CQC report explained · a residential care home
What the CQC found at Anchor House - Doncaster
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, May 2022
Rated Good overall; inspectors found safe care and kind staff, but the home was not always well-led and had missed some required reports.
This was an unannounced inspection on 09 May 2022. The inspector spoke with four people, three relatives and four staff, observed care and reviewed care, medicines and management records.
The home was rated Good overall and Safe was rated Good. Inspectors found enough staff, safe medicines practice, suitable risk management and good infection control. People said they felt safe, and staff were observed to be kind and caring.
Well-led remained Requires Improvement. Accidents, incidents and safeguarding concerns had been recorded but were not always reported to the CQC or local authority. The home had improved its monitoring systems since the previous inspection, but managers were still putting a reporting system in place.
Enough staff
Inspectors found enough staff to meet people's needs promptly. Recruitment checks were also in place.
“We observed staff interacting with people and found there were enough staff available to meet people's needs in a timely way.” from the report
Safe medicines
People received their medicines as prescribed. Records were completed and staff had been trained and checked.
“People received their medicines as prescribed. Medication administration records were completed following administration of medicines.” from the report
Kind care
Staff knew people well and were observed supporting them in line with their preferences. People and relatives spoke positively about the care.
“We observed staff interacting with people and found they were kind, caring and supported people in in line with their preferences.” from the report
Infection control
The home was predominantly clean and inspectors were assured that infection prevention arrangements were in place.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Improved monitoring
The home's quality monitoring systems had improved since the previous inspection. Monthly audits were being completed and actions were taken.
“Systems in place to monitor the service had continued to improve since our last inspection.” from the report
Important events not reported
seriousSome accidents, incidents and safeguarding concerns were not reported to the CQC or local authority. The management team agreed to report them retrospectively.
“However, during our inspection we found accidents, incidents and safeguarding concerns which should have been reported to the CQC or the local authority.” from the report
Visiting guidance
needs fixingThe inspector recommended that visits take place in line with current government guidance.
“We recommend the provider ensures visits take place in accordance with the current government guidance.” from the report
Limited meal information and choice
minorThe menu had not been updated, so staff could not tell people what pudding was available. One person said they did not usually get a choice.
“We observed lunch and found this could be more person centred.” from the report
- 01What system is now used to make sure every accident, incident and safeguarding concern is reported to the CQC or local authority on time?
- 02Which events were reported retrospectively after this inspection, and what was learned from them?
- 03How do you make sure visits follow the current government guidance?
- 04How are residents given clear information about each day's meals and offered a choice?
- 05What checks are now carried out to make sure actions from audits are completed?
This inspection focused on the Safe and Well-led key questions, including infection prevention and control; the report does not give new ratings for Effective, Caring or Responsive. This explanation was written from the published report of 28 May 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2021
Anchor House - Doncaster is rated Requires Improvement; inspectors found enough staff and correctly given medicines, but safety checks and quality monitoring were not yet consistent.
This was an unannounced inspection on 9 June 2021. The inspector spoke with two people, three relatives and six staff, observed care, and checked care, medicines and management records.
The home had enough staff to meet people's needs. People received their medicines as prescribed and staff knew how to respond to suspected abuse. However, weekend cleaning of high-touch surfaces was reduced, some building safety processes needed to become routine, and the temperature of the medicines room remained a concern.
The overall rating was Requires Improvement. Safe and Well-led were both rated Requires Improvement. The rating was unchanged from the previous inspection. The report says quality monitoring had improved and the earlier Regulation 17 breach had ended, but the systems still needed to be embedded and made more consistent.
Staffing
Inspectors found enough staff available to meet people's needs in a timely way.
“Through our observations and talking with people and staff we found there were enough staff available to meet people's needs.” from the report
Medicines
People received their medicines as prescribed, and staff responsible for medicines had been trained.
“The administration of medicines was managed in a safe way and people received their medicines as prescribed.” from the report
Safeguarding
Staff had safeguarding training and understood what to do if they suspected abuse.
“Staff received training in this subject and knew how to respond if they suspected abuse taking place.” from the report
People felt cared for
People and relatives told inspectors they were happy with the care and felt their needs were met.
“People and relatives we spoke with were complimentary about the service and felt their needs were met.” from the report
Reduced weekend cleaning
needs fixingThere was no domestic staff on duty on Saturdays, so care workers carried out essential domestic tasks and high-touch surface cleaning was significantly reduced.
“Care workers carried out essential domestic duties such as emptying bins and laundry, but cleaning of high touch surfaces was significantly reduced over the weekend.” from the report
Building safety checks
needs fixingSome action had been taken on building and maintenance risks, but the home needed a clear process to make sure checks continued safely.
“At this inspection we found initial action had taken place, however, a clear process needed to be embedded to ensure risks continued to be managed safely.” from the report
Audits missed problems
needs fixingQuality checks had not identified every issue found by inspectors, including problems with two bathroom fittings.
“Some issues we identified during our inspection had not been identified during the audit process.” from the report
Incidents not reported
needs fixingA couple of incidents that should have been reported to the CQC had been overlooked. Management agreed to report them retrospectively.
“However, during our inspection we found a couple of incidents which should have been reported to the CQC.” from the report
Medicines room temperature
needs fixingThe report says the temperature of the medicines room had remained a concern despite attempts to reduce it.
“The registered manager told us they had tried a range of methods to reduce the temperature, however, this remained a concern.” from the report
- 01How is cleaning of high-touch surfaces covered at weekends, particularly when there is no domestic staff on duty?
- 02What current checks are in place for building and maintenance risks, including legionella, and how do you make sure these checks are completed consistently?
- 03How do your audits now identify problems such as damaged or unsuitable bathroom fittings?
- 04What were the incidents that were not reported to the CQC, and what has changed to prevent this happening again?
- 05How do you control and record the temperature of the medicines room now?
This was a planned inspection based on the previous rating and covered Safe and Well-led; the report does not give ratings for Effective, Caring or Responsive. This explanation was written from the published report of 23 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Anchor House - Doncaster
5 rated inspections over 6 years: the service has held its Good rating throughout.
- May 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- May 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2015
Report published without a new overall rating.
- September 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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