All inspections: Amelia House Care Home

This inspection took place on 6,10 and 24 July 2018. All days were unannounced.

Amelia House Care Home 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. The service is registered to provide accommodation and care for up to 81 older people, some of whom are living with dementia. At the time of our inspection there were 48 people living at the home. The home is divided into three areas: Appleton (general nursing), Bancroft (dementia residential) and Carlton (dementia nursing). The accommodation was on three floors with a passenger lift to connect all areas of the home.

At the last inspection, published February 2018, we found that there were breaches of five of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, safeguarding, staffing, recruitment and the overall oversight and governance of the service. The overall rating for this service was 'Inadequate' and the service was in 'Special measures'.

After that inspection we received concerns in relation to the levels of staffing and the regular use of agency staff and that this was impacting on people’s safety. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Amelia House Care Home on our website at www.cqc.org.uk

At this inspection we found that there were five breaches of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, safeguarding, staffing, nutrition and hydration and the overall oversight and governance of the service.

The service is required to have a registered manager in post. 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 service had a new manager in post, who received confirmation of being registered with CQC during the inspection.

Despite the service being rated as inadequate at the last comprehensive inspection and additional support being provided, the provider has failed to deliver the required improvements to ensure people receive safe care and treatment in line with the fundamental standards. The more serious concerns raised within this report refer to people living on the dementia nursing unit, known as the Carlton Unit.

People whose dementia meant they posed a risk of harm to themselves or others or experienced periods of distress were not provided with the support they required to reduce these risks. This was because risks were not adequately assessed and staff were not provided with the guidance they required to support people.

Medicines were not safely managed and incidents of harm or potential harm were not consistently reported which meant action required to reduce these incidents recurring was not taken.

Staff consistently told us that there were insufficient numbers of staff to meet people’s needs. There was a high number of vacancies and the service relied heavily on agency staff, which resulted in a lack of consistent and stable staff on the dementia nursing unit. Insufficient numbers of staff had a direct impact on the support that people received to eat and drink during meal times.

The systems which the provider had in place to assess the experience of people receiving care had not identified the extent of concerns we observed during our inspection. There had been a failure to rectify the failings identified during our last inspection and this meant people continued to receive inadequate care.

The overall rating for this service remains 'Inadequate' and the service is therefore still in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate enforcement action, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

This inspection took place over five days on 30 November, 4 December 2017, 9 and 31 January 2018 and 1 February 2018. The first inspection day was unannounced and we told the manager we would be returning to the home on 4 December 2017. The third day of inspection was unannounced and was in response to concerns we had received following the previous inspection days. We returned to the service on 31 January 2018 and 1 February 2018 in response to information of concerns we received about the service.

At the inspection in October 2015 we judged the service to be Requires Improvement in Safe and Good in all other areas. There was no breach of regulation at this time but we recommended that staff deployment and the use of agency staff was reconsidered to ensure that staff were always visible in the home.

Amelia House Care Home 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. The service is registered to provide accommodation and care for up to 81 older people, some of whom are living with dementia. At the time of our inspection there were 71 people living at the home. The home is divided into three areas: Appleton (general nursing), Bancroft (dementia residential) and Carlton (dementia nursing). The accommodation was on three floors with a passenger lift to connect all areas of the home.

The service is required to have a registered manager in post and on the first two days of there was a manager in post who had not yet registered with CQC. This manager subsequently left. From the third day onwards there was an acting home manager in post who was not registered with CQC. A registered manager is a person who has registered with CQC 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 this inspection we found that there were breaches of five of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, safeguarding, staffing, recruitment and the overall oversight and governance of the service.

Measures which were required to reduce the risk of harm to people were not in place.

Although the registered provider had systems in place to monitor the care being delivered to people these were not effective in ensuring people were provided with safe care.

Staff recruitment was not consistently robust. We saw one member of staff had been recruited to a senior role despite the registered provider being aware of a poor reference from a previous employer.

Because of our concerns about people's care and treatment during the inspection, we made six individual safeguarding referrals to City of York Council. We will monitor the outcome of these investigations.

