Archived: Amerind Grove Care Home

Following the inspection the home was placed into 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. 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 at its next comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection the provider wrote to us to say what they would do to meet the legal requirements. We undertook a focused inspection on 3 February 2016 to check the provider was meeting the legal requirements for the regulation for which they had been served a Warning Notice; this related to safe care and treatment. At our focused inspection on 3 February 2016, we found that the provider had taken sufficient action to achieve compliance with the Warning Notice.

You can read the report for previous inspections, by selecting the 'All reports' link for ' Amerind Grove Nursing Home' on our website at www.cqc.org.uk

At this inspection the provider had made sufficient improvements to be removed from special measures.

Amerind Grove is a nursing home with a total of 171 beds. The home is split between five individual units. Kingsway provides nursing care, Picador is a residential unit for people with dementia and Embassy, Regal and Capstan units provide a mixture of residential and nursing care. Capstan unit in particular provides care for people with acute dementia. At the time of our inspection there were 96 people living in the home and Embassy unit was closed.

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.

People’s needs were regularly assessed and resulting care plans provided practical guidance to staff on how people were to be supported. Care plans however were not consistently person centred. Care plans were not personalised and did not contain individual information and references to people’s daily lives.

Procedures for the safe covert administration of medicines were not followed appropriately.

Training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been provided to staff. DoLS aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Staff were not knowledgeable about the protection of people’s rights. The service had also failed to ensure that best interest decisions were undertaken when people lacked the mental capacity to make decisions and give their consent.

Risk assessments did not always reflect necessary actions required to reduce risks to people. Some risk assessments were risk averse and placed unnecessary restrictions on people’s independence. Other risk assessments did not contain enough information to enable staff to prevent risk to people.

People were not supported to undertake person centred activities.

The provider had quality monitoring systems in place which were used to bring about improvements to the service. Some improvements had yet to be embedded by the service.

There were enough staff to meet people’s basic personal care needs.

There were mainly positive and caring relationships between staff and people at the service. We did see some instances of care which was uncompassionate. People praised the staff that provided their care. We received positive feedback from people’s relatives and visitors to the service. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way when responding to their needs.

The staff had received training regarding how to keep people safe. They were aware of the service safeguarding and whistle-blowing policy and procedures.

There was a robust staff recruitment process in operation. The recruitment process was designed to employ staff that would have or be able to develop the skills to keep people safe and support their needs.

Staff demonstrated a detailed knowledge of people’s needs. They had received training to support people to be safe and respond to their care needs.

People had access to healthcare professionals when required, and records demonstrated the service had made referrals when there were concerns.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded.

The provider had made appropriate notifications to the Commission; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

We found three breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

In addition to this, we also found an additional eight breaches of five other regulations of the Health and Social Care Act 2008 during that inspection. Following the inspection the home was placed into special measures. The overall rating for this service is ‘Requires improvement’ however as there was a continued rating of ‘Inadequate’ in the key question of ‘Safe’ at the last inspection the service is 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.

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 at its next comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection the provider wrote to us to say what they would do to meet the legal requirements. They told us they would meet all of the regulations by 28 February 2016; we will check compliance with these regulations at a future inspection.

We undertook a focused inspection on 3 February 2016 to check the provider was meeting the legal requirements for the regulation they had breached and had complied with the Warning Notice. This report only covers our findings in relation to this area. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘ Amerind Grove Nursing Home’ on our website at www.cqc.org.uk

Amerind Grove is a nursing home with a total of 171 beds. The home is split between five individual units. Kingsway provides nursing care, Picador is a residential unit for people with dementia and Embassy, Regal and Capstan units provide a mixture of residential and nursing care. Capstan unit in particular provides care for people with acute dementia. At the time of our inspection there were 105 people living in the home and Embassy unit was closed.

There was no 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 manager in charge of the home had submitted their application to the Commission to become registered and was awaiting the outcome.

At our focused inspection on 3 February 2016, we found that the provider had taken sufficient action to achieve compliance with the Warning Notice and the regulation in order to meet the legal requirements. There were however improvements required to ensure continued compliance.

We found that the home and kitchen areas were generally clean and were being monitored by the manager and senior staff. We did however observe some practices undertaken by staff which were unhygienic.

