Amherst Court

Amherst Court is a residential care home providing personal care to up to a maximum of 15 people. The service provides support to people living with a range of mental health needs and some who require support living with Parkinson’s disease, diabetes, and early onset dementia. At the time of our inspection there were 14 people using the service.

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

People lived safely at the service and were protected from harm. Risks to people had been identified, were documented and managed with assessments of risk being reviewed monthly or more frequently if needed. Staff knew people well and were aware of people’s needs. Staff had been safely recruited. Medicines were stored, administered and recorded correctly by trained staff who received regular competency checks. Staff had access to personal protective equipment (PPE) and the service was clean throughout. Any trends, patterns and learning identified following accidents and incidents were shared with staff.

A pre-assessment meeting took place with people and their loved ones before moving into the service. The registered manager made sure that their staffing team had the right training and experience to be able to support people’s needs. New staff went through an induction period and support continued through regular supervision meetings. People were supported to make and keep health and social care appointments. The service was accessible throughout to everyone living there. People’s nutrition and hydration needs were met. 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 supported this practice.

People were treated with kindness, respect and dignity. People’s privacy was respected and any cultural, faith or personal lifestyle choices were acknowledged and celebrated. People were encouraged and supported to be as independent with daily tasks as possible within a safe environment.

Care plans were held on a computer system and daily notes were inputted using handheld devices. Care plans were centred around people, highlighting what was achievable independently before going on to describe support needs. People’s communication needs were met, and staff provided activities to people either 1 to 1 or in small group sessions. Complaints and concerns raised by people and their relatives were dealt with appropriately. Staff had received training in end of life care.

The registered manager was a visible and a supportive presence at the service and everyone we spoke to spoke highly of them and the wider management team. Auditing processes were in place and people, their relatives and staff all had opportunities to provide feedback and suggestions about the service. Feedback was acted on by the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 24 April 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the age of the rating.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice. New people living at the home were provided additional one to one support to help them through the initial isolation period. People who felt anxious about leaving the home when restrictions were lifted, were supported by staff accompanying them on their first trips out. Infection prevention and control audits carried out identified the need to refurbish the kitchen and to convert a bathroom to a wet room. Both of these improvements had been made. Staff were involved daily in a robust cleaning schedule of the entire home.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well led to at least good. This inspection found improvements had been made and the breaches of regulation met.

Amherst Court 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. It is registered to provide support to a maximum of 15 people and 12 people were using the service at the time of our inspection. People who used the service were younger and older adults with mental health needs. Some people may also have alcohol or substance misuse problems.

The service had a registered manager in place. 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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan as stated in their provider information return (PIR), and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Amherst Court has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People were content and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with specific mental health disorders, such as schizophrenia, bipolar and korsakoff disease. Formal personal development plans, including two monthly supervisions and annual appraisals were in place. Staff were supported to become ‘champions’ in areas of care delivery such as infection control, medicines and well-being. People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Support plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People chose how to spend their day. Activities were mixed and people could choose either group activities or one to one. People told us that they enjoyed the theatre and going out to local venues. People were encouraged to stay in touch with their families and receive visitors. The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

We carried out an unannounced comprehensive inspection of this service on 8 and 10 September 2015. Three breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check they had followed their plan and to confirm that they now met legal requirements.

The home had a registered manager. 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 this inspection, we found that some improvements had been made. However, we found the provider had breached different regulations and continued to remain requires improvement in other areas of practice. The provider did not ensure there were enough staff on duty to keep people safe. People were not supported to be involved in their community and there was a risk that people may become isolated. Recruitment practices were not robust and people’s care plans required further development to ensure they were detailed enough. Although the registered manager had made improvements to the quality of care, they were limited in the amount of work they could do in this area because of the lack of support and resources from the provider.

At this inspection, we found the provider had not made any improvements to their recruitment practices. Although most of the appropriate pre-employment checks were completed before staff started working for the provider, there continued to be gaps in the information asked for by the provider.

