Anbridge Care Home

Anbridge Care Home is a residential care home registered with the Care Quality Commission to provide nursing and personal care for up to 21 people. The service provides support to older adults. The single room accommodation is arranged over two floors and has lift access. There are shared communal lounges and bathrooms and an outside secure garden area. At the time of the inspection 21 people were using the service.

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

Systems in place helped safeguard people from the risk of abuse. Assessments of risk and safety and supporting measures in place helped minimise risks. Staff managed people’s medicines safely. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection. Staffing levels were sufficient to meet people’s needs and managers recruited staff safely. Staff followed an induction programme, and training was on-going throughout employment.

Care plans included information about support required in areas such as nutrition, mobility and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.

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 told us they were well treated, and their equality and diversity respected. People felt staff respected their privacy and dignity and took into account their views when agreeing on the support required. Staff identified people’s communication needs and addressed these with appropriate actions.

The provider and manager responded to complaints appropriately and used these to inform improvement to care provision. The provider was open and honest, in dealing with concerns raised. The registered manager was available for people to contact, and managers undertook regular quality checks, to help ensure continued good standards of care.

The provider and managers followed governance systems which provided oversight and monitoring of the service. These governance systems and processes ensured the service provided to people was safe.

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 good (published 30 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

At the entrance of the home, information was displayed to inform visitors about any infection control procedures to be followed. Temperature checks were completed, along with a questionnaire to establish if visitors had recently displayed any symptoms of COVID-19. Lateral flow testing (a Covid-19 test where the results can be obtained within 15 minutes) was carried out for any visitors.

Enough personal protective equipment (PPE) was available and we saw staff wore it at all times during our visit. Some PPE was not stored safely and was left out of its original packaging. This presented the risk of cross contamination. We raised this issue with the service and it was resolved quickly.

We observed the home to be clean and tidy, with domestic staff carrying out their duties throughout the day. Cleaning schedules were in place and this included a deep clean of people's bedrooms.

Some furniture, particularly armchairs in the lounge, were damaged and were in need of replacing. This meant there was a risk they might not be cleaned effectively. We were given assurances that arrangements were in place for this furniture to be replaced.

Staff had received both infection control and hand hygiene training. This included the safe donning and doffing of PPE.

Zoning arrangements were used when people had tested positive for COVID-19 and needed to self-isolate in certain areas of the home. Where people had tested positive and were self-isolating in their bedroom, a sign was placed on the door so people were aware.

COVID-19 testing was in place for both staff and people using the service. People living at the home were also scheduled to receive their COVID-19 vaccination imminently.

Appropriate arrangements were in place for new admissions, although due to the outbreak, none were being taken at the time of our inspection.

Windows were opened at various times during the day and outdoor facilities were used when better weather allowed. Air conditioning units had also been purchased earlier in the pandemic to aid ventilation.

Risk assessments were completed where certain groups may be at higher risk of contracting the virus. An appropriate infection control procedure was in place and regular infection control audits were undertaken to ensure standards were maintained.

The service was last inspected in April 2016, and rated Requires Improvement. There were two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to safeguarding people from abuse and carrying out financial assessments. Following the inspection the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in all areas.

Anbridge Care Home provides accommodation and personal care for up to twenty people in a large converted and extended residential building approximately one mile from the centre of Oldham. At the time of our inspection the service had no vacancies.

When we looked around the home, we found it looked clean and homely with no unpleasant odours, and had been decorated in a dementia friendly fashion.

We spoke with staff who demonstrated a good understanding of safeguarding and showed they understood how abuse can occur. We saw that the service had safeguarding procedures in line with legislation and local authority policies so when incidents of potential abuse occurred these were reported and appropriate action taken to protect people from harm.

We saw that when recruiting new staff, appropriate processes were in place to ensure that they had the right quality and character to work with vulnerable people, and once in post all staff were provided with training opportunities to develop their skills. There were sufficient staff on duty, and we saw that they had time to spend talking and interacting positively with the people who used the service.

The home had good systems in place to provide safe administration of medicines, but we noticed that it would be possible for people to gain access to the room where medicines were stored when not being used. We pointed this out to the registered manager who took immediate action to ensure that the room was kept secure and accessible only to the responsible person on duty.

When we looked at care plans we saw that risks had been identified, assessed and steps had been taken to minimise the risk. When accidents and incidents occurred these were logged and audited so that any patterns could be identified and remedied.

Where people lacked the capacity to consent to their care and treatment, and were subject to a deprivation of liberty the service obtained the appropriate authorisation to provide care and support. We saw evidence in the care files of discussion and negotiation to show that people were consulted on how they liked their care to be delivered, but best interest decisions were not always documented.

Care staff at Anbridge House monitored people’s general health, and where specific healthcare needs were identified the service was proactive in seeking the right level of support; liaising with health care professionals, such as general practitioners (GPs), District Nurses and mental health workers to provide an appropriate level of support. We spoke to a health care specialist who was visiting the home, who told us that staff listened to, accepted and acted on their advice.

