Archived: Ami Court

We found the registered manager had not always worked in line with national guidance. You can see information about this in the detailed findings. We have signposted the registered manager to current guidance and are assured they will work in line with it moving forward.

We found the following examples of good practice.

People were reminded about the importance of social distancing. People were isolating in their rooms when necessary, in separate areas on the floors.

Changes had been made to the service as a direct result of the pandemic. Staff wore personal protective equipment (PPE), such as masks, aprons and gloves. There were PPE 'stations' around the service to help ensure PPE was available to staff when needed.

The registered manager kept relatives up to date with people’s well-being by phone and e-mails, including video calling systems.

The provider was engaged in the national testing programme for staff and people who lived at the service.

The registered manager had sought advice and guidance from other agencies about infection control and prevention and had updated staff practice accordingly.

Ami Court is a residential care home providing personal and nursing care to 36 older people, some who were living with dementia at the time of the inspection. The service can support up to 38 people in a purpose built unit. Some people were living at the service for up to three weeks for assessment and rehabilitation.

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

People told us they felt safe living at the service, however, medicines were not always managed safely. Medicines that require specific storage, recording and administration had not always been administered following national guidance.

Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place to mitigate risks. Accidents and incidents had been recorded, analysed and action taken to reduce the risk of them happening again.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff received training, supervision and appraisal to develop their skills and meet people’s needs. Staff monitored people’s health and referred them to healthcare professionals when their needs changed. Staff followed the guidance given to keep people as healthy as possible.

People were supported to eat a balanced diet. People had access to activities and were supported to stay as active as possible.

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.

Each person had a care plan containing details about their choices and preferences. People had been involved in developing the care plan and deciding their future care needs. People met with a member of the management team before they moved into the service to check staff would be able to meet their needs. People’s end of life wishes were recorded, staff supported people at the end of their lives.

People were treated with dignity and respect. People were supported and encouraged to express their views on the service. Complaints had been recorded and investigated following the provider’s policy. People were given information in a way they could understand.

Checks and audits had been completed on the quality of the service and action had been taken when shortfalls had been identified. The registered manager attended local forums to keep up to date with developments in adult social care to continuously develop the service.

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 14 December 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of part of one regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the management of medicines at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Ami 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. Ami Court accommodates up to 38 older people in one adapted building, which included up to ten people who were receiving short term support and assessment as they had just come out of hospital. At the time of the inspection, 32 people were living at the service receiving nursing care.

There was a registered manager in post, who is also the provider. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected the service in March 2016 and the service was rated Good overall. During this inspection we found two breaches of Regulation and the service is no longer rated Good.

The registered manager was present at the service regularly, but relied on a team of staff to run the service on a day to day basis. The registered manager did not have oversight of the quality of the service. Checks and audits had been completed, however, the staff completing them did not have the knowledge to know when there were shortfalls and what action to take. The registered manager had not checked the audits staff had completed and had not been aware of the shortfalls present in the service.

Potential risks to people’s health and welfare had been assessed but action had not been taken to mitigate the risks. Staff completed checks on the environment and these had been recorded, however, the registered manager and staff had not recognised when people were at risk and had not acted to rectify the shortfalls. Potential risks to people’s health had been assessed but there was not always detailed guidance for staff to mitigate the risk.

Medicines were not managed safely. People were not always protected from the risk of infection. Incidents and accidents were recorded and analysed but there was enough detail about the action taken to reduce the risk of them happening again.

Staff had not received regular training updates, a new training system had recently been put in place, we observed staff moving people safely. Staff understood their responsibility to keep people safe. However, when incidents happened staff took appropriate action to keep people safe, but had not immediately reported them to the registered manager. When incidents were reported the registered manager took appropriate action and reported the incidents to the local safeguarding team.

Each person had a care plan, however, these varied in the level of detail about people’s choices and preferences. People’s care plans were reviewed but changes in people’s needs were not always changed in the care plan. The care plans did not always reflect the care being given. Before people moved into the service, staff completed an assessment of the person’s clinical needs, using referral documents and telephone assessments from health professionals.

People, staff and stakeholders were asked for their views about the service. Regular meetings were held and action had been taken when suggestions had been made. However, negative feedback from some people who had been at the service for rehabilitation had not been analysed.

Staff were recruited safely, people told us there were enough staff to meet their needs. Staff received supervision and appraisal to discuss their development. Nurses received training to keep their clinical skills up to date. Staff monitored people’s health and referred them to health professionals when required. Staff followed the guidance from health professionals to keep people as healthy as possible and promote their independence. Staff supported people to live as healthy a life as possible. People were supported to eat a balanced healthy diet.

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 were supported to make decisions about their care and support. Staff supported people at the end of their lives and keep them comfortable.

People had access to a variety of activities which they told us they enjoyed. The provider had a complaints policy and any complaints received were investigated following the policy.

People were treated with kindness and respect. Staff supported people to be as independent as possible. Staff knew about people’s choices and preferences including their sexuality and religious needs and supported them to live the lives they wanted. People’s dignity was respected.

