This inspection took place on 31 July 2018 and was unannounced. This means no-one connected to the home knew we were visiting that day. The home was previously inspected in August 2017 when we found the system used to monitor how the home operated was not always effective in highlighting areas needing attention. We judged the overall rating of the service to be 'Requires Improvement’. We asked the registered provider to submit an action plan outlining how they were going to address the shortfalls we found, which they did.

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

At this inspection we found improvements had been made and the breach of Regulation found at the last inspection had been addressed. A more robust auditing system had been implemented, which meant areas needing improvement had been identified and actioned in a timelier manner. We also found care plans and risk assessments provided better information.

Amphion View 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 home is located close to the centre of Doncaster, with easy access to local transport, shops and other community facilities. It offers en-suite accommodation for up to 35 people who have needs associated with those of older people, including people living with dementia. There were 30 people living at the home at the time of the inspection.

The service had a registered manager in post at the time of 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.

Care and support was planned and delivered in a way that ensured people were safe. People were protected, as any risks associated with their care were identified and appropriately managed. Systems were also in place to safeguard people from abuse.

The process for recruiting new staff continued to be robust, thereby ensuring staff were suitable to carry out their roles and responsibilities in a safe manner. Staff were trained and supported to develop their skills and provide people with the standard of care they required, but some training needed updating.

There was enough staff employed to meet the needs of the people living at the home at the time of our inspection.

Medication was managed safely and administered by staff who had completed appropriate training.

Infection control policies and procedures were in place, with issues identified and many actioned. However, where it involved replacing equipment or upgrading areas this was part of the registered providers environmental action plan.

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 received a varied and healthy diet that offered choice. However, we noted the dining experience some people received could have been better.

Staff supported people in a compassionate, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. All the people we spoke with made positive comments about how staff delivered care and said they were happy with the way the home was managed.

People’s needs had been assessed and care plans put in place to highlight these needs and tell staff how care should be delivered. Care plans had been reviewed periodically to make sure plans reflected pe

This unannounced inspection took place on 9 August 2017. The home was previously inspected in November 2016 when we identified breaches of the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 11 (consent); Regulation 12 (safe care and treatment); Regulation 15 (maintenance and infection control of the premises) and Regulation 17 (governance). We judged the overall rating of the service to be ‘Inadequate’. In response to this we took enforcement action against the provider and the registered manager. We also placed the service into special measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

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

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. Although we saw improvements have been made and the service is no longer in special measures, we saw areas where further improvements are required particularly in relation to good governance to ensure the monitoring systems are fully effective and embedded into practice.

Amphion View care home is located close to the centre of Doncaster. It provides en-suite accommodation for up to 35 people on two floors. Care is provided for people who have needs associated with those of older people, including people living with dementia.

The service had a registered manager in post at the time of 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 and associated Regulations about how the service is run.

On the day of our visit there were 33 people living at the home. The people we spoke with all said they were very happy with the care and support provided.

Staff we spoke with were aware of safeguarding policies and knew the procedure to follow if they suspected abuse. Staff were also familiar with the company’s whistleblowing procedures.

People’s needs had been assessed before they moved into the home and we found they had been involved in formulating care plans. Information in some care files was difficult to access as they were being rewritten and we found some conflicting information in one file. Risk assessments were in place, but they were not always sufficiently detailed to ensure staff could meet people’s needs. However, we found no evidence that these shortfalls had any adverse impact on people.

Medication systems protected people against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration. However, we identified some minor issues that had been identified in an audit in March 2017, but had still not been addressed.

A robust recruitment system had been undertaken, which helped the employer make safer recruitment decisions when employing new staff.

At the beginning of their employment staff had received an induction into how the home operated, and their job role. Staff told us they received essential training and regular support sessions to help them meet the needs of people who used the service. Although we saw there were some gaps in staff training, the registered manager had identified where further training or refresher courses were required. A training plan was underway to ensure staff completed the required training.

Overall the service was meeting the requirements of the Mental Capacity Act and Deprivation of Liberty

Amphion View provides accommodation and residential care for up to 35 people. At the time of our inspection, 33 people were resident at the home.

This inspection took place on 9 November 2016 and was unannounced. The inspection was conducted by two adult social care inspectors.

There was a registered manager in post. 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 responsible for the day to day management of the home and was available throughout the inspection.

At the last comprehensive inspection on 20 and 21 January 2016, we identified the service was not meeting one of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the home did not always ensure the proper and safe management of medicines and did not always effectively assess the risks to the health and safety of service users of receiving the care or treatment. At this inspection, there remained breaches in regulation within these and other areas.

The provider had made some improvements in regard to medicines but was still failing to manage medications safely. Stocks did not always tally with the amount that records said had been administered.

The atmosphere in the home was calm and relaxing. Staff had a good understanding of people's interests, likes and dislikes. People described the staff as kind and caring.

Assessments to identify where people may be at risk of harm or injury did not always ensure that the risk was minimised. Some risks had not been assessed and staff did not have the information available to refer to, if needed, to know how to minimise risks.

People had choices offered to them about what they wanted to eat and drink and were supported to maintain their health and see a GP, for example, if they felt unwell.

Staff had received training and felt this gave them the skills and knowledge they needed to meet people's needs effectively. Staff promoted people's privacy when they were supported with personal care.