The provider had systems in place to protect people from avoidable harm however staff had not consistently followed these.

The provider had not ensured staff received the support, training and supervision they required to deliver effective care.

We saw care staff tried their best to deliver a good standard of care and we saw they were compassionate and kind towards people. However, this was not based on effective leadership, record keeping or management oversight.

Care plans contained conflicting information and monitoring charts associated with care plans were inconsistent so were not an accurate record of care provision. This meant there was no guarantee that people were receiving care that met their current assessed needs.

On the general nursing care and dementia residential care unit it was clear that staff knew people well and this helped them to provide person-centred care.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate enforcement action, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures.

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.

The service is registered to provide accommodation and care, including nursing care, for up to 81 older people, some of whom may be living with dementia. The premises are purpose built and bedroom and communal areas are located over three floors. Each floor is managed and staffed as a separate unit. All of the bedrooms are single and have en-suite facilities and the first and second floors are accessed by a passenger lift.

The registered provider is required to have a registered manager in post and on the days of the inspection there was a manager in post who was not yet registered with the Care Quality Commission (CQC). 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. On 21 October 2015 the manager wrote to us to confirm that they had commenced the registration process.

We saw that staffing levels had increased; more permanent staff had been employed but there was still a reliance on using high numbers of agency staff.

People told us that they felt safe living at Amelia House. We saw that there were appropriate assessments in place to protect people from the risk of harm when staff were assisting them with mobilising and that staff used equipment safely. The premises had been maintained in a safe condition.

We found that people were protected from the risks of harm or abuse because the registered person had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Managers and care staff had attended training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They followed the basic principle that people had capacity unless they had been assessed as not having it. When people lacked the capacity to make decisions, meetings were held to make sure any decisions were made in their best interest. The manager was aware of their responsibilities in relation to DoLS and had made applications to the local authority when someone was considered to be deprived of their liberty.

There were robust recruitment and selection practices in place and we saw that only people considered suitable to work with vulnerable people had been employed. There were systems in place to check each nurse’s registration details to ensure they remained fit to practice.

We saw that staffing levels had increased; more permanent staff had been employed but there was still a reliance on using high numbers of agency staff. We made a recommendation about this in the inspection report.

Staff told us that they were happy with the training provided for them. The training records evidenced that staff were provided with induction training when they were new in post and then on-going training to ensure they had the skills needed to carry out their role.

Staff who had responsibility for the administration of medication had completed appropriate training. Medicines were administered safely by staff and the arrangements for storage and recording were robust.

People’s nutritional needs had been assessed and people told us that their special diets and likes and dislikes were catered for, and that they were happy with the meals provided at the home. We saw there was a choice available at each mealtime, and that staff ensured people were aware of the choices available.

People told us that staff were caring and we observed that staff had a caring and supportive attitude towards people; this was supported by the relatives and health care professionals who we spoke with.

There were systems in place to seek feedback from people who lived at the home, relatives and friends, staff and health care professionals. Any complaints made to the home had been dealt with in line with the home’s complaints procedure and we saw that people were given feedback about the outcome of the complaints investigation.

People who lived at the home, relatives and staff told us that the home was well managed. The quality audits undertaken by the manager and senior staff were designed to identify any areas that needed to improve in respect of people’s well-being and safety. We saw that some improvements had been made as a result of people’s comments and staff told us that any issues were discussed openly so that they could learn from the outcome of investigations.

The inspection took place on the 1 and 7 April 2015. The inspection was unannounced. At the last inspection the service was fully compliant with the regulations we looked at.

Amelia House Care Home provides care for up to 81 older people. It is a purpose built three storey property located in a residential area on the northern outskirts of York.

The home does not currently have a registered manager although a new manager has been employed. 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.

During our inspection we identified two breaches in regulations. This related to the way risks were managed and to medication practices. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe and we saw that staff received training in safeguarding vulnerable adults.

We found that risks were not always appropriately managed which meant that people’s safety may be compromised.

