The inspection took place on 12 June 2018 and was unannounced.

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 rest

We carried out this inspection on 27 September 2017 and 10 October 2017. Both of these dates were unannounced.

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 medic

We carried out this inspection on the 28 September 2015, it was unannounced.

Ampersand is a care home providing accommodation and support for up to 27 older people who may be living with dementia. It is over three floors and there is lift and a stair lift available to access the first floors. At the time of the inspection 24 people lived at the service.

The manager of the service has been in post since February 2015 and is currently applying to become registered. 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.

Medicines were stored, administered and disposed of safely. Only designated staff administered medication, they had received training and their competency to do this had been checked. Audits of medicines made sure people were getting the medicines they had been prescribed.

People were given individual support to take part in their preferred hobbies and interests. There had been an increased range of activities for people living with dementia. However there were no planned trips out of the home, we have made a recommendation about this.

The providers needed to enhance the environment for people living with dementia. Doors were all the same colour, and patterned wall papers were seen around the home. However the provider was aware of the guidance and was considering these points when redecorating the home and building on the extension. Toilets and bathrooms were clearly identified to aid and support independence of people living with dementia.

People demonstrated that they were happy at the service by showing open affection to the staff who were supporting them. Staff were available throughout the day, and responded quickly to people’s requests for care. Staff communicated well with people, and supported them when they needed it.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings with people using the service and their families and annual surveys.

The providers investigated and responded to people’s complaints. People or their family knew how to raise any concerns and were confident that the manager would deal with them appropriately. People and relatives told us they had no concerns.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications were being completed in relation to DoLS, the providers understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the manager or outside agencies if this was needed.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. The providers and staff contacted other health professionals for support and advice.

People were provided with diet that met their needs and wishes. Menus offered variety and choice. People said they liked the home cooked food. Staff made sure that people had plenty of drinks offered through the day. We observed lunch being served and people were happy with their choice. Staff gave appropriate support to people who needed assistance to eat their meal.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one supervision and annual appraisal so they were supported to carry out their roles.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant changes to reduce further harm.

The inspection was carried out by one Inspector and lasted for six hours. We spoke with the registered manager, 2 senior carers, a carer, the activities coordinator, and chatted to five people who lived in the home some of which had dementia.

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.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector, and who was joined by an Expert by

Experience (people who have experience of using services and who can provide that

perspective).

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who were not able to tell us their experiences.

We spoke to fourteen people who live at the home. Everyone said that privacy, dignity and independence were at the centre of the care provided at Ampersand. Comments included, “They treat me with respect. I have no complaints”.

People said that they were provided with choices as part of their daily routine. One person told us, "They always offer you choices".

Everyone told us that they were satisfied with the quality of food that was provided. Comments included, "The food is very good”. People told us that care staff provided the specific support that they needed to eat their meals. One person told us, "I can't chew so they liquidise my meals. They are very helpful".

Although people were not clear about the exact details of the complaints procedure, they knew how to raise any concerns that they may have about the service. People that we spoke to said that they had not experienced or witnessed any form of abuse whilst living at the home.

People said that there were sufficient numbers of care staff on duty throughout the day and night to meet their needs.

People told us that they thought that the care staff team had the necessary skills to meet their needs.

People said they liked living at Ampersand. They said they had visited the home before admission and been involved in discussions about the help they needed and their preferred day to day routines. People said there were different activities to do and that they could join in with activities if they wanted to. They said they were happy with the support they received, that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. They said that the home was always kept clean and smelled fresh. People said they knew who to speak to should they have any concerns, but said they had no complaints.