At the inspection in September 2015 we identified other areas of practice that required improvement to make sure people were as safe as possible. This included assessing and managing the risk to people’s safety, and staff’s understanding of how to report any safeguarding concerns. Individual risk assessment and management practices had improved and each person had a review of the possible risks to their safety. Person centred risk management plans had been put in place. However, the management plans continued to lack enough detail to enable staff to keep people as safe as possible so the provider must continue to develop their practice in this area. Staff had completed training in safeguarding adults and knew how to recognise the signs of abuse and what to do if they thought someone was at risk.

At the inspection in September 15 we found that while care workers demonstrated they had the skills to meet people’s needs effectively, they were not well supported with training, supervision and appraisal. Most training needed refreshing and supervision and appraisals had not been completed regularly. The provider did not have a schedule in place for when this should happen. At this inspection we found the provider had supported and encouraged staff to complete a variety of training. This included safeguarding, medicines management and risk assessment. Staff were also given specific training so they could effectively meet the individual needs of each person. This included supporting people with mental health problems. Staff gave us positive feedback about the training and support they received.

At the last inspection we found the provider’s quality monitoring systems were not accurate, and had not identified areas of practice that required improvement. The registered manager had made improvements to the quality monitoring systems. However, they were limited in the amount of improvements they could make because the provider did not offer enough support or resources to the service. Feedback about the registered manager was very positive but not for the provider. The provider lacked insight into the views of staff and disagreed with their views when we discussed these with them.

At the inspection in September 2015 we found essential risk assessments had not been completed around the home. This included fire and legionella. At this inspection we found the provider had taken action and the risk assessments had been completed. The provider had either completed the necessary work that had been identified in the assessments, or was in the process of doing so.

The registered manager and staff had a good understanding of the Mental Capacity Act (2015) and understood their responsibilities under the Act. Appropriate Deprivation of Liberty referrals had been made and people were asked for their consent in line with legislation.

People were supported to eat and drink enough and food was homemade and nutritious. People gave us positive feedback about the quality of food but there was mixed feedback about whether or not there was enough choice. People were supported to maintain good health and all of the appropriate referrals were made to health care professionals when required. People’s medicines were safely managed, and people were able to self-administer their medicines if they wanted to.

Staff were caring and had a good understanding of the care and support needs of people living in the home. People had developed good relationships with staff and there was a happy and relaxed atmosphere in the home. People had their privacy and dignity protected. Their needs were understood by staff and were met in a caring way. People said they were comfortable to make a complaint, but no one had needed to. Any accidents or incidents that had occurred were well managed by the registered manager.

The registered manager asked for feedback about the service from people and staff. Any feedback received was acted on where possible. There was a complaints procedure in place and the registered manager and staff knew what they should do if anyone made a complaint.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not supported to be involved in their community and there was a risk that people may become socially isolated. There were not enough staff to meet people needs and keep them safe and recruitment practices were not robust. You can see what action we told the provider to take at the back of the full version of this report.

The manager wrote to us with an action plan which told us how these shortfalls would be addressed. This inspection was carried out to follow up on the progress made by the home in relation to these essential standards.

We found that the home now had a maintenance plan which identified when repairs and improvements to the premises would be completed. We saw that significant improvements to the home had been undertaken since 19th September 2013. One person told us, "The new floors in the toilet are nice."

We saw that staffing levels had been increased. We found that this had positively impacted on the quality of cleaning within the home.

We spoke with four people who lived at the home, three staff and looked at three people's care plans.

We saw that people were treated with dignity and respect and involved in their care.

Care plans we looked at were up-to-date and reflected the individual needs of people.

All areas of the home were tidy, most areas were seen to be clean. However, we found that low staffing levels could affect the quality of domestic cleaning.

We found that parts of the home required refurbishment and maintenance.

We saw the home had an effective complaints procedure.

The people we spoke with told us they enjoyed living at Amherst Court. One person said 'I like it here' I would miss my friends and the staff if I left. The staff are kind.' Another person said 'I've had to go into hospital before. I'm very happy to be back now. The girls assist me, and between us we get there.'

The staff we spoke with were knowledgeable about people's needs and what support they required.

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The service had assurance systems in place to monitor the quality of the service provided and to gain the views of the people who lived there.