Archived: Amicus Care Home Limited

Updated 14 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 25 September and 1 October 2018. The inspection was unannounced on the first day and we told the provider when we would be returning to complete the inspection on the second day. The inspection was carried out by two inspectors and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications about important events that had taken place in the service which the provider is required to tell us by law. We also looked at action plans sent in by the provider to tell us about the improvements they were making to address the concerns found at the last and previous inspections. We used this information to help us plan our inspection.

We spoke with eleven people who lived at the service and two visitors, to gain their views and experience of the service provided. We received feedback from one relative following the inspection. We also spoke to the registered manager and four staff. We received feedback from two health care professionals and one local authority commissioner.

We spent time observing the care provided in the communal areas of the service and the interaction between staff and people. We looked at seven people’s care files, medicine administration records, four staff recruitment records as well as staff training records and the staff rota. We spent time looking at the provider’s records such as; policies and procedures, auditing and monitoring systems, complaints and incident and accident recording systems.

We asked the provider to send us further information after the inspection and they sent this within a timely manner.

Updated 14 November 2018

The inspection took place on 25 September and 1 October 2018. The inspection was unannounced.

Amicus Care Home Limited is a ‘care home’. People in care homes receive accommodation and nursing and 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. Amicus Care Home Limited provides accommodation and support for up to 18 older people. There were 12 people living at the service at the time of our inspection. People had varying care needs. Some people were living with dementia, some people had diabetes or had suffered a stroke, some people required support from staff with their mobility around the home and others were able to walk around independently.

The service had a registered manager. The registered manager was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection on 18 July 2017, the service was rated as ‘Requires improvement.’ We found continued breaches of Regulations12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to, the provider was not ensuring the safe administration of people’s medicines; risk assessments were not effectively managing risks to people’s safety. We added conditions to the provider’s registration to ensure they kept us updated of improvements by reporting to CQC once a month to update on, new admissions to the service and their planned care and support; the review of staffing levels as a result of new admissions; actions taken as a result of regular audits of medicines administration records; actions taken as a result of result of regular auditing of risk assessments in place.

The provider sent their report at the end of each month as requested with the information required for CQC to monitor their progress in ensuring the safety of people in their care.

At the inspection in July 2017 we also found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to follow the basic principles of the Mental Capacity Act 2005 (MCA 2005). We added a condition to the provider’s registration to ensure the provider reviewed capacity assessments for those people who lacked the capacity to make decisions relating to their care, to demonstrate they were adhering to the principles laid down within the MCA 2005. The provider was requested to report on this by 27 October 2017.

The provider sent a report by email on 25 October 2017 to confirm they had taken the action necessary to meet Regulation 11.

At this inspection, on 25 September and 1 October 2018 the service continues to be rated ‘Requires improvement. This is the third consecutive time the service has been rated Requires Improvement. The provider had made improvements in some areas. There was a greater understanding of the MCA 2005 and people were now supported to maintain their rights within the guiding principles of the Act. Peoples prescribed medicines were now managed in a safe way. Risks to people’s safety were now appropriately managed. Improvements continued to be needed to the monitoring processes to ensure the quality and safety of the service are robust and consistently applied.

We found further concerns at this inspection around fire safety within the service. People had not been asked their views of the service to help to drive improvement.

Fire door retainers were not working as batteries were allowed to fail and not replaced. The battery failure of fire door retainers led to a constant bleeping which meant people were subject to the noise day and night and for an unspecified period of time. Fire alarm testing was not carried out regularly to ensure the safe working of the system. Fire evacuation drills had not been undertaken to make sure staff were able to practice the safe evacuation of people from the premises. Some people’s personal evacuation plans did not suitably describe their individual support needs.

Auditing systems to monitor the quality and safety of the service were not used consistently or effectively. People’s views of the service were not regularly sought or recorded in order to use their feedback to develop and improve.

Individual risks were appropriately identified and managed although the review process needed some improvement.

Staff knew their responsibilities in keeping people safe from abuse. Procedures were in place for staff to follow. The provider had worked with the local safeguarding team when concerns had been raised.

Accidents and incidents were appropriately recorded by staff, action was taken and followed up by the provider.

The procedures for the administration of people’s prescribed medicines were managed and recorded appropriately so people received their medicines as intended. Regular audits of medicines were undertaken to ensure safe procedures continued to be followed and action was taken when errors were made.

Suitable numbers of staff were available to provide the care and support people were assessed as needing. The provider continued to make sure safe recruitment practices were followed so only suitable staff were employed to work with people who required care and support. Staff received training appropriate to their role, their competency was checked to make sure their work met the required standard. Staff told us they felt supported, they received one to one supervision.

The provider carried out an initial assessment with people before they moved in to the service. People were involved in the assessment, together with their relatives where appropriate. Each person had a care plan, the plans contained detailed guidance about people’s choices and preferences. The care plan review process needed to be improved to ensure changing needs were recorded. We have made a recommendation about this.

People with a sensory impairment had a care plan to help guide staff with their support. Advice had not been sought from an organisation specialising in the support of people with a sensory impairment. We have made a recommendation about this.

People’s end of life wishes had been recorded, staff supported people at the end of their lives according to their choices and preferences.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to eat and drink a balanced diet, snacks and drinks were available through the day. People told us they were given a choice of food for their meals. Staff monitored people’s health and referred people to healthcare professionals as needed, following the advice given. People had access to health professionals such as dieticians and opticians to keep them as healthy as possible.

Staff knew people well and people described staff as kind and caring. Staff respected people’s privacy by knocking before entering their personal bedroom space.

People who refused baths and showers on a regular basis were not encouraged to regularly bath.

People had access to various activities. Some people preferred their own company and pursued interests such as reading or watching TV and this was respected by staff. People told us they knew how to complain and were confident that any complaints would be taken seriously.

People knew who the provider was and were able to speak to them when they wished. Staff told us they felt supported by the provider.

All the appropriate maintenance of the premises and servicing of equipment was carried out at suitable intervals. The service was clean and odour free and infection control practices were being used.

The provider had displayed the ratings from the last inspection, in July 2017, in a prominent place so that people and their visitors were able to see them.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.