People felt staff were kind and had a caring approach to them. People felt involved in making decisions about their day to day care and how they spent their time. There were planned group activities for people to take part in if they wished to do so.

The provider did not have effective arrangements in place to protect people from the risk of harm due to infection. The condition of the premises was poor in parts. The bathrooms we checked were damaged, with broken tiles, damaged walls and unsealed floors. Cleaning records in the dining room indicated that the room had only been cleaned six times in the preceding five weeks.

People’s care plans did not reflect appropriate decision making in accordance with the Mental Capacity Act 2005 (MCA.) The care plans we checked contained a generic document in relation to decision making, but there was little information about specific decisions that had been made for people, or who had contributed to the decision making.

When we inspected this service in January 2016, we found that the provider was not carrying out audits of the service at an appropriate frequency. This meant that failings in the way the service was delivered were not identified. We rated the service “Requires Improvement” in relation to how well led it was. At this inspection, we found that the provider had failed to address this, and audits continued to be ineffective.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not ta

This inspection was carried out on 21 and 22 January 2016 and was unannounced.

Amphion View provides accommodation and personal care for up to 35 people older people, some of whom live with dementia. There were 33 people living at the service on the day of our inspection. At their last inspection in September 2013, they were found to be meeting the standards we inspected.

There was a registered manager in post who had been registered since 2014. 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 and associated Regulations about how the service is run.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome.

People's needs were met in a way that they preferred and they felt they were listened to. Staff knew how to identify and monitor risks to people's health and welfare and respond appropriately. People had choice on how they spent their days and there were activities provided with ties to the local community. There was a good choice and variety of food and people's health was monitored with regular contact with health and social care professionals.

People's privacy and dignity was promoted and they were supported to maintain relationships which were important to them. Staff knew people well and they, along with the registered manager, had a people first approach. There were systems in place to monitor the quality of the service and address any issues that arose. Staff were recruited through a robust recruitment procedure and received regular training and supervision.

There were sufficient staff, with appropriate experience, training and skills to meet people's needs. The service was well managed and took appropriate action if

expected standards were not met. This ensured people received a safe service that promoted their rights and independence.

Staff were well supported through a system of induction, training and professional development. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

The service was not always well-led. Audits and quality systems were in place but were not always completed with regularity. There were other formal quality assurance processes in place. This meant that not all aspects of the service were frequently monitored to ensure good care was provided and planned improvements and changes could be implemented in a timely manner.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One member of staff told us: “To gain consent from people in everything we do is essential.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One member of staff told us: “It’s not just about the tasks, time to talk is important.” One person who used the service told us: “Staff here are lovely.”

People were cared for in a clean, hygienic environment. We noted that the standard of cleanliness observed throughout the premises was good and that the home was free of any offensive odours.

There were enough qualified, skilled and experienced staff to meet people’s needs. One staff member told us: "There are always enough staff to make sure people receive the care they should.”

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We observed staff being respectful and maintaining people’s dignity and privacy. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We saw evidence that peoples likes, dislikes and hobbies were included in the care plans, which enabled staff to relate to people about things that were important to them.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People’s care plans were written in a person centred way.

People were protected from the risks of inadequate nutrition and dehydration. Care plans contained completed individual catering requirement forms. People’s preferences had been documented regarding food, drinks and snacks.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

All staff had completed training on safeguarding and those we spoke to were aware of their responsibility to report concerns.

Staff received appropriate professional development. Staff told us they were well supported by each other and by the management team.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Questionnaires to residents, staff and relatives were sent out annually.

People said that they were very happy at the home. They said the staff were polite, friendly and helpful. One relative told us “My aunt is happy and seems settled. The care workers are pleasant and helpful.” Another relative said “My father has put on weight and he looks much better. He is not an easy person to look after the staff are doing a good job.”

A person spoke to us about when they arrived at the home; they said, “I could choose my room. Everything is fine and they have been very good.”

A relative told us that she felt people could do with more activities as it was difficult to entertain everyone. People told us they would like to go out on day trips.

People said that the home was clean and their clothes were laundered and returned to their rooms by the care staff.

People said to us that they felt there were sufficient staff available to meet their needs. Referring to the staff one person said, “They ask us from time to time about the home. I say this is home from home. I like it here.”

One relative said that they were not aware of the resident and relatives’ meetings and would have attended if they had been informed.

People told us what it was like living in the home; that it was OK and that staff were very kind and caring. Relatives said they were pleased with the care people received and that staff always seemed willing to help. They appreciated being able to look around before their relatives moved in. Relatives commented that all the care staff worked very hard to make sure people were clean and cared for. People told us there always seem to be plenty of staff around when needed.

We asked people if they were able to choose what time they get up and go to bed and about activities during the day. They said:

“Yes I can more or less do as I please”

“I stay up late if there is a film on the television”

“I spend time in my room painting”

When we asked about privacy and dignity, people said

“The staff always knock on my door before they come in”

We asked people if the staff helped them to be as independent as possible. They said:

“The staff help to get ready in the morning and help me get dressed”

“The staff help me a lot”

People living in the home commented on the food and meals provided:

“I really like the food”

“There is always plenty of food”

“The choice at meal times is nice”

I can have something to eat during the night if I am hungry”

We asked people living in the home if they would know what to do if they had a complaint about the home or any of the care staff. People and their relatives were confident about approaching the managers and staff if they needed to do so.