Ampersand

Ampersand is a residential care home providing accommodation for persons who require nursing or personal care to up to 43 people. The service provides support to older people, some of who lived with dementia. At the time of our inspection there were 35 people using the service, 1 of whom was in hospital during the inspection.

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

The service was not always well led. Records were not always robust and accurate. The provider’s audits and checks had failed to identify issues relating to risk assessments, medicines management, infection control and safe recruitment practice. Their quality monitoring processes had not identified issues with records that we found on inspection.

Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was poor. The provider could not be assured that people had received their medicines as prescribed. Some areas of the service were not clean.

People could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe. We found no evidence that people had been harmed. However, systems were not robust enough to demonstrate staff recruitment was effectively managed. We were not fully assured that staff were deployed effectively across the service. We have made a recommendation about this.

Despite the feedback above, people and relatives told us staff were kind, caring and friendly. Comments included, “They are all very nice and very respectful. They always call me by my name”; “They are excellent, very friendly and kind. They will get me anything” and “I have been here a long time and am used to it. I am happy here. The staff make me feel safe here.”

Staff understood their responsibilities to protect people from abuse. Staff described what abuse meant and told us how they would respond and report if they witnessed anything untoward.

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.

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 26 October 2019).

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. This service has been rated requires improvement for the last 4 consecutive inspections.

Why we inspected

We carried out an inspection of this service on 21 August 2019. A breach of legal requirements was found. 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained 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 Ampersand on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management, infection control, medicines management, safe recruitment practice and good governance at this inspection. We have made a recommendation about staff deployment.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 work with the 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 following examples of good practice.

• People living at the service had individual COVID-19 risk assessments. This was to help identify any issues which might make them more vulnerable and to plan how to support them safely.

• Staff deployment had been modified to minimise the need for staff to move between different areas of the service.

• The layout of communal areas had been adapted to help with social distancing. For instance, tables and chairs in the dining area and lounge had been spaced out where possible.

Further information is in the detailed findings below.

We found the following examples of good practice.

• There were robust procedures in place to support safe visiting. Signage was clear and there was personal protective equipment (PPE) and hand sanitiser for visitors with clear instructions. There was a booking system in place with one-hour time slots and numbers were restricted. Visits took place in the garden, except when people were at the end of their lives, when alternative arrangements were made. The local authority produced guidance for providers on safe visiting. Staff shared this guidance with relatives.

• There was an up to date admissions policy with procedures in place. This included processes such as the need for a negative test for COVID-19 before admission and a 14 day isolation period after admission. During the 14 days isolation people had their temperatures, pulse and oxygen saturation levels recorded daily. The manager told us how they had isolated and barrier nursed people who had been COVID-19 positive.

Ampersand is a residential care home providing personal care to older people and people living with dementia. Some people were cared for in bed. At the time of the inspection, 37 people were using the service. The service had been extended since the last time we inspected. A new wing had been added with 12 bedrooms. The service can support up to 43 people.

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

Medicines had not always been managed safely. Medicines administration records (MAR) did not correspond with controlled drugs records. Some people had run out of their medicines and had gone without essential medicines for several days.

There were systems in place to check the quality of the service. However, the systems to review and check the quality of the service were not always robust, they had not identified the concerns we raised in relation to medicines management. This was an area for improvement.

There continued to be enough staff to keep people safe. The registered manager was able to deploy more staff as and when people's needs changed. Staffing was arranged flexibly. Staff continued to be recruited safely.

Prior to people moving in to the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. People were reassessed as their needs changed to ensure the care they received met their needs.

People felt safe living at Ampersand. Staff had the knowledge and training to protect people from abuse and avoidable harm. People said, “I have lived here a long time, it’s where I am happy. I am safe here” and “I have nothing to complain about, I have my friends and family who visit when they like.”

Risks to people’s safety had been suitably assessed and managed, this was a clear improvement since the last inspection. The service had been maintained to a good standard and was clean and fresh.

Improvements had been seen across the service since our last inspection. The management team and staff had worked hard to make sure people received quality care and support.

People had choice over their care and support, dignity and privacy was respected by staff. People told us staff were kind and caring and treated them well.

People’s needs were appropriately assessed. People had care plans which were up to date and accurately reflected their needs. This was a clear improvement since the last inspection.

People had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable. Activities were also provided for people who received their care and treatment in bed.

People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians. The service worked closely with the GP and other health care professionals who visited the service regularly.

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.

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 25 August 2018) and there were three breaches of regulation. The provider and registered manager had failed to operate effective quality monitoring systems. The provider and registered manager had failed to effectively manage risks. The provider and registered manager had failed to plan care and treatment to meet people’s needs and preferences. 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. However, there was a new breach of regulation.

We have identified a breach in relation to safe management of medicines at this inspection. This is the third consecutive time that the service has been rated as requires improvement overall.

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

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.

Ampersand is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 was not registered to provide nursing care. Any nursing care was provided by community nurses.

The service is one of three care homes owned by Sovereign Care Limited. The service accommodated up to 31 older people. The service is set out over three floors and has a passenger lift, so that people can access all areas of the home. The service is undergoing building works which will eventually add further bedroom capacity, a second passenger lift and a large lounge area overlooking the garden. At the time of our inspection, 27 older people were living at the service, some of whom were living with dementia. Some people had limited mobility and several people received their care in bed.

At the last inspection on 27 September 2017 and 10 October 2017 we rated the service Requires Improvement overall. We found breaches of Regulations 9, 12, 17, 18, 19 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to plan care and treatment to meet people’s needs, preferences and failed to provide activities to meet people’s needs in a responsive or person-centred way. The provider had failed to assess, mitigate and monitor risks to people. The provider had failed to operate effective recruitment procedures. The provider had failed to deploy sufficient staff to meet people's needs and failed to provide training and support for staff relating to people's needs. The provider had failed to operate effective quality monitoring systems and failed to make accurate records. The provider had failed to display the rating.

We also made recommendations. We recommended that registered persons reviewed medicines practice and arrangements in line with good practice guidance about medicines management in care homes. We recommended that registered persons reviewed practice relating to assessing people’s capacity in line with published guidance. We recommended that the provider and registered manager reviewed systems and processes to gather feedback from people about their care. We recommended that the complaints procedure was reviewed and updated to give people all the information they need in order to complain should they need to.

The provider submitted an action plan on 08 January 2018. This detailed that the actions were in progress and would be completed by the end of May 2018 at the latest. At this inspection we found the provider had met some of their actions. However, there continued to be breaches in Regulations. The service has been rated Requires Improvement overall. This is the second consecutive time the service has been rated Requires Improvement.

The service 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 people told us they were happy and enjoyed living at the service.

Risks to people’s safety continued to be poorly managed. People were not adequately protected from the risks of fire. Fire doors were partly blocked by items such as hoists and seated weighing scales which were charging. A fire escape route was blocked by six wheelchairs. Doors to the boiler room were unlocked which meant that people could access boilers and hot water pipes which could cause them harm. The quiet lounge at the front of the service was in the process of being redecorated and turned into a dining room. The doors to the room had not been locked to restrict access. Water temperatures for sinks, baths and showers in the service had not been checked to see if the water was at a safe temperature since we last inspected the service.

Staff had been recruited safely. The provider had obtained a full employment history for new staff. Other pre-employment checks had been carried out. Staff were appropriately supervised. There were sufficient numbers of staff to meet people’s needs and keep people safe. The provider had a dependency tool which was used to assess people’s level of needs. However, the provider and registered manager had not used the information from the tool to assess whether the level of staffing met people’s assessed needs. We made a recommendation about this.

The systems and processes to monitor and improve the service had not been effective in highlighting the issues we found at this inspection.

People’s needs were appropriately assessed. Most people had care plans which were up to date and accurately reflected their needs. Some people who had recently moved to the service did not have care plans or risk assessments to detail what staff needed to do in order to provide person centred care.

There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Staff were confident that any reported concerns would be dealt with appropriately.

Medicines were managed safely. Medicine records were accurate and up to date and people received their medicines on time and when they needed them. Medicine was stored safely and staff had the training they needed to administer medicines safely.

Staff had the skills, training and knowledge they needed to support people safely and effectively. There were opportunities for staff to undertake training and development to enhance their skills.

People were supported to eat and drink healthily and maintain or achieve a balanced diet. Menus were not available in an accessible format to help people living with dementia make informed choices. We made a recommendation about this.

People were supported to manage and monitor their health and had appropriate access to healthcare services when they needed it. When people accessed other services such as going in to hospital they were systems in place to ensure continuity of care.

People were treated with respect, kindness and compassion. People were supported by a staff team that knew them well and understood how to meet their needs. Staff knew how to support people to communicate and express their views. People were supported to maintain relationships with those who were important to them.

People were supported to maintain their independence. People and their relatives were involved in decisions about their support as appropriate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not support this practice. Where people had been assessed as not having capacity to make a decision, a best interests meeting had not been held with appropriate representatives to agree what action would be in the person’s best interests. We made a recommendation about this.

The environment was in the process of being decorated. Signage had been ordered to enable people to navigate around the service.

Staff and the registered manager understood their roles and responsibilities. The provider had a clear vision and values for the service and staff understood and acted in accordance with. The registered manager worked in partnership with other agencies to develop and share best practice.

When things went wrong lessons were learnt and improvements were made. Staff understood their responsibilities to raise concerns and incidents were recorded, investigated and acted upon. Lessons learnt were shared with staff.

People were kept safe against the risk of infection by the prevention and control of infection hazards. Infection control training had been completed by all staff.

People and their relatives gave us mixed feedback about the activities. Activities took place during the inspection. Some people were enabled to access their local community independently and some with support from their relatives and with the staff.

People and their relatives had opportunities to provide feedback about the service they received. People and their relatives knew who to talk to if they were unhappy about the service. No complaints had been received. The complaints procedure required some updating. We made a recommendation about this.

Relatives and staff told us that the service was well run. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.

At our last inspection, the service was rated Good overall.

Ampersand House is a care home providing accommodation and support for up to 31 older people, some of whom have dementia. People in care homes receive accommodation and nursing or personal care as 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 had increased in size by four bedrooms since we last inspected. The service is one of three care homes owned by Sovereign Care Limited. The service is set out over three floors and has a passenger lift, so that people can access all areas of the home. The service is undergoing building works which will eventually add further bedroom capacity, a second passenger lift and a large lounge area overlooking the garden. At the time of our inspection, 27 older people were living at the service, some of whom were living with dementia. Some people had limited mobility and several people received their care in bed.

The service has a registered manager. The registered manager was not available on the first day of our inspection as they were on holiday. A registered manager is a person who has registered with the Care Quality Commission (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. The registered provider was also on holiday on the first day of our inspection.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments had not always been completed to address risks and measures had not been put in place to mitigate risks.

Fire safety procedures within the home were not up to date, this put people at risk of harm if a fire broke out.

Some people’s view and experiences were sought during meetings and through quality assurance surveys. However, a system to ensure that everyone was given an opportunity to feedback was not in place. We made a recommendation about this.

People’s care plans were not complete and were not updated to ensure that their care and support needs were clear and their preferences were known. People were not provided with sufficient and meaningful activities to promote their wellbeing.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always accurate and complete.

The decoration of the home did not follow good practice guidelines for supporting people who live with dementia.

There were procedures and guidance in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff gave people choices throughout the day and helped them to make decisions by using pictures or the best method of communication for the individual. However, capacity assessments did not follow the principles of the MCA 2005.

Some staff had not received all the training they required to carry out their role providing care and support to people. The provider had not always deployed enough staff in the home to meet people’s needs.

The provider did not follow safe recruitment practice. Gaps in employment history had not always been explored to check staff suitability for their role.

Complaints had been appropriately managed, investigated and responded to. Complaints procedures needed updating to give people and their relatives the correct information about who to complain to if they were not happy with how their complaint had been handled. We made a recommendation about this.

Medicines had not always been appropriately managed. One person had not received their prescribed medicine; protocols were not in place to detail when staff should administer as and when required medicines. We made a recommendation about this.

The provider had not displayed the rating on their website or within the home.

The home was clean and tidy, staff had access to gloves and aprons to help minimise cross infection.

Staff were given clear information about how to report abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies. Staff had a good understanding of what their roles and responsibilities were in preventing abuse.

People had choices of food at each meal time. People were offered more food if they wanted it and people that did not want to eat what had been cooked were offered alternatives.

People were supported and helped to maintain their health and to access health services when they needed them.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Staff told us they felt supported by the registered manager. Health and social care professionals gave us positive feedback about the management of the service.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that staff treated people with dignity and respect and supported people to make sure that their health, care and welfare needs were met. People we spoke with were happy with the care and treatment that they received at the home.

We found that people were protected from the risks associated with infection because appropriate procedures were followed by staff. People told us that their rooms and the rest of the home were "Always clean and tidy".

Medicines were kept safely and there were processes to ensure they were received, returned to the chemist and administered appropriately.

There were formal quality monitoring processes in place to ensure the quality of the service people received.