Ami Group - The Knoll Unit and Ami Court Unit

Ami Group is a residential care home comprising of The Knoll and Ami Court Units providing personal and nursing care to up to 67 people. The service provides support to adults who require nursing care. At the time of our inspection there were 64 people living at the service.

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

People told us they felt safe living at the service, relatives confirmed they thought their relatives were safe and safe knew how to support them.

The visiting protocols at the service had not always followed government guidance, not all people were given the option to receive visitors in their room. Before the inspection, people who could leave their room were required to see their visitors outside in sheds or a summerhouse. During the inspection, the registered manager contacted relatives to inform them they could visit in their loved one’s room. We confirmed with relatives after the inspection, they had been admitted to the service for their visits.

Practices within the service did not always promote good infection control or support people’s privacy. During the inspection, the podiatrist completed treatments in the communal lounge, where meals were served and surrounded by other people.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service and website where a rating has been given. The provider had developed their first website but had not displayed the rating for the service. The provider told us they did not know they had to do this. During the inspection, the rating was put on the provider website.

There was enough staff to meet people’s needs who had been recruited safely. Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to reduce risks. Accidents and incidents had been recorded and analysed to identify patterns and trends, the action taken had been effective in reducing the risk of them happening again.

People received their medicines as prescribed, however, records were not always accurate. The registered manager had reported safeguarding concerns appropriately and staff knew when to report concerns.

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 had attended meetings to express their opinions of the service and make suggestions about activities and the menu, which had been acted on.

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 18 December 2019).

Why we inspected

We received concerns in relation to visiting arrangements. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

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

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to Good Governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the registered manager had not always worked in line with national guidance. You can see information about this in the detailed findings. We have signposted the registered manager to current guidance and are assured they will work in line with it moving forward.

We found the following examples of good practice.

¿ The registered manager had implemented procedures to minimise the risk of infection from visitors. There was a garden room where people could meet their family or friends in a safe way. This was external to the main building, meaning visitors did not have to walk through the service. There was a screen in place within the garden room to minimise the risk of COVID-19 transmission.

¿ Staff had a cleaning schedule in place which included additional cleaning of areas such as the door bell, handles, phones and hand held devices. This was completed on a regular basis throughout the day and when items had been used.

¿ Changes had been made to the service as a direct result of the pandemic. Staff wore personal protective equipment (PPE), such as masks, aprons and gloves. There were PPE 'stations' and hand sanitizer around the service to help ensure it was available to staff when needed.

¿ The service provider had engaged in the national COVID-19 testing programme for staff and people who lived at the service.

The Knoll is a residential care home providing personal and nursing care to 18 older people at the time of the inspection. The service can support up to 29 people in one large adapted building.

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

People told us they felt safe living at the service. Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place to mitigate risks. Medicines were managed safely, and people received their medicines as prescribed. Accidents and incidents were recorded, analysed and action taken to reduce the risk of them happening again.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff received training and supervision to develop their skills and meet people’s needs. People’s health was monitored, and staff referred people to healthcare professionals when people’s needs changed. Staff followed the guidance given to keep people as healthy as possible.

People were supported to eat a balanced diet. People had access to activities they enjoyed and were supported to stay as active as possible.

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.

Each person had a care plan containing details about their choices and preferences. People had been involved in developing their care plan. People met with a member of the management team before they moved into the service. People were given information in a way they could understand. People told us they knew how to complain, and any issues were dealt with immediately.

Checks and audits had been completed on the quality of the service and action had been taken when shortfalls had been identified. The registered manager attended local forums to keep up to date with developments to continuously develop the service.

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 6 December 2018) and there were two breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Knoll 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 are looked at during the inspection. The Knoll accommodates up to 29 older people in one adapted building, which included up to 5 people who were receiving short term support and assessment as they had just come out of hospital. At the time of the inspection 25 people were living at the service.

There was a registered manager in post who 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.

The service was last inspected in March 2016 and was rated Good overall. At this inspection, we found two breaches of Regulation, the service is now rated Requires Improvement.

The registered manager was present at the service on a regular basis, but they relied on a team of staff to run the service on a day to day basis. The registered manager did not have oversight of the quality of the service. Checks and audits had been completed, however, the staff completing them did not have the knowledge to know when there were shortfalls and what action to take. The registered manager had not checked the audits staff had completed and had not been aware of the shortfalls present in the service.

Potential risks to people’s health and welfare had been assessed but there was not always detailed guidance for staff to mitigate the risk. People’s care plans had been reviewed but they did not always reflect the care being given. Some care plans did not contain detailed guidance for staff about people’s choices and preferences.

Before people moved into the service, staff completed an assessment of the person’s clinical needs, using referral documents and telephone assessments from health professionals. They did not meet with the person to discuss their needs and check that the service could meet their goals, cultural and social needs.

Medicines were not managed safely. Staff had not received regular training updates, however, staff were observed working within the current guidance. Staff understood their responsibility to keep people safe, the registered manager reported any concerns to the local safeguarding authority.

Accidents and some incidents had been recorded and analysed, however, more detail was required about the action taken to reduce the risk of them happening again. Some areas of the service such as the laundry room were not clean.

Checks had been completed on the environment and equipment to keep people safe. Checks had been completed on fire equipment. Fire drills had been completed, however, staff names had not been recorded and the drills had not been reviewed to assess if any issues needed to be addressed. The Knoll had been adapted to meet people’s needs, however, some areas needed refurbishment.

Staff were recruited safely, there were enough staff on duty to meet people’s needs. Staff received appraisal and supervision to discuss their practice and development needs. People’s health was monitored and referred to health professionals when required. Staff followed the guidance from health professionals to maintain people’s health. People were supported to eat a balanced diet and lead as healthy a life as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to make decisions about their care and support. Staff supported people at the end of their lives.

