.
People said that they enjoyed the food and the leisure activities and that they found they had plenty to occupy them.
Relatives of one person commented that the home was clean and the people living there always 'looked nice'.