Following the inspection we considered all of the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was not safe in all areas because the home was not safe, clean and hygienic. We found examples of poor infection control in Kingsway House. This was putting people at risk of harm. We also found that people's personal records were not always completed fully. Therefore it was not clear from the information whether the person had received care in line with their identified need. Improvements were needed in order to ensure that people receive a safe service

Appropriate arrangements were in place for managing medicines. People's medicines were available for them and given in a safe way. People told us their medicines were given at the correct times. Comments people made included 'I'm given my medicines regularly and I take them, so there is no need for me to worry.' Another person told us 'Medicines are perfect.'

People who used the service were cared for by staff who knew how to protect them from the risk of abuse. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The registered manager stated that since a recent change in the criteria for making Dols applications, applications were to be made for a number of people and that advice had been sought from the appropriate authority. Relevant staff were being trained by the provider to understand when an application may be required. This meant that people were safeguarded from abuse.

Is the service caring?

People were supported by sensitive and attentive staff. Comments we received from people living in the home and their relatives were positive. Comments included 'I feel happy and well looked after here', 'Very good care' and 'I can't fault this place, they are brilliant here'.

We saw that care staff showed patience and gave encouragement when supporting people. We spent time in the communal lounges observing interactions between staff and people that used the service. People were treated with care and respect while using handling equipment such as a hoist. People were encouraged to be as independent, while staff were ready and willing to offer assistance sensitively when it was needed.

Is the service effective?

We found people's health and care needs were assessed and reviewed regularly. Care plans provided guidance for staff to follow to ensure people's individual specific needs were met. Care plans were reflective of people's current level of need. Specialist dietary, mobility and equipment needs had been identified in care plans where required and staff were observed using equipment to support people competently.

Most care documentation that we viewed was reflective of people's current level of need. However some recording charts were not completed fully. This meant there was a risk people were not being given the support required in line with their care plan.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is the service responsive?

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example people's files held information and advice sought from the district nurse team in relation to their wound management care.

People's needs had been assessed before they moved into the service. Documentation that we viewed evidenced that people were involved with the planning of their care. One person told us that they were involved in their pre-assessments and had been informed of what they could expect from the service.

Is the service well led?

People told us the registered manager was available to talk to them if they had any concerns. Staff we spoke with felt supported by the management team. One member of staff told us "we can always talk things out here".

People that used the service, their relatives and external professionals completed a satisfaction survey once a year. Comments we viewed were positive from people.

The provider wrote to us and informed us they would be compliant in the outcome area by 30 November 2013.

We inspected the systems that were in place on Kingsway house for the recording, management and storage of records. We also checked if Picador House had maintained compliance and continued to keep up to date accurate records about people who used the service.

We saw how staff interacted and assisted people with their needs. We found people were supported in the ways that were set out in their care records.

We spoke with seven people who used the service. We also spent time sat in communal areas on Kingsway House and Picador House.

We saw staff interacted in a polite and friendly manner with people who were not able to make their views known. The staff were calm and attentive in manner with people when they assisted them with their needs.

During our inspection we spoke with people who lived in the home, staff, relatives, the clinical services manager and the registered manager.

We examined the care records for people who lived in the home and observed how staff interacted and supported people in communal areas. We crossed referenced peoples care plans with the observations that we made. We found most people were being supported in line with their assessed needs.

Overall people's comments were positive. One person said: 'I am well content, everything is ok, they look after me ok; they let me do what I want.' Another person said: 'Staff treat me lovely, they are so kind, couldn't get better, no one is nasty and they are respectful. I join in everything and am very lucky to be here.' Another resident said 'I leave everything to them; they look after me very well they know what to do for me. I read my paper and watch TV if there is something I like on".

Relatives that we spoke with told us 'they are fantastic here how they care for X. Sometimes X can be very distressed and they are lovely to them'.

During our two day inspection we spoke with people living in the home, staff, relatives, visiting professionals and examined the care records. We also spoke with the manager and senior members of the BUPA management team.

Not all people were able to verbally tell us about the care they received and if they were happy. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We observed some people being supported and examined their care plan documentation at different stages of their assessments. This was to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

Overall people we spoke with, who used the service and their relatives were happy with the care they received. One person told us 'I am able to do what I want here'. This person continued to tell us if they were bored they could go outside. Other comments included; 'the food is nice'. 'I feel safe here', 'I like the activities but I wished we could go out more'.

One person we spoke with told us they had to wait some time for their call bell to be answered. However, this was not indicative of our observations made during our inspection. For example, we noted call bells were answered within three or four rings during our visit.