Abney Low Nursing home

Anchorage Nursing Home is a 'care home' providing accommodation, nursing and personal care for up to 40 older people. At the time of the inspection 23 people were living at the home, some of whom lived with dementia.

People’s experience of using this service and what we found

Systems in place to monitor the quality and safety of the service were not effective. Although internal and external audits identified areas for improvement, we found that action had not been taken to ensure those improvements were made. There was a lack of management oversight of staff practice to ensure best practice guidance was being adhered, and a lack of systems to ensure records were maintained accurately and stored securely.

Risks to people were not always managed safely, as care plans did not always provide information regarding people's current needs and how risks would be minimised. Identified risks were not robustly mitigated, as records did not evidence that people received planned care that met their needs. People’s nutrition and hydration needs were not always met adequately. The environment posed risks to people as it was not safely maintained. Personal protective equipment was available for use when required. Medicines were not always stored and managed safely, as room and fridge temperatures were not monitored daily, and no action was taken when the temperature was out of recommended ranges. Best practice guidance was not followed, such as for the administration of covert medicines. Not all staff had had their competency assessed to ensure they were safe to administer people’s medicines.

People, relatives and staff told us there were not always enough staff available to support people in a timely way. Our observations during the inspection supported this feedback. Not all safe recruitment practices were evident within staff files, and we made a recommendation about this. Not all staff received the necessary training to enable them to carry out their roles effectively, or relevant support, such as regular supervisions and an appraisal. However, staff told us they were kept updated and could raise any concerns with the management team.

Systems and procedures in place to safeguard people from the risk of abuse were not always effective, as although staff knew how to raise concerns, actions agreed to reduce risks to people were not always followed. Systems had been implemented to manage Deprivation of Liberty Safeguards and we found applications had been made appropriately. However, the principles of the Mental Capacity Act were not always adhered to when seeking and recording people’s consent to their care and treatment, therefore people were not supported to have maximum choice and control of their lives.

Most people told us they were respected and treated well by staff, and staff told us they knew people’s needs and how they wanted to be supported. People told us their family and friends could visit when they chose to, and we observed visitors in the home during the inspection.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 10 July 2023) and there were breaches of regulation identified. At this inspection we found sufficient improvements had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk and medicines, staffing, person-centred care, nutrition and hydration, consent and governance systems at this inspection. We also made a recommendation regarding staff recruitment practices.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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.

Anchorage Nursing Home is a 'care home' providing accommodation, nursing and personal care for up to 40 older people; some of whom lived with dementia. At the time of the inspection 32 people were living at the home.

People’s experience of using this service and what we found

There were failings by the provider in the way the service was led and managed. The systems in place to assess, monitor and improve the quality and safety of the service were inadequate. They failed to identify and mitigate risk and bring about improvements to the service people received.

The provider had failed to comply with fire recommendations set out by Merseyside fire service and fire safety training compliance was low.

Records used to monitor, and review people's care had not been fully completed and kept up to date. We found examples where sections of care plans and other care records had not been updated to reflect changes in people’s needs.

People did not always receive their medicines in line with the prescribers' instructions. Risks to people were not always managed and learning from accident and incidents had not identified themes.

Staff had not received all the training they needed to support people safely or appropriate support from the provider.

The principles of the Mental Capacity Act (2005) were not consistently followed when providing care and treatment for people. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans did not accurately reflect people's needs and they lacked guidance for staff about how to deliver person-centred care. The design and signage around the home did not take into account the needs of those people who lived with dementia.

The provider was receptive to the inspection findings, they told us they were willing to learn, improve and share the actions they would take to address the issues found at this inspection. The provider submitted an action plan following the inspection to inform us of further actions they would take to ensure improvements were made.

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

Rating at last inspection

This service was registered with us 11 April 2022 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 5 November 2021.

Why we inspected

This was a planned inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Anchorage Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to monitoring and assessing risk, medicines, staffing, person-centred care and oversight and governance of the home.

Follow up

Will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 6 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.