Systems were in place to ensure good recording of information, and communication amongst staff ensured that information was passed on in a timely manner. Staff demonstrated a good understanding of the needs of people who used the service and how they would like their needs to be met. This information was recorded in care plans.

We found the service had developed a homely and caring atmosphere. Staff demonstrated a knowledge and understanding of the people who used the service and provided care in a person centred way. Case notes and daily logs reflected interventions.

There were a variety of activities and we saw that people were not left to their own devices. Staff spent time with people to provide stimulation and activity.

The registered manager had developed a good system of governance with regular reviews of care files and risk assessments. Elements of service delivery were audited on a regular basis, and people were consulted in how they wanted their care to be delivered. We saw that when complaints were made directly to the service these were investigated with a response sent to the complainant. However, we were aware of an outstanding complaint being handled by the local authority.

We last inspected Anbridge Care Home (Anbridge) in December 2014. At that inspection we found that the service was meeting all the standards we assessed.

Anbridge Care Home provides accommodation and personal care for up to 20 people in a large converted and extended residential building. The service is located approximately one mile from Oldham town centre. Accommodation is provided over two floors with a passenger lift and stairs between the floors. The home was fully occupied at the time of our inspection. We found the building to be well maintained, clean tidy and odour free. Care staff said that in sunny weather the door leading out into the garden was left open so that people could walk freely between the two areas.

The home had a manager who was registered with the Care Quality Commission (CQC) and was present on both days of the inspection. 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 manager has been registered since October 2010.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Care records reviewed included detailed risk assessments to mitigate risks associated with falls, moving and handling, pressure relief and nutrition, with clear plans in place to show how to minimise the risk. However no financial risk assessments was in place for one person to ensure that they were protected from the risk of potential financial abuse, as he had capacity to withdraw money from a cash point.

On reviewing care records we identified that the registered manager had not completed an initial needs assessment for a person recently admitted. This meant that the registered manager could not be certain the service could meet this person’s needs.

The service had quality assurance audit tools in place. Audits were carried out by the registered manager however on reviewing these records we noted no member of staff had been identified to complete any follow up of actions. We have made a recommendation about the auditing of the quality assurance systems in place.

People who used the service told us they felt safe, and that they thought there were enough care staff available to support them.

The building and equipment were safe and secure. We saw that the home was clean and that cleaning rotas were in place and being followed to ensure that all areas were kept clean and hygienic, including kitchen and laundry areas.

We saw that systems were in place to ensure that all medicines were stored correctly and dispensed by care staff that had been appropriately trained.

The care staff we spoke with had a good understanding of people’s individual needs and the support they required, and we found that care was delivered consistently by a team of carer's who knew how to support people and meet their care needs.

We saw that mandatory training for care staff is followed and regularly updated, and care staff were supported to complete training in other issues.

People told us that they liked the meals and we saw that the food looked appetising and hot and was in sufficient quantities. Visitors commented “The food is appetising’’ and “[person] is well fed.’’

Care staff were attentive to people’s health care needs and sought appropriate medical attention when required.

The registered manager and care staff had built up good working relationships with health care professionals such as district nurses, Speech and language therapists and other health care specialists.

One visitor described how the care staff knew how to care for their relative and commented “There’s nothing they wouldn’t do for [person], it’s the next best thing to home, I have no worries leaving [person] here.’’ Visiting professionals we spoke to were impressed with the quality of care.

We saw the home promoted positive and close relationships with the people who use the service and the Registered Manager encouraged an open and friendly atmosphere.

Care staff treated people with dignity and respect and spoke politely to them.

People who used the service told us that care staff responded to their needs and provided them with support when they required it.

The home had a good understanding of dementia care and care at the end of life.

Care was delivered by a stable and consistent care staff team who spent time with the people who used the service, and knew them well.

We saw that there were a wide variety of activities on offer to people who used the service.

There were policies and procedures in place to support the daily running of the home and help to make sure that care staff were clear about their duties when they were involved with all aspects of people’s healthcare and wellbeing.

Care staff had received training in safeguarding adults and whistleblowing. They were able to tell us of the correct action to take should they have any concerns about people who used the service.

People told us they were involved in discussion and decision-making about their care. One person told us that staff treated them with "great respect".

People's care and support was based on a written plan which in turn was based on a comprehensive series of assessments. Care plans were regularly reviewed. People told us that "they [staff] always listen to me" and "they [staff] find time to sit down and talk to you". Staff told us that communication within the home was good and they were kept up to date with the changing needs of individuals.

There was an appropriate procedure, which was followed, for the safe storage and administration of medication.

Staff were only recruited after a rigorous vetting process. This helped to ensure only suitable people were employed at the home. Staff were described by people using the service and their relatives as "friendly" and "lovely".

The home had a written complaints procedure. People told us they were confident that any complaint they may have would be appropriately dealt with.