We received mixed views about staffing numbers. People expressed concern regarding the high number of agency staff being used and said that this impacted on care delivery. Although a recruitment drive was in progress the management agreed to ‘block book’ additional staff from an agency until more staff have been employed.

We found that people using the service were not safe because they were not fully protected against the risks associated with use and management of medicines. People did not always receive their medicines at the times they needed them or in a safe way.

We found that infection control practices were not always robust and observed some poor examples of infection control during our visit.

Each person living at Amelia House Care Home had an assessment and care plan. These documents were generally well written and provided detailed information. Some areas did require review and updating.

Staff told us they received induction, supervision and training. Some staff told us they would benefit from additional training particularly in core topics, for example, dementia and supporting people with distressed behaviour.

Mental Capacity assessments had been completed for some people living at the home and some staff had received training in this area. Additional training may be required for the remaining staff.

Staff told us they required additional training in dementia care and training and support in managing distressed behaviour.

The dining experience for people did not always promote good person centred care or a relaxed social opportunity which people could enjoy.

The environment was being refurbished and we were told would be more ‘dementia friendly’. However this work was in the early stages.

We some good examples of people being cared for and some negative ones. We saw people being ignored and we heard people being referred to in a negative manner. We also observed staff who were pleasant, kind and caring in their approach to people.

We found that care was very task focused and that staff did not make the most of opportunities to sit and talk with people. We saw staff knocking on doors before entering people’s rooms and speaking to people politely.

The home had a programme of activities taking place and we saw people engaging in a range of activities.

The complaints procedure was displayed and most people said they would feel confident in raising concerns with the manager. Some people felt that feedback between the manager and relatives could be improved further and it was hoped that more meetings would take place and more information be displayed as some people did not feel that concerns raised were fully addressed.

The home had a new manager who told us they were intending to apply for registration at the service. We received mixed views about the manager; some very positive but some that was less positive.

The home was going through a major period of change which can be unsettling for people living and working at the home. Some people said that they could see improvements yet others felt that this was less evident and they were taking too long.

A number of audits and monitoring systems were being introduced which the manager told us would address some of the concerns raised during our visit.

Two inspectors and a specialist nurse visited the service because concerns had recently been raised with the Care Quality Commission (CQC) about the way people's safety and welfare was being managed at Amelia House.

We could not speak with many people using the service in detail, because of their complex needs, however, those we did speak with told us they were content living at Amelia House. We spoke with four visitors who told us they were satisfied with the care their relative received. One person said 'The care has improved lately. There seems to be more staff. The staff know what they're doing. I think my relative is getting the care they want and need.'

We observed that the care staff were kind, respectful and attentive. People looked cared for and were given assistance with their meals and drinks, when necessary. There was a relaxed and friendly atmosphere in the home.

People were receiving the care and support they wanted, when they needed it.

The risk of harm to people from losing weight, or not drinking sufficient amounts was kept under review. The service had systems in place to support those people identified as 'at risk' of harm from not eating or drinking enough.

People overall were cared for in a clean environment and the service had systems in place to minimise the risk of harm from the spread of infection.

Amelia house provides services for people at various stages of dementia type illnesses. As such we were unable to talk to people meaningfully about their experience of living at the home. We used a number of different methods to help us understand the experiences of people using the service, including talking to relatives, staff and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people.

We observed that staff and service users had positive relationships and people appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in. We saw that staff spoke at a pace which met people's needs and engaged with people in a calm and patient way, which allowed people time to explain what they wanted or where they wanted to go.

We spoke with relatives who were very satisfied with the care and support that was provided by the home. One person said 'the care provided is excellent. I have been involved in decisions about the care provided and communication between me and the home is very good.'

We spoke with six members of staff, who were able to demonstrate a good understanding of the needs of the people who lived at Amelia House. They told us that they were well supported by managers of the home and there were good opportunities for training.

Archived: Amelia House Care Home

All Inspections

6 July 2018

During an inspection looking at part of the service

30 November 2017

During a routine inspection

19 and 20 October 2015

During a routine inspection

1 and 7 April 2015.

During a routine inspection

18 February 2014

During an inspection in response to concerns

16 April 2013

During a routine inspection