2, 6 and 16 March 2015
During a routine inspection
This inspection took place on 2, 6 and 16 March 2015 and was unannounced.
Amicus is a care home providing accommodation and personal care for up to 18 older people, some of whom were living with dementia. The service is located in Strood, Rochester, approximately half a mile from the town centre. The service was provided in a detached property with accommodation on two floors. People had a variety of needs including mobility and communication difficulties. The last inspection was carried out on 9 December 2013 when we found the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were met.
The registered provider is an individual in day to day charge of the service and therefore the service is not subject to a condition to employ a registered manager. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
During this inspection we found breaches 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 back of the full version of this report.
The comments people gave us about the service they received were mixed. They were complimentary about some aspects of the service they received, particularly the caring nature of staff and the quality of meals provided. However people told us that they were often bored and that staff did not spend time chatting with them or helping them to be occupied.
People were not safeguarded against abuse. People told us that they felt the staff were skilled in keeping them safe from harm, however we found that staff did not understand how to appropriately report and respond to allegations of abuse in the service. Staff did not have access to relevant guidance to support them in recognising and responding to abuse.
People were not safeguarded against the risk of unsafe or inappropriate care. People’s care plans did not provide staff with the information they needed to provide a personalised service. People’s choices were not respected in relation to receiving personal care. Not all staff, particularly agency staff, knew people well. They did not know about their needs or their life history to enable them to provide the care people needed in a person centred way.
People were not safeguarded against the risk of unsafe or unsuitable premises. The risks associated with unsafe or unsuitable premises had not been assessed to ensure people were kept safe. Individual risks, such as the risk of falling, had been assessed and the registered provider had sought the advice of relevant professionals. However, accidents and incidents in the service had not been monitored to identify any patterns and improvements that could be made to reduce the risk of accidents happening again. Some staff did not know how to evacuate the building in the event of a fire or other emergency.
People were not safeguarded against the risks associated with unsafe management of medicines.
People did not always receive their prescribed medicines because there was a lack of effective systems for ordering medicines from the pharmacy.
People who use services and others were not protected against the risks of acquiring an infection. Most areas of the home were clean but there was no system in use to check that all areas of the home remained clean.
People were at risk of dehydration because they did not have clear care plans to ensure staff knew how to respond to the risks and seek medical advice when needed. People were generally, but not always, complimentary about the quality of the food provided. People that needed support to eat were delivered their meals but waited an unreasonable amount of time to receive this support.
The premises had not been assessed to ensure they met the needs of people living with dementia. Those living with dementia were at risk of social isolation because staff did not understand how to engage them in meaningful activities. People were not provided with enough appropriate activities to occupy them in a meaningful way. People told us they were bored and they would like to have more to do. There were no personalised programmes of activity for people living with dementia.
People that had made a decision about receiving life-saving treatment had not had this decision reviewed to ensure it continued to reflect their wishes.
Staff had been trained to meet people’s needs. They had completed relevant qualifications in health and social care to be able to safely and effectively care for people. However, staff did not always respond to people’s needs appropriately or quickly enough. For example, staff did not offer assistance to a person struggling to get out of their chair.
Most staff were respectful, kind, caring and patient in their approach and had a good rapport with people. However, we found that interactions staff had with people were focused on the care tasks they were carrying out with them, such as administering medicines and providing drinks. They spent little time talking with people in a way that acknowledged their individuality. People told us that staff did not spend much time chatting with them. The language used within people’s care plans to describe their needs was not always respectful.
The culture of the service did not match the stated aims in the service brochure. People did not always have choice and control over their care and routines in the service did not reflect their preferences. People living with dementia did not have their care planned or delivered in a personalised way. The registered provider did not have effective systems in place for checking that care reflected the vision and values of the service.
Robust records were not kept to ensure that the registered provider could monitor the delivery of care. Some records, such as policies and guidance, were not accessible to staff when they needed them.
Systems for ensuring the safety of the service were not effective and had not been checked by the registered provider. This meant that failures in the systems had placed people at risk of harm, such as infection and injury from fire and accident.
People had their physical health needs met. Consideration had been given in care planning to how people’s physical health could affect their mental well-being. Staff knew how to monitor people’s health needs, but there was a lack of written guidance for them to follow to ensure people received a consistent response to their needs.
People and staff felt the registered provider was approachable, but some people did not feel their complaints were taken seriously.
Safe recruitment procedures ensured that staff were suitable to work with people. There were sufficient numbers of staff employed to meet people’s needs.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider ensured that, where there were restrictions to people’s freedom and liberty appropriate applications had been made to local authority and had been authorised. This ensured people’s rights were protected and they were protected from harm.
People were enabled to be as independent as they wished.
In addition to the breaches of regulation which are detailed at the back of our main report, we have also made some recommendations for the registered provider to consider for improving the service.
We recommend that the registered provider seek guidance on people’s decisions about receiving lifesaving treatment.
We recommend that the registered provider seek guidance on implementing care plans for monitoring health conditions such as diabetes.
We recommend that the registered provider seek guidance on the suitability of the premises for meeting the needs of the people using the service, taking into account relevant guidance.
We recommend that the registered provider seek guidance on how to engage people with dementia.
We recommend that the registered provider seek guidance on the use of language to describe people’s needs.
We recommend that the registered provider seek guidance on the provision of individualised personalised care to people with dementia.
We recommend that the registered provider review how the outcome of complaints investigations are communicated to people.
We recommend that the provider seek further guidance on management and analysis of incidents and accidents in care homes.