Amethyst Lodge

Updated 22 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

One inspector carried out this inspection.

Service and service type

Amethyst Lodge is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Amethyst Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post since September 2022, but had not yet made an application to register.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

We spoke with two people who lived at the service. We also observed staff supporting people in their day to day lives. We spoke with two senior support workers, and the operations manager. We reviewed three care plans, four medicines records, and documents relating to complaints and incidents in the service. Further records such as governance audits, rotas, and supervision records were sent to us electronically.

We received feedback from two relatives, the local authority quality monitoring officer, one social worker, and a learning disability nurse.

Updated 22 December 2022

About the service

Amethyst Lodge is a residential care home providing accommodation and personal care for adults with learning disabilities or autistic people. The service is registered to accommodate up to four people and there were four people living at the service at the time of the inspection.

People who used the service had their own bedrooms with a separate communal kitchen and lounge. There was also a shared garden area people had access to.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Amethyst Lodge is based in a residential building. It is close to local facilities and externally, there was nothing to indicate it was a registered care home which helped to promote the concept of community living.

Improvements were required to ensure that the premises were designed and decorated in a way that supports autistic people and people with a learning disability, and we have made a recommendation about this.

Staffing levels had sometimes fallen short. There had been a high use of agency staff to cover some shortfalls, but people told us they preferred staff they knew well. The provider had recently recruited five new staff and hoped the use of agency staff would reduce as a result, meaning people will receive care from a consistent staff team. Recruitment processes needed to be more robust to ensure staff were suitable for their roles. The provider had begun implementing more detailed checks and were reviewing all previous recruitment files.

Care records did not always reflect what people's aspirations or longer-term goals were. Some goals were not person-centred. There was limited evidence that people had been involved in creating their care plans.

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 support this practice. However, documentation in relation to decisions that had been made in people’s best interests required review to ensure that people continue to have maximum choice and control over their lives and that the least restrictive option was always considered.

Right Care:

People were taking part in activities of their choosing, including in the community, and with family or friends. Staffing levels sometimes impacted on how long people could be out for as staff needed to return to attend to other clinical duties.

We observed caring interactions between staff and people. Staff told us they cared about the people at the home. The core staff team knew people well and had established positive relationships with them.

Although we observed staff to be effective in supporting people, some staff were overdue refresher training in several subjects.

People received their prescribed medicines by staff who had completed relevant training. People's hydration and nutritional needs were met, and people received a varied diet of their choosing.

Right Culture:

More robust monitoring and auditing checks were required to ensure all aspects of people's care needs and their quality of life were being measured effectively. Several audits which monitored the quality and safety in the service had not been completed in the timeframes set by the provider.

The previous registered manager had left, and there was a new manager in post. However, they had been covering staffing shortfalls, impacting on their time to complete the usual quality checks. As a result, opportunities to identify shortfalls had been missed, such as infection control procedures. Staff told us they liked the new manager and considered that they would be good for the service going forward.

There was no formal feedback documented around people’s views about the service they received. Improvements were needed to ensure that people were consistently supported to provide feedback and to ensure people were fully involved in shaping their support.

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 17 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviewed people’s care records to ensure they reflected the principles of the Mental Capacity Act 2005. At this inspection we found that the provider had made improvements in this area. However, these were not always being reviewed in line with the provider’s own guidance.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned comprehensive inspection. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service remains requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amethyst Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to infection control procedures, care record documentation, and governance at this inspection.

We have made a recommendation about improving the environment.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress, and continue to monitor information we receive about the service, which will help inform when we next inspect.