Archived: Amelia House Care Home

Updated 9 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 6 and 10 July 2018 in response to concerns we had received about the service. Following further information of concern, we attended for a third day of inspection on 24 July 2018. All days were unannounced.

We carried out a comprehensive inspection of this service in February 2018. After that inspection we received concerns in relation to the levels of staffing and the regular use of agency staff. 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

Day one of the inspection was carried out by three inspectors, day two and day three was carried out by two inspectors.

Before this inspection we reviewed the information, we held about the service, such as information we had received from the local authority and notifications we had received from the provider. Notifications are documents that the registered provider submits to the Care Quality Commission (CQC) to inform us of important events that happen in the service. We also considered the action plans submitted by the provider following our last inspection.

During the inspection we spoke with four people who lived at the home, 10 members of staff, five family members/visitors, the deputy manager, the registered manager and the regional manager. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked around communal areas of the home and some bedrooms, with people’s permission. We also spent time looking at records, which included the full care records for six people, who lived at the home and parts of care records for a further six people, the recruitment and induction records for one newly recruited member of staff and other records relating to the management of the home, such as quality assurance and medication.

Updated 9 August 2018

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.