Amphion View Limited

Amphion View is a residential care home providing personal care to 31 people at the time of the inspection. The service can support up to 35 people. Some people using the service were living with dementia.

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

The provider’s systems for auditing the quality of the service had improved. We saw a range of audits were in place and actions were identified and addressed.

Systems in place to manage risks associated with people’s care, had improved and were managed safely. Staff knew people well and supported them in line with their current needs.

The provider had addressed the concerns raised at our last inspection regarding staff training. Staff told us they received appropriate training to ensure they had the knowledge and skills to carry out their role.

Sufficient numbers of staff were available to meet people’s need in a timely way. Staff had been recruited appropriately.

People received their medicines as prescribed. However, we identified concerns around the temperature of the medicine room. This had already been identified by the provider and the registered manager was addressing this. There were processes in place to ensure people were safeguarded from the risk of abuse.

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 were supported to maintain a balanced diet. We observed staff serving meals and found they gave people choices and provided meals in line with their dietary needs.

People had access to healthcare professionals when required, and staff followed their advice to ensure people received safe care.

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 requires improvement (published 8 December 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

Our previous inspection identified three breaches of legal requirements. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staff training and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective and Well-led which contain those requirements.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amphion View on our website at www.cqc.org.uk

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.

All visitors were screened for symptoms of infection before being allowed to enter the home. The home had facilities for people to wash their hands or sanitize on entering and leaving the home. Information was easily accessible on arrival to ensure visitors followed guidance.

The home had a visiting ‘pod’ to help facilitate visits safely. There was a booking system in place for visits. Communal areas were used creatively to help with infection prevention and control.

The provider understood and complied with the vaccination requirements for visitors to the service.

Amphion View is a residential care home providing personal care to 33 people at the time of the inspection. The service can support up to 35 people. Some people using the service were living with dementia. The service is also registered to provide nursing care, however, the provider is not currently providing or offering this regulated activity.

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

The provider’s systems for auditing the quality of the service were not always effective. Some concerns found during the provider’s audits, but actions had not been taken. Other concerns identified on inspection had not previously been identified by the provider’s governance systems.

People did not always receive person centred care and support. During our inspection we spent time observing staff interacting with people and found whilst they were kind, they were often task focused.

We were not always assured infection control was being managed in a safe way. For example, there were a lack of pedal bins throughout the service, a bath chair was rusty and dirty, two mattresses and covers were heavily stained, and some areas of the building were worn and not able to be cleaned effectively. Action was taken following our inspection to reduce cross infection.

Risks associated with people’s care had been identified. However, risks to people were not always minimised. For example, some mattresses were in poor condition and could have posed a risk to people’s skin integrity. Also, staff were not always confident and knowledgeable about managing risks associated with behaviours that could challenge.

On the day of our inspection we observed staff interacting with people and found there were enough staff to meet people’s needs. Staff had been recruited appropriately. We spoke with staff, observed practice and reviewed training records and found staff had not always received appropriate training necessary to carry out their duties safely.

People received their medicines as prescribed however, we found concerns regarding the temperature of the medicine room and recording of as required medicines, such as paracetamol.

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.

The provider had a process in place to record and analyse accidents. Trends and patterns were identified, and action taken to minimise reoccurring incidents.

There was a policy in place to safeguard people from the risk of abuse. A record of incidents was in place which showed actions taken and the outcome.

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

Rating at last inspection

The last rating for this service was good (published 5 September 2018). At this inspection we found the provider needed to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection inline with our current methodology.

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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Effective systems were in place which allowed people to be admitted to the service safely. Arrangements to provide a separate entrance to the home for staff had been implemented and staff supervised all essential visitors to ensure social distancing and infection control guidelines were followed.

The system ensured visitors to the service followed government guidelines for wearing Personal Protective Equipment (PPE). Facilities were available for visitors to sanitise their hands and put on PPE. Screening questions and a temperature check were standard requirements for all visitors.

All staff were trained in safe IPC practices. We observed staff wearing appropriate PPE throughout our visit and sufficient supplies were available.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. There had been a good uptake of residents receiving the COVID-19 vaccine.

The environment was clean and enhanced cleaning took place daily.

People were supported to maintain contact with their relatives in different ways including window visits and video calls.

People admitted to the service were supported following government guidance on managing new admissions during the COVID-19 pandemic. The provider had specific care plans in place for people to provide guidance for staff caring for them.

