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Inspection carried out on 29 January 2018

During a routine inspection

This inspection took place on the 29 and 31 January 2018 and was unannounced. At the previous inspection of this service in October and November 2016 the overall rating was requires improvement. At that inspection we found Breaches of Regulation 18 and19. This was because the provider had not ensured there were enough staff on duty to keep people safe and recruitment processes were not robust. People were not supported to be involved in their community and there was a risk that people may become isolated.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well led to at least good. This inspection found improvements had been made and the breaches of regulation met.

Amherst Court 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. It is registered to provide support to a maximum of 15 people and 12 people were using the service at the time of our inspection. People who used the service were younger and older adults with mental health needs. Some people may also have alcohol or substance misuse problems.

The service had a registered manager in place. 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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan as stated in their provider information return (PIR), and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Amherst Court has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People were content and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with specific mental health disorders, such as schizophrenia, bipolar and korsakoff disease. Formal personal development plans, including two monthly supervisions and annual appraisals were in place. Staff were supported to become ‘champions’ in areas of care delivery such as infection control, medicines and well-being. People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards

Inspection carried out on 20 October 2016

During a routine inspection

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 sy

Inspection carried out on 8 and 10 September 2015

During a routine inspection

This inspection took place on 8 and 10 September 2015 and was unannounced. Amherst Court provides accommodation and personal care for up to 15 who have mental health conditions. Some people may also have alcohol or substance misuse problems. There were 11 people living at the home at the time of our inspection.

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.

The provider did not have clear processes in place for assessing and managing the risks to people’s safety and the environment. People did not have suitable risk management plans in place and those that were in place were not regularly reviewed and updated. Appropriate fire and legionella risk assessments had not been completed. Incidents and accidents were well recorded but not always well analysed to identify if action needed to be taken to prevent a recurrence.

People were not fully involved in making decisions about their care. People’s plans did not demonstrate how they had been included in reviews of their care needs. Although people had regular one to one meetings with staff, changes to people’s needs were not reflected in their care plan.

Staff knew how to recognise the signs abuse and that they should report any concerns they may have to the registered manager. However, staff were not clear what they should do if the registered manager were unavailable, and contact details for the local authority safeguarding were not easily available.

The provider’s quality monitoring system was not always effective. Although the provider and registered manager were completing quality monitoring audits, they were not always identifying areas for improvement.

While care workers demonstrated they had the skills to meet people’s needs on a day to day basis effectively, staff were not well supported with training, supervision and appraisal. Staff had not received additional training to help them meet the specific mental health needs of people who use the service. Most mandatory 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.

There were some minor gaps in pre-employment checks, such as full employment history, but disclosure and barring service checks were completed for all staff before they began work. There were enough staff to keep people safe and meet their needs and people’s medicines were managed safely.

The registered manager and staff had a good understanding of the Mental Capacity Act (2015) and understood that all of the people living in the home had the capacity to make their own decisions about their care.

People were well supported to eat and drink enough. Food was homemade and nutritious and people were involved in making decisions about menus. People were supported with healthy eating and to maintain a healthy weight. Everyone was supported to maintain good health and all of the appropriate referrals were made to health care professionals when required.

Staff were caring and had a good understanding of the care and support needs of people living in the home. People had developed positive relationships with staff and there was a friendly and relaxed atmosphere in the home. People were well supported to remain independent and do the things that were important to them, such as going on holiday or to the shops.

The provider 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.

There was an open culture in the home, and the registered manager was described as “The best manager we’ve ever had”. Staff felt confident to discuss any concerns they might have and said the registered manager would act on them. Staff said they were well supported and were well motivated to provide good care.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always supported to make decisions about their care, appropriate risk assessments had not been completed and staff did not receive appropriate training, supervision and appraisal. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 9 January 2014

During an inspection to make sure that the improvements required had been made

When we inspected this service on 19 September 2013 we found the premises were not suitably maintained. We also found there were insufficient staff on duty during the morning shift. This had impacted on the quality of the home’s cleaning.

The manager wrote to us with an action plan which told us how these shortfalls would be addressed. This inspection was carried out to follow up on the progress made by the home in relation to these essential standards.

We found that the home now had a maintenance plan which identified when repairs and improvements to the premises would be completed. We saw that significant improvements to the home had been undertaken since 19th September 2013. One person told us, "The new floors in the toilet are nice."

We saw that staffing levels had been increased. We found that this had positively impacted on the quality of cleaning within the home.

Inspection carried out on 19 September 2013

During a routine inspection

At the time of our inspection the provider did not have a registered manager in post.

We spoke with four people who lived at the home, three staff and looked at three people’s care plans.

We saw that people were treated with dignity and respect and involved in their care.

Care plans we looked at were up-to-date and reflected the individual needs of people.

All areas of the home were tidy, most areas were seen to be clean. However, we found that low staffing levels could affect the quality of domestic cleaning.

We found that parts of the home required refurbishment and maintenance.

We saw the home had an effective complaints procedure.

Inspection carried out on 24 October 2012

During a routine inspection

During our visit we spoke with three people who lived at the home, three staff members and one visiting social worker.

The people we spoke with told us they enjoyed living at Amherst Court. One person said “I like it here… I would miss my friends and the staff if I left. The staff are kind.” Another person said “I’ve had to go into hospital before. I’m very happy to be back now. The girls assist me, and between us we get there.”

The staff we spoke with were knowledgeable about people’s needs and what support they required.

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The service had assurance systems in place to monitor the quality of the service provided and to gain the views of the people who lived there.

Reports under our old system of regulation (including those from before CQC was created)