Ampersand

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The key question of safe was rated inadequate at our last inspection. At this assessment we found improvements had been made in the management of risk and the recruitment of staff. The management of medicines had improved but further improvement was required. The key question of safe is now rated requires improvement. Potential risks to people’s health and welfare were managed and staff understood how to support people safely. There were enough staff to meet people’s needs, who had been recruited safely. Staff understood their role to recognise and report abuse. Accidents and incidents were analysed and used to learn lessons to reduce the risk of them happening again. The service was clean and staff used personal protective equipment appropriately.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were effective systems in place to learn lessons when things went wrong. Accidents and incidents were recorded and analysed to identify patterns and trends. Records confirmed actions had been taken to reduce the risk of the incidents happening again. Meetings held each day discussed changes to people's care and support in response to any accidents or incidents.

The registered manager told us, they discussed lessons learnt from incidents with staff including within the supervisions staff had regularly. Staff confirmed incidents were discussed in handovers and felt supported by the information given. Staff told us, care plans were updated when people's needs changed and staff had access to these changes immediately on the electronic care records.

Relatives told us they had been kept up to date if their loved one has an incident or becomes unwell. They told us, they were encouraged to ask questions and bring up any concerns with the management team and felt comfortable doing this.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were systems in place to report safeguarding concerns to the local authority. The registered manager had reported concerns when needed and had worked with the local authority to reduce the risk of incidents happening again.

Staff enabled people to walk freely in the lounge. One resident moved furniture about. Staff watched them and ensured they were safe and others too. During the assessment we spoke to the staff about this person they told us it was part of the person’s behaviour. They kept an eye on them but they did not restrict them as it could make them agitated.

People told us, they felt safe with staff and were confident and happy to raise any concerns they had with the registered manager or senior staff. Relatives told us their loved ones had not raised any concerns about not feeling safe living at the service. One relative explained how staff knew their loved one well, staff knew how to respond to their demanding and at times challenging behaviour. The relative told us the person was much more settled at Ampersand than when they were in hospital and incidents had reduced.

Staff understood their responsibilities to protect people from discrimination and abuse. Staff told us, " I have a duty of care. I will report any allegation of abuse to the registered manager. I know how to whistle blow to CQC or social services if I need to." Another staff member told us, "I have done safeguarding training and I know the different forms of abuse. If I suspect any abuse, I will take it to the registered manager. They will take it from there – report to the local authority, investigate it and make sure the resident is safe." The management team understood their responsibility to report safeguarding concerns and described how they were working with the local authority to improve the service and support people as safely as possible.

Potential risks to people's health and welfare had been identified and there was guidance in place for staff to manage the risks and keep people safe. The care plans and risk assessments had been regularly reviewed and adapted to meet the person's needs. Care plans contained specific information for the person including when people were living with diabetes or had a catheter in place to drain urine from their bladder.

Relatives told us they had been involved in the development and review of care plans and risk assessments, when people were not able to be. One relative told us, "We get invited to meetings and reviews." Another relative confirmed they had been involved in the person's care since they were admitted to the service. One relative told us they had been pleased with how staff had managed their loved ones dementia care and the risks involved. They felt the staff kept their loved one as safe as possible and had reduced the risks.

We observed staff supporting people to eat their lunch safely when they needed support. Staff understood potential risks to people, for example, one person was encouraged to use their zimmer frame to mobilise safely. One person did not eat their main meal, staff had identified they had not been eating well and offered them their favourite pudding and biscuits which they enjoyed.

Staff were positive about the number of staff available on each shift. One staff member told us, "The number of staff during each shift is enough. Some days are busier than others but we manage ok. Since we have new management the staffing has been much better." Other staff told us, "I feel its enough for the number of residents. There are times of the day that are busy like the mornings and dinner times but we get through it well. Team work helps." Staff confirmed they received regular supervisions, "I get supervisions regularly. I feel well supported in my role. I can speak to any of the managers freely and they listen." One of the nursing staff described how they were supported with their clinical development, "The management are supportive. I can discuss issues with the managers. I go to (name) for clinical support. She provides guidance and support. She supports with my professional development." Staff confirmed they had received training appropriate to their role and the skills required to support people safely. Staff told us they had received an induction when they started at the service including shadow shifts with more experienced staff.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

When we arrived at the service, staff were extremely busy but this quickly changed. During the rest of our onsite visit staff spent time with people. We observed staff sitting with people in the lounge chatting and laughing. There were enough to support people at lunch time with their meals and giving people their meals at the same time so they could eat together. There were always staff in the communal lounge who were available to support people when they needed support.

People generally thought there was enough staff, one person told us they had to wait a short while during busy times. Others told us they thought there were enough staff and staff came when they used the buzzer to call them. Relatives told us there were enough staff, "There are always staff. There is always staff about and they sit in the lounge with people, I can always find someone. They are always the same staff. I know a lot of them by name." Another relative told us, "There's plenty of staff. They are always around; they are very kind and caring no concerns."

Staff were positive about the number of staff available on each shift. One staff member told us, "The number of staff during each shift is enough. Some days are busier than others but we manage ok. Since we have new management the staffing has been much better." Other staff told us, "I feel its enough for the number of residents. There are times of the day that are busy like the mornings and dinner times but we get through it well. Team work helps." Staff confirmed they received regular supervisions, "I get supervisions regularly. I feel well supported in my role. I can speak to any of the managers freely and they listen." One of the nursing staff described how they were supported with their clinical development, "The management are supportive. I can discuss issues with the managers. I go to (name) for clinical support. She provides guidance and support. She supports with my professional development." Staff confirmed they had received training appropriate to their role and the skills required to support people safely. Staff told us they had received an induction when they started at the service including shadow shifts with more experienced staff.

Staff had been recruited safely. There were effective systems in place to complete checks before staff started work at the service, to make sure they are of suitable character to work with people. The registered manager used a dependency tool to calculate how many staff were needed to meet people's needs. Records confirmed the required number of staff had been available to support people on a regular basis and these had been permanent staff. There were effective systems in place to provide staff training and regular supervision to support staff with their development.

The provider had infection control policies in place. The registered manager completed regular infection control audits and spot checks to make sure staff were working within the policies. The registered manager had identified areas for improvement in infection control within the service. These improvements were being put in place including new carpets and towel holders in people's rooms.

People told us they thought the service was clean and their room was cleaned daily. One person told us, "They clean my room and toilet everyday”. Relatives we spoke with did not raise concerns about the cleanliness of the service.

Staff told us they had received training in infection control. A staff member told us, "I have done infection control training. I use PPE and wash my hands. The domestic staff do the cleaning. We put soiled clothes in a red or yellow bag." Another staff member told us, "I have done Infection control training and I follow procedures. Wear my PPE when doing personal care." The domestic staff understood their role to help prevent cross infection including how laundry should be separated and soiled laundry to be washed separately. The registered manager understood their responsibility under infection control and described changes made to improve the environment following audits being completed.

We walked around the service, all areas appeared clean and smelt fresh. The communal lounge was cleaned daily, the furniture was clean and undamaