Archived: Amicus Care Home Limited

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.

Amicus Care Home Limited provides accommodation and personal care for up to 18 older people. Some were older people living with dementia, some people had mobility difficulties and sensory impairments. Accommodation is arranged over two floors. The top floor was not in use. There were 12 people living at the home on the day of our inspection.

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 home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our previous inspection on 26 January 2017 we found breaches of Regulations 9, 12, 15, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We received a fortnightly action plan from the provider following the inspection, which detailed what action they had taken to address the breaches.

At this inspection we found that the provider had made improvements to the service, these improvements were still in progress. Further improvements were required to meet the regulations.

Relatives told us their family members received safe, effective, caring and responsive care and the service was well led. Health and social care professionals told us that they had seen improvements, but still had concerns in some areas.

Medicines were not always managed safely. Medicines were stored securely. Some people had not received their medicines as prescribed.

Risks to people’s safety and wellbeing were not always managed to minimise the risks of harm. Risk assessments were not in place for each assessed risk. Risk assessments had not always been reviewed and updated frequently.

There were procedures and guidance in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff gave people choices throughout the day and helped them to make decisions by using pictures or the best method of communication for the individual. However, capacity assessments did not follow the principles of the MCA 2005.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always complete or accurate. The provider had made some improvements to systems. However, these had not been fully embedded, which meant further improvements were required.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known. One person's care plan had been reviewed but the reviewer had not identified that a nutrition care plan was not in place. We made a recommendation about this.

The provider had made some improvements to the environment such as redecorating the corridor and dining room and installing upgraded fire doors to the lounge. Further improvements were required such as replacing carpets in the main hallway.

Effective recruitment procedures were in place to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. Appropriate numbers of staff had been deployed to meet people’s needs. Staff had received training relevant to their roles. Staff had received regular supervision.

The decoration and signage within the home had improved. The provider had followed good practice guidance in supporting people who live with dementia.

People were provided with meaningful activities to promote their wellbeing, some people said they were bored and would like more to keep them occupied.

People had choices of food at each meal time. People were offered more food if they wanted it and people that did not want to eat what had been cooked were offered alternatives.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

People were supported and helped to maintain their health and to access health services when they needed them.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

People had opportunities to provide feedback about the service they received. People and their relatives knew who to talk to if they were unhappy about the service. Complaints had been appropriately managed, investigated and responded to.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Amicus Care Home Limited provides accommodation and personal care for up to 18 people. Some were older people living with dementia, some people had mobility difficulties and sensory impairments. Accommodation is arranged over two floors. The top floor was not in use. There were 13 people living at the home on the day of our inspection, one of these people was in hospital.

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 home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our previous inspection on 23, 24 and 26 August 2016 we found breaches of Regulations 9, 10, 12, 13, 14, 15, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We placed the service in special measures and initiated action against the provider. We received a weekly action plan from the provider following the inspection, which detailed what action they had taken to address the breaches.

At this inspection we found that the provider had made improvements to the service however, these improvements were still in progress.

Relatives told us their family members received safe, effective, caring and responsive care and the service was well led.

The provider had reduced the numbers of people living in the home since the last inspection which had relieved some of the pressure on staff. However, there was not enough staff deployed to meet people’s care and support needs.

At this inspection we found that medicines were not always managed safely. Medicines were stored securely. Most people had received their medicines as prescribed. However, some people had not had their pain relief patches applied as per the prescriber’s and manufacturer’s instructions which meant they were at risk of poor pain control.

Recruitment processes had improved, however improvements were not consistent. Photographs of staff were in place as were references. The provider had carried out their own disclosure barring service (DBS) checks on new staff and volunteers who were working in the home with people to ensure staff were suitable. Gaps in employment history had not been explored for two staff to check their suitability for their role.

Risk assessments had improved. Risk assessments were in place in relation to people’s care needs and safety. Risk assessments did not always detail what action staff should take to reduce the risk to people. One person had been assessed as being at medium risk of dehydration. There was nothing noted in the assessment to detail what staff should do to reduce the risk.

Further improvements were required to the environment such as replacing carpets in the main hallway and covering a radiator in the lounge as this was exposed, which increased the risk of people burning themselves. We made a recommendation about this.

The decoration of the home did not follow good practice guidelines for supporting people who live with dementia.

Some staff had not received all the training they required to carry out their role providing care and support to people.

Complaints had not always been appropriately managed, investigated and responded to.

People were not provided with sufficient, meaningful activities to promote their wellbeing.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Policies and procedures were out of date. The provider had made some improvements to systems however these had not been fully embedded, which meant further improvements were required.

People had choices of food at each meal time. People were offered more food if they wanted it and people that did not want to eat what had been cooked were offered alternatives.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

People were supported and helped to maintain their health and to access health services when they needed them.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff gave people choices throughout the day and helped them to make decisions by using pictures or the best method of communication for the individual.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

People and their relatives knew who to talk to if they were unhappy about the service.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known.

People had opportunities to provide feedback about the service they received. There was evidence that comments made had been acted upon to show that people had been listened to.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the registered manager. They felt they could raise concerns and they would be listened to.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Amicus Care Home Limited provides accommodation and personal care for up to 18 people. Some were older people living with dementia, some had mobility difficulties and sensory impairments. Some people received their care in bed. Accommodation is arranged over two floors. There is a stair lift to access bedrooms and a bathroom on the top floor. There were 18 people living at the home on the days of our inspection.

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 home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider of the service had recently changed their legal entity. The change meant that this was the first inspection for the new provider. However the home had been inspected before. We inspected the home on 02, 06 and 16 March 2015, and rated the home inadequate overall.

At our previous inspection on 02, 06 and 16 March 2015 we found breaches of Regulation 9, Regulation 12, Regulation 13, Regulation 14 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a warning notice in relation to Regulation 12. We asked the provider to meet the regulations by 22 June 2015. We also asked the provider to take action in relation to Regulation 9, Regulation 13, Regulation 14 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found sufficient action had not been taken to resolve these breaches, and new breaches were also identified.

At this inspection people gave us mixed feedback about the service they received. People told us they felt safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Most of the relatives who we spoke with during our visit were satisfied with the service.

Medicines had not been administered, recorded, stored or monitored effectively. People had not received medicines that had been prescribed for them which put them at risk of harm. We reported this to the local authority safeguarding team.

The provider did not have an effective system to assess how many staff were required to meet people’s needs and to arrange for enough staff to be on duty at all times. There was not enough staff deployed to meet people’s care and support needs.

The provider did not follow safe recruitment practice. Essential documentation was not available for all staff employed. Gaps in employment history had not been explored to check staff suitability for their role.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments had not always been reviewed and updated when people’s health needs changed.

Fire escape routes were not suitable for people living in the home, one fire escape was blocked with laundry and one fire escape was not safe to use. We reported our concerns to the fire service.

Several areas of the home smelt of stale urine, the flooring in one of these areas was not suitable.

We were unable to ascertain if all staff had received the training they needed to provide care and support to people as we were not provided with the training records that we had requested. Staff files we viewed contained some training certificates. Staff we spoke with were knowledgeable about subjects such as safeguarding and food hygiene but practice evidenced that they had not received training in all areas to enable them to meet people's assessed needs. Staff did not receive regular supervision and support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had submitted Deprivation of Liberty Safeguards (DoLS) applications for some people, but had failed to reapply for these in a timely manner when these had expired and had failed to meet conditions within these.

Staff had mixed understanding of the Mental Capacity Act 2005, however they could describe and demonstrate how they provided people with choice and respected decisions.

Decoration of the home did not follow good practice guidelines for supporting people who live with dementia.

People did not receive suitable nutrition and hydration that met their needs. People did not always received food and drink in a safe way following guidance that had been given by healthcare professionals. Records did not evidence what action had been taken when people had lost weight. Food stocks were low, staff told us this was a frequent problem.

People had not always been treated with dignity and respect. People’s preferences had not been listened to.

People who were able to voice their own views and opinions were consulted through resident’s meetings. However their views had not always been taken into account. Complaints had not always been appropriately managed, investigated and responded to. Action had not always been taken to resolve issues such as complaints about lack of staffing. The provider’s complaints procedure did not give people the right information about who they could raise concerns with.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. The provider was not aware of the concerns we found at the inspection. Action taken by the provider to make improvements after our previous inspection had not been timely or effective.

Records relating to people’s care and the management of the home were not well organised, adequately maintained or stored securely.

People were not always provided with personalised care. They were not provided with sufficient, meaningful activities to promote their wellbeing.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy did not give staff all of the information they needed to report safeguarding concerns to external agencies.

People’s health needs were not always met quickly so they did not always have access to health professionals when they needed it.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was generally calm and relaxed.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

You can see what action we told the provider to take at the back of the full version of this report.