A COVID-19 business contingency plan was in place and had been followed. Staff knew how to respond to an outbreak of infection to ensure the safety of people and staff.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Amphion View’ on our website at www.cqc.org.uk’

At this inspection we found improvements had been made and the breach of Regulation found at the last inspection had been addressed. A more robust auditing system had been implemented, which meant areas needing improvement had been identified and actioned in a timelier manner. We also found care plans and risk assessments provided better information.

Amphion View is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is located close to the centre of Doncaster, with easy access to local transport, shops and other community facilities. It offers en-suite accommodation for up to 35 people who have needs associated with those of older people, including people living with dementia. There were 30 people living at the home at the time of the inspection.

The service had a registered manager in post at the time of our 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.

Care and support was planned and delivered in a way that ensured people were safe. People were protected, as any risks associated with their care were identified and appropriately managed. Systems were also in place to safeguard people from abuse.

The process for recruiting new staff continued to be robust, thereby ensuring staff were suitable to carry out their roles and responsibilities in a safe manner. Staff were trained and supported to develop their skills and provide people with the standard of care they required, but some training needed updating.

There was enough staff employed to meet the needs of the people living at the home at the time of our inspection.

Medication was managed safely and administered by staff who had completed appropriate training.

Infection control policies and procedures were in place, with issues identified and many actioned. However, where it involved replacing equipment or upgrading areas this was part of the registered providers environmental action plan.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received a varied and healthy diet that offered choice. However, we noted the dining experience some people received could have been better.

Staff supported people in a compassionate, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. All the people we spoke with made positive comments about how staff delivered care and said they were happy with the way the home was managed.

People’s needs had been assessed and care plans put in place to highlight these needs and tell staff how care should be delivered. Care plans had been reviewed periodically to make sure plans reflected people’s changing needs.

There was a range of activities and events people were supported to take part in.

There were systems in place to continuously assess and monitor the quality of the service. This included obtaining people’s views and checking staff were following the correct procedures. The premises and furnishings needed some attention, but these had been identified during audits and action plans put in place to address them.

Further information is in the detailed findings below.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Amphion View Limited’ on our website at www.cqc.org.uk’

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. Although we saw improvements have been made and the service is no longer in special measures, we saw areas where further improvements are required particularly in relation to good governance to ensure the monitoring systems are fully effective and embedded into practice.

Amphion View care home is located close to the centre of Doncaster. It provides en-suite accommodation for up to 35 people on two floors. Care is provided for people who have needs associated with those of older people, including people living with dementia.

The service had a registered manager in post at the time of our 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 and associated Regulations about how the service is run.

On the day of our visit there were 33 people living at the home. The people we spoke with all said they were very happy with the care and support provided.

Staff we spoke with were aware of safeguarding policies and knew the procedure to follow if they suspected abuse. Staff were also familiar with the company’s whistleblowing procedures.

People’s needs had been assessed before they moved into the home and we found they had been involved in formulating care plans. Information in some care files was difficult to access as they were being rewritten and we found some conflicting information in one file. Risk assessments were in place, but they were not always sufficiently detailed to ensure staff could meet people’s needs. However, we found no evidence that these shortfalls had any adverse impact on people.

Medication systems protected people against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration. However, we identified some minor issues that had been identified in an audit in March 2017, but had still not been addressed.

A robust recruitment system had been undertaken, which helped the employer make safer recruitment decisions when employing new staff.

At the beginning of their employment staff had received an induction into how the home operated, and their job role. Staff told us they received essential training and regular support sessions to help them meet the needs of people who used the service. Although we saw there were some gaps in staff training, the registered manager had identified where further training or refresher courses were required. A training plan was underway to ensure staff completed the required training.

Overall the service was meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards [DoLS]. However, we found some of the information about people’s capacity to make decisions was unclear.

People were supported to maintain good health, have access to healthcare services and received on-going healthcare support. The care records we checked showed they had received support from healthcare professionals when required.

We found staff approached people in a kindly manner. We observed staff were caring and considerate. Staff respected people and treated them with dignity. However, at times we saw staff lacked direction to ensure people’s needs were met in a timely way.

The standard of cleanliness at the home had much improved and we found the service was clean at the time of our inspection. Refurbishment work was on going at the time of our inspection, which meant some areas of the environment still required attention.

People received a well-balanced diet that met their nutritional needs and preferences. However, we found the mealtime experience varied depending on which dining room people sat to eat.

An activities co-ordinator was employed to facilitate regular social activities and stimulation to meet people’s needs and preferences. People told us they enjoyed the activities provided.

We saw the complaints policy was easily available to people using and visiting the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. When concerns had been raised we saw the correct procedure had been used to record, investigate and resolve issues.

People using the service, relatives and staff were happy with the way the service was run. They spoke positively about the registered manager and how staff delivered care.

An audit system had been used to check if the home was safe and well maintained, and staff were following company polices. However, shortfalls had not always been identified and where they had, timescales had not always been met. This meant the system was not fully effective in improving the quality of the service provided.

We found one continued breach 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 end of this report.

This inspection took place on 9 November 2016 and was unannounced. The inspection was conducted by two adult social care inspectors.

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 registered manager is responsible for the day to day management of the home and was available throughout the inspection.

At the last comprehensive inspection on 20 and 21 January 2016, we identified the service was not meeting one of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the home did not always ensure the proper and safe management of medicines and did not always effectively assess the risks to the health and safety of service users of receiving the care or treatment. At this inspection, there remained breaches in regulation within these and other areas.

The provider had made some improvements in regard to medicines but was still failing to manage medications safely. Stocks did not always tally with the amount that records said had been administered.

The atmosphere in the home was calm and relaxing. Staff had a good understanding of people's interests, likes and dislikes. People described the staff as kind and caring.

Assessments to identify where people may be at risk of harm or injury did not always ensure that the risk was minimised. Some risks had not been assessed and staff did not have the information available to refer to, if needed, to know how to minimise risks.

People had choices offered to them about what they wanted to eat and drink and were supported to maintain their health and see a GP, for example, if they felt unwell.

Staff had received training and felt this gave them the skills and knowledge they needed to meet people's needs effectively. Staff promoted people's privacy when they were supported with personal care.

People felt staff were kind and had a caring approach to them. People felt involved in making decisions about their day to day care and how they spent their time. There were planned group activities for people to take part in if they wished to do so.

The provider did not have effective arrangements in place to protect people from the risk of harm due to infection. The condition of the premises was poor in parts. The bathrooms we checked were damaged, with broken tiles, damaged walls and unsealed floors. Cleaning records in the dining room indicated that the room had only been cleaned six times in the preceding five weeks.

People’s care plans did not reflect appropriate decision making in accordance with the Mental Capacity Act 2005 (MCA.) The care plans we checked contained a generic document in relation to decision making, but there was little information about specific decisions that had been made for people, or who had contributed to the decision making.

When we inspected this service in January 2016, we found that the provider was not carrying out audits of the service at an appropriate frequency. This meant that failings in the way the service was delivered were not identified. We rated the service “Requires Improvement” in relation to how well led it was. At this inspection, we found that the provider had failed to address this, and audits continued to be ineffective.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Amphion View provides accommodation and personal care for up to 35 people older people, some of whom live with dementia. There were 33 people living at the service on the day of our inspection. At their last inspection in September 2013, they were found to be meeting the standards we inspected.

There was a registered manager in post who had been registered since 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome.

People's needs were met in a way that they preferred and they felt they were listened to. Staff knew how to identify and monitor risks to people's health and welfare and respond appropriately. People had choice on how they spent their days and there were activities provided with ties to the local community. There was a good choice and variety of food and people's health was monitored with regular contact with health and social care professionals.

People's privacy and dignity was promoted and they were supported to maintain relationships which were important to them. Staff knew people well and they, along with the registered manager, had a people first approach. There were systems in place to monitor the quality of the service and address any issues that arose. Staff were recruited through a robust recruitment procedure and received regular training and supervision.

There were sufficient staff, with appropriate experience, training and skills to meet people's needs. The service was well managed and took appropriate action if

expected standards were not met. This ensured people received a safe service that promoted their rights and independence.

Staff were well supported through a system of induction, training and professional development. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

The service was not always well-led. Audits and quality systems were in place but were not always completed with regularity. There were other formal quality assurance processes in place. This meant that not all aspects of the service were frequently monitored to ensure good care was provided and planned improvements and changes could be implemented in a timely manner.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One member of staff told us: 'It's not just about the tasks, time to talk is important.' One person who used the service told us: 'Staff here are lovely.'

People were cared for in a clean, hygienic environment. We noted that the standard of cleanliness observed throughout the premises was good and that the home was free of any offensive odours.

There were enough qualified, skilled and experienced staff to meet people's needs. One staff member told us: "There are always enough staff to make sure people receive the care they should.'

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People's care plans were written in a person centred way.

People were protected from the risks of inadequate nutrition and dehydration. Care plans contained completed individual catering requirement forms. People's preferences had been documented regarding food, drinks and snacks.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

All staff had completed training on safeguarding and those we spoke to were aware of their responsibility to report concerns.

Staff received appropriate professional development. Staff told us they were well supported by each other and by the management team.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Questionnaires to residents, staff and relatives were sent out annually.