About the service: Aniska Lodge is a ‘care home’ situated just outside the village of Warninglid, near Haywards Heath. Aniska Lodge Nursing Home is a Grade II listed building with a large extension backing onto woodlands and has 49 bedrooms, all single with ensuite facilities. Residential and nursing care is provided for long term or respite care. There is also a separate unit,’ The Willows’ for people who are living with dementia. There were 44 people living at the service at the time of the inspection.

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.

This inspection took place on 13 July 2016 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 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 impr

We gathered information from a variety of sources. These included talking with people who lived at the service and their relatives. We also spoke with the manager and members of staff including nurses who were on duty. As some people were unable to tell us about their care and support we also observed how people were cared for, particularly within the dementia unit and when the lunchtime meal was being served.

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 spoke with ten staff, five relatives and 15 people who lived at the service and two external health care professionals who were involved in supporting people at the service. There were thirty nine people living at the service at the time of our inspection.

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.

People we spoke with told us that independence and individuality were promoted within the home. They said they felt able to express their views and they felt listened to.

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 living at Aniska Lodge told us they liked living there and felt safe.

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 told us that they felt that the home did meet their needs but that sometimes they had to wait for staff to support them.

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.

People told us that they were happy living in the service. They said that the staff were kind and polite.

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’.

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.