Anchorstone Nursing Home is situated in a residential street in Farnham, Surrey. The home is registered to provide care and nursing for up to 40 people, who may have dementia.

The home made up of two buildings joined by a central corridor. Communal areas, for the use of people from both buildings, include a large dining area, conservatory and secure gardens.

There was a registered manager in post. 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 inspection took place on 15 November 2016 and was unannounced. At our last inspection in July 2015 we identified two breaches in the regulations. These were around the safety and cleanliness of the environment (specifically the kitchen), and that the requirements of the Mental Capacity Act had not always been followed. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that all the areas of concern had been addressed, and people had a positive experience living at Anchorstone. There was positive feedback about the home and caring nature of staff from people who live here.

People told us they were happy living here. One person said, “I really like it here, and since I’ve been here I’ve made lots of friends.” A relative said, “We wouldn’t change a thing here, they’re very good. No one shouts at the residents, staff are so calm and patient.” Staff were happy and confident in their work and proud of the job they do.

People were safe at Anchorstone because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks.

Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them.

Staff received comprehensive training, to ensure they could meet and understand the care needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health improved due to the care and support staff gave. People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.

The staff were kind and caring and treated people with dignity and respect. The staff knew the people they cared for as individuals. People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical needs. People and relatives were involved in reviews of care to e

Anchorstone Nursing Home is situated in a residential street in Farnham, Surrey. The home is registered to provide care and nursing for up to 40 people, who are living with dementia. The home is made up of two houses joined together and care is provided across both buildings. Access to the first floor is by stair lift or passenger lift. Modifications have been made to the home to meet the needs of people that live there. At the time of our visit 35 people lived here.

The inspection took place on 08 July 2015 and was unannounced.

Everyone we spoke with praised the care and support they received from the staff and the registered manager. One person said, “I don’t have any worries, I’m safe here and staff are brilliant.” A relative said, “This is very special place. They treat people as people. The staff have love for residents and relatives and I can’t speak too highly of them.”

There was a registered manager in post. 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 were not completely safe at Anchorstone Nursing Home. Not all risks to people’s health and safety had been identified and managed. The assessment of the risk of harm to people from storage of hazardous substances, food hygiene and cleaning had not been appropriately managed by the staff.

Where people did not have the capacity to understand or consent to a decision the provider had not always followed the requirements of the Mental Capacity Act (2005). Decisions had been made for people without an appropriate assessment and review being completed. People told us that staff did ask their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards to ensure the person’s rights were protected.

People received their medicines when they needed them, and staff managed the medicines in a safe way. Staff were trained in the safe administration of medicines, however they had not had competency checks in line with best practice, and there were gaps and out of date information in medicine administration records.

Care and support documents did not always look at the person as a whole. There were gaps in care plans for people’s personal history or personal preferences, although staff were able to tell us about them. Care plans were predominantly based on people’s healthcare needs. Records of daily care did not always give enough detail to show that people received appropriate care and support. People told us that they had been included in the generation of their care plans, and involved in reviews.

The staff were kind and caring and generally treated people with dignity and respect. One person said, “The staff are brilliant they really know what they are doing here.” We identified some issues with the actions of a small number of staff that could be improved, for example at meal times, and ensuring people had meaningful interaction.

There were enough staff to meet the needs of the people that live here, however we identified that the deployment of staff around meal times could be improved so that everyone received the support to enjoy their meals.

People enjoyed the food and were offered a choice if they did not like what was on the menu for the day. People had enough to eat and drink. The hydration of people was high on staff’s priority as they understood how this could affect people’s health.

People were supported to maintain good health as they have access to relevant healthcare professionals when they needed them.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received training to support the individual needs of people in a safe way. The provider carried out thorough recruitment checks to ensure staff were safe to support the people that live here.

People had activities that met their needs and the equipment and environment was personalised to the people that used it, rooms were all decorated in a different way to suit peoples tastes. The staff knew the people they cared for as individuals.

People knew how to make a complaint. Feedback from people was that the registered manager and staff would do their best to put things right if they ever needed to complain. A relative said, “The staff will sort out anything that is wrong and that goes along way for our peace of mind.”

People and staff had the opportunity to be involved in how the home was managed, and the management listened and acted on what was said. The registered manager carried out a number of audits to check that a good quality service was being provided.

We have identified two breaches in the regulations. You can see what action we told the provider to take at the back of the full version of this report.

On the day of our visit there were 34 people residing in the service out of a total of 36. We were met by the head of care and the deputy manager and then joined by the registered manager. Later on we also met with the proprietor.

We looked at consent to care and treatment and found that people were being asked for their permission to have care and treatment provided to them, and had the right to refuse care and treatment. We also found that staff had a proper understanding of mental capacity issues.

We looked at the care and welfare of people who used the service and found they and their relatives were happy with the level of care they were receiving. We also found that a proper system of care planning and management was in place.

We looked at the premises and its grounds and found that it was suitable for its purporse, and that regular maintenance and refurbishment was being carried out.

We looked at staffing and found that there were appropriate staffing levels in the service, and that care and nursing staff were experienced and qualified to fulfil their roles.

We looked at how the provider ensured a high quality of service, and found that they regularly sought feedback from people who used the service and from staff. We also found they conducted regularly reviews and audits on all aspects of the service. However, we found that the provider had failed to carry out regular checks on the employment status of its staff.

We spoke with four people who used the service and six visitors. Everyone we spoke with gave very positive feedback about the care at this home and how kind and friendly the staff were.

Many of the people at this home were unable to verbally express their views, so we used the Short Observational Framework for Inspection

(SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

These observations demonstrated that the staff knew each person really well; they treated people with respect, dignity and kindness.