This inspection took place on 23 and 24 April 2015, was unannounced and carried out by one inspector and an expert by experience. The expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
The last inspection was carried out on 14 January 2014 and there were no breaches in the regulations.
Ami Court provides accommodation, support and nursing care for up to 38 older people. At the time of the inspection there were 34 people living at the service, which included ten people receiving rehabilitation and support as they had just come out of hospital.
A registered manager was in post, who was also the registered manager for the two other services owned by the organisation. 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.
Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the support they needed to keep them as safe as possible.
Accidents and incidents were recorded but had not been summarised to identify if there were any patterns or if lessons could be learned to support people more effectively to ensure their safety.
Although there were policies and procedures in place, which covered emergency events, there were no plans in place to help people to safely leave the building in an emergency such as a flood.
People’s needs had been assessed to identify the care they needed, however care plans varied in detail to ensure personalised care was being provided. Some care plans lacked clear detail to show how people were receiving the care they needed. People told us they knew about their care plans but there was a lack of evidence to confirm they had been involved in planning their care or had agreed with the care being delivered.
Systems were in place to check the safety of the service but checks had not been completed on the quality of the care people received and on medicines. People were asked for their feedback about the service, but the views of their relatives and health care professionals had not been sought to continuously improve the service.
Policies and procedures were not all in place, for example, mental capacity and deprivation of liability guidelines. Some policies also needed to be updated in line with current legislation.
Records were not always completed accurately.
People told us they felt safe living at the service and would raise any concerns or issues with the registered manager and staff. All staff had been trained in safeguarding adults, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff were aware of the whistle blowing policy and were confident they could raise any concerns with the registered manager or outside agencies if necessary.
Checks were done to ensure the premises were safe, such as fire safety checks. Equipment to support people with their mobility had been serviced to ensure that it was safe to use.
People and relatives told us that there was enough staff on duty. Staff were allocated their duties, on each shift, to ensure the right skill mix and experience of staff to make sure people’s needs were met. Staff received regular supervision and a yearly appraisal to support them in their role.
Recruitment processes were in place to check that staff were of good character to work with people living at the service. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles. New staff received an induction and had access to a range of training courses.
People and their relatives told us that medicines were handled safely. The nursing staff demonstrated good practice in medicine administration by carefully ensuring that the right person received the correct medicines.
People told us the premises were clean and the service was free from unpleasant odours. People told us their rooms were cleaned regular and the standard of cleanliness in the service was good.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Although there was no Mental Capacity and DoLS policy and procedure in place, the manager understood when an application should be made and was aware of the recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. There were no DoLS applications required at the time of this inspection.
People were supported to have a varied and balanced diet. Staff understood people’s likes and dislikes and dietary requirements, and promoted people to eat as independently as possible.
People’s health needs were assessed and monitored, and professional advice was sought when it was needed.
Staff treated people with kindness, encouraged their independence and responded to their needs. People’s care plans were reviewed on a regular basis and people were supported to remain in contact with people who were important to them, such as family members.
People had the opportunity to participate in activities, however some people said these could be improved and there were long periods of time during the inspection when people were sitting in the lounge without any activities and with no television or radio on.
Information about how to make a complaint about the service was given to people and displayed in the service. People and relatives told us that they would raise concerns with the registered manager or staff if they had any issues. They felt confident to make a complaint and that it would be acted on.
There was a statement of quality on display in the service, which outlined the visions and values of the service, such as compassionate care. Staff were aware of these values and demonstrated their understanding of how to achieve this by offering people choice, treating them with dignity and responding to their needs.
Staff and resident meetings were held on a regular basis to encourage people to feedback their views on the service.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.