People were comfortable in the company of the registered manager and relatives told us the management team were approachable. The service was purpose built and met people’s needs.

The registered manager attended local forums and groups to keep up to date. The service worked with other agencies to provide joined up care for people. The building was purpose built and met the needs of people.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall.

Ami Court provides accommodation, support and nursing care for up to 38 older people. At the time of the inspection there were 36 people living at the service, which included ten people who were receiving rehabilitation and support as they had just come out of hospital.

The service is run by a registered manager who was present during 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. The registered manager, who is also the registered provider, is supported by deputy managers and a clinical lead, who leads the team of nursing staff across the three services run by the provider.

We carried out an unannounced comprehensive inspection of this service on 23 and 24 April 2015. Breaches of legal requirements were found. After the comprehensive inspection the provider wrote an action plan to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and confirmed that they now met legal requirements.

People told us that they felt safe living at the service. Staff understood the importance of keeping people safe. Staff knew how to protect people from the risk of abuse and how to raise any concerns they may have.

Risks to people’s safety were identified, assessed and managed appropriately. People received their medicines safely and were protected against the risks associated with the unsafe use and management of medicines. Accidents and incidents were recorded and analysed to reduce the risks of further events. This analysis was reviewed, used as a learning opportunity and discussed with staff to reduce the risk of further occurrences.

Recruitment processes were in place to check that staff were of good character. Information had been requested about staff’s employment history, including gaps in employment. However, a full employment history and reasons for any gaps in employment had not been obtained for all staff. We have made a recommendation about this. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff.

People were provided with healthy food and drinks which ensured that their nutritional needs were met. People’s health was monitored and people were referred to and supported to see healthcare professionals when they needed to.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Applications for DoLS had been made in line with guidance and were kept under review.

People and their relatives were involved with the planning of their care. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. People spoke positively about staff and told us they were supportive and caring.

People were supported by staff to keep occupied to reduce the risk of social isolation. People, their relatives, staff and health professionals were encouraged to provide feedback to the provider to continuously improve the quality of the service delivered. People knew how to raise any concerns and felt that they would be listened to and that actions would be taken.

Staff had an in-depth appreciation of people’s individual needs around privacy and dignity. Staff were motivated to provide kind and compassionate care to people and felt it was very important to also support people’s relatives.

The registered manager and management team coached and mentored staff through regular one to one supervision. Staff were clear about what was expected of them and their roles and responsibilities and felt supported by the management team. The management team were visible and worked with the staff team. People, their relatives and staff were positive about the leadership at the service. There was a clear management structure for decision making which provided guidance for staff.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We considered our inspection findings to answer questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people, relatives and the manager:

Is the service safe?

The service was safe. When people had accidents the most appropriate and safe action was taken to make sure they received the treatment they needed. There were systems in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

Practices in the service protected people using the service, staff and visitors from the risk of harm.

Assessments had been undertaken to ensure that people received safe and appropriate care. The relevant people were consulted with regard to people's mental capacity and the deprivation of people's liberty was taken into account.

People using the service had a care plan which detailed their care and support needs. We saw there was guidance for staff to follow to reduce risks and implement strategies to make sure people were as safe as possible.

Is the service effective?

The service was effective. Care was consistently planned and delivered in response to people's changing needs. People's health and care needs were assessed with them and /or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person's needs.

People who used the service told us that their care needs were met. One person said that staff did everything they asked for. A relative commented, 'They are generally pretty good here. I say if there is something that X needs or if I am worried about anything. They sort things out'.

Staff support was consistent and structured. A core staff team was used across the three services run by the provider. Staff had the knowledge, skills and competencies to carry out their role effectively and safely because staff were properly trained, supervised and appraised.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

One person who used the service told us, 'I've been here quite a while. The staff are all pretty good. I tell the staff what I prefer'. A relative commented, 'We are very happy with their care here'.

Is the service responsive?

The service was responsive. Staff and visitors with whom we spoke told us they felt they would be listened to if they raised any concerns.

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led. There was a clear management structure in place and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

We found that people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing. We found that some improvement needed to be made regarding care planning for end of life care as people sometimes went into hospital when it may have been better for them to stay in the home and be cared for.

People said they would prefer it if there was more to do in the home as they found the time went very slowly. An activities coordinator was employed and outside therapists visited the home to provide some activities but there were still long periods of time when people were unoccupied. There was only a small amount of interaction with the staff because they were always busy providing care for people although people said they did stop and have a chat sometimes. There were lots of visitors in and out of the home throughout the day.

There were thorough recruitment processes in the home to make sure the right staff were employed. Staff received training to give them the knowledge and skills to support people. People said there were enough staff to support their needs and that they were able to call them if needed. They said they were confident and satisfied with the service and were able to visit at any time.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made, did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated an appropriate level of experience and knowledge that enabled them to support people who lived at the service with their needs effectively.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected. One person who used the service said "Staff are very good. I have no concerns". Another person said 'Food is great, lovely choices and plenty of it'. Another person said "If I was unhappy I would talk to the manager. Staff look after me well. I have no concerns".