People had access to a variety of activities which they enjoyed. The provider had a complaints policy and any complaints received were investigated following the policy and resolved.

People were treated with kindness and respect. Staff supported people to be as independent as possible. Staff knew about people’s choices and preferences including their religious needs and supported them to live the lives they wanted.

People were comfortable in the company of the registered manager and people told us the management team were approachable. The registered manager attended local forums and groups to keep up to date. The service worked with other agencies to provide joined up care for people.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall.

The Knoll Nursing Home provides accommodation for 29 older people who require nursing or personal care. At the time of the inspection there were 27 people living at the service.

The service is run by a registered manager who was present during our inspection. 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. The registered manager is supported by deputy managers and a clinical lead, who leads the team of nursing staff across the three services run by the provider.

We last inspected this service on 23 and 24 April 2015 and breaches of legal requirements were found. After the inspection the provider wrote an action plan to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and confirmed that they now met legal requirements.

People told us that they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take keep people safe. Staff were confident to whistle blow to the registered manager or other organisations if they had any concerns and were confident that the appropriate action would be taken.

Risks to people’s safety were identified, assessed and managed. Assessments identified people’s specific needs, and showed how risks could be minimised. When new risks had been identified the registered manager had taken action to prevent them from re-occurring. They had updated risk assessments and passed the information to staff so that people would be safe.

People received their medicines safely and when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. Accidents and incidents were recorded, analysed and discussed with staff to reduce the risks of them happening again.

Recruitment processes were in place to check that staff were of good character. Information had been requested about staff’s employment history, including gaps in employment. However, a full employment history and reasons for any gaps in employment had not been obtained for all staff. We have made a recommendation about this. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff.

People were supported to have a healthy diet. Their dietary needs were monitored and appropriate referrals to health care professionals, such as dieticians, were made when required.

Before people decided to move into The Knoll their care and support needs were assessed by the registered manager to make sure the staff would be able to offer them the care that they needed. People told us that they were happy with the care and support they received. People received their care in the way that they preferred. Care plans contained information and guidance so staff knew how to provide people’s care and support. Staff were familiar with people’s life stories and were knowledgeable about people’s likes, dislikes, preferences and care needs.

People and their relatives were involved with the planning of their care. Care and support was planned and delivered in line with people’s individual care needs. People spoke positively about staff and told us they were supportive and caring. Privacy was respected and people were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Applications for DoLS had been made in line with guidance and were kept under review.

People were involved in activities they enjoyed. This reduced the risk of them being isolated. People, their relatives, staff and health professionals were encouraged to provide feedback to the registered manager about the quality of the service. The registered manager used this to continuously improve the quality of the service delivered. There was a complaints system and people knew how to complain. Views from people and their relatives were taken into account and acted on.

The registered manager and staff carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Safety checks were carried out regularly throughout the building and there were regular fire drills and people knew how to leave the building safely.

The registered manager and management team coached and mentored staff through regular one to one supervision. Staff were clear about what was expected of them and their roles and responsibilities and felt supported by the management team.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people, relatives and the manager.

Is the service safe?

The service was safe. When people had accidents the most appropriate and safe action was taken to make sure they received the treatment they needed. There were systems in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve. Practices in the service protected people using the service, staff and visitors from the risk of harm.

Assessments had been undertaken to ensure that people received safe and appropriate care. The relevant people were consulted with regard to people's mental capacity and the deprivation of people's liberty was taken into account.

People using the service had a care plan which detailed their care and support needs. We saw there was guidance for staff to follow to reduce risks and implement strategies to make sure people were as safe as possible.

Is the service effective?

The service was effective. Care was consistently planned and delivered in response to people's changing needs. People's health and care needs were assessed with them and /or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person's needs.

People who used the service told us that their care needs were met. One person said, 'The staff work really hard, [manager] is a busy bee. They all do their best. I couldn't do it.' Staff support was consistent and structured. A core staff team was used across the three services run by the provider. Staff had the knowledge, skills and competencies to carry out their role effectively and safely because staff were properly trained, supervised and appraised.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

One person who used the service told us, 'If you want anything the staff will get it for you. They are really good. It's a good home.'

Is the service responsive?

The service was responsive. Staff and visitors with whom we spoke told us they felt they would be listened to if they raised any concerns.

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led. There was a clear management structure in place and we saw that there were quality assurance processes in place. Staff told us they were clear about their roles and responsibilities and that they felt well supported by the management team.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People who used the service and their relatives, told us that they liked the home and the staff were polite, respectful and caring. People said there were enough staff to support their needs and that they were able to call them if needed. Visitors said they were confident and satisfied with the service and were able to visit at any time. One relative said, 'I visit every other day and [person] always looks well cared for.' One person using the service commented that the care was good, 'I feel safe'. Another person said, 'I like the food and there is plenty to eat'. We found that people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing. We found that some improvement needed to be made regarding care planning for end of life care as people sometimes went into hospital when it may have been better for them to stay in the home and be cared for.

People said they would prefer it if there was more to do in the home as they found the time went very slowly. An activities coordinator was employed and outside therapists visited the home to provide some activities but there were still long periods of time when people were unoccupied. There was only a small amount of interaction with the staff because they were always busy providing care for people although people said they did stop and have a chat sometimes. There were lots of visitors in and out of the home throughout the day.

There were thorough recruitment processes in the home to make sure the right staff were employed. Staff received training to give them the knowledge and skills to support people and staff we spoke to said they enjoyed their work.

People said that they were happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One person said 'They look after me well here. I have no concerns". Another said "They have all been very good here. I have recently moved in and I like it here". Other people were complimentary of the food and had no concerns re the quality of care.