This inspection took place on 20 October and 1 November 2016 and was unannounced. Amherst Court provides accommodation and personal care for up to 15 people who have mental health conditions. Some people may also have alcohol or substance misuse problems. There were 14 people living at the home at the time of our inspection.We carried out an unannounced comprehensive inspection of this service on 8 and 10 September 2015. Three breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check they had followed their plan and to confirm that they now met legal requirements.
The home had a registered manager. 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.
At this inspection, we found that some improvements had been made. However, we found the provider had breached different regulations and continued to remain requires improvement in other areas of practice. The provider did not ensure there were enough staff on duty to keep people safe. People were not supported to be involved in their community and there was a risk that people may become isolated. Recruitment practices were not robust and people’s care plans required further development to ensure they were detailed enough. Although the registered manager had made improvements to the quality of care, they were limited in the amount of work they could do in this area because of the lack of support and resources from the provider.
At this inspection, we found the provider had not made any improvements to their recruitment practices. Although most of the appropriate pre-employment checks were completed before staff started working for the provider, there continued to be gaps in the information asked for by the provider.
At the inspection in September 2015 we identified other areas of practice that required improvement to make sure people were as safe as possible. This included assessing and managing the risk to people’s safety, and staff’s understanding of how to report any safeguarding concerns. Individual risk assessment and management practices had improved and each person had a review of the possible risks to their safety. Person centred risk management plans had been put in place. However, the management plans continued to lack enough detail to enable staff to keep people as safe as possible so the provider must continue to develop their practice in this area. Staff had completed training in safeguarding adults and knew how to recognise the signs of abuse and what to do if they thought someone was at risk.
At the inspection in September 15 we found that while care workers demonstrated they had the skills to meet people’s needs effectively, they were not well supported with training, supervision and appraisal. Most training needed refreshing and supervision and appraisals had not been completed regularly. The provider did not have a schedule in place for when this should happen. At this inspection we found the provider had supported and encouraged staff to complete a variety of training. This included safeguarding, medicines management and risk assessment. Staff were also given specific training so they could effectively meet the individual needs of each person. This included supporting people with mental health problems. Staff gave us positive feedback about the training and support they received.
At the last inspection we found the provider’s quality monitoring systems were not accurate, and had not identified areas of practice that required improvement. The registered manager had made improvements to the quality monitoring systems. However, they were limited in the amount of improvements they could make because the provider did not offer enough support or resources to the service. Feedback about the registered manager was very positive but not for the provider. The provider lacked insight into the views of staff and disagreed with their views when we discussed these with them.
At the inspection in September 2015 we found essential risk assessments had not been completed around the home. This included fire and legionella. At this inspection we found the provider had taken action and the risk assessments had been completed. The provider had either completed the necessary work that had been identified in the assessments, or was in the process of doing so.
The registered manager and staff had a good understanding of the Mental Capacity Act (2015) and understood their responsibilities under the Act. Appropriate Deprivation of Liberty referrals had been made and people were asked for their consent in line with legislation.
People were supported to eat and drink enough and food was homemade and nutritious. People gave us positive feedback about the quality of food but there was mixed feedback about whether or not there was enough choice. People were supported to maintain good health and all of the appropriate referrals were made to health care professionals when required. People’s medicines were safely managed, and people were able to self-administer their medicines if they wanted to.
Staff were caring and had a good understanding of the care and support needs of people living in the home. People had developed good relationships with staff and there was a happy and relaxed atmosphere in the home. People had their privacy and dignity protected. Their needs were understood by staff and were met in a caring way. People said they were comfortable to make a complaint, but no one had needed to. Any accidents or incidents that had occurred were well managed by the registered manager.
The registered manager asked for feedback about the service from people and staff. Any feedback received was acted on where possible. There was a complaints procedure in place and the registered manager and staff knew what they should do if anyone made a complaint.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not supported to be involved in their community and there was a risk that people may become socially isolated. There were not enough staff to meet people needs and keep them safe and recruitment practices were not robust. You can see what action we told the provider to take at the back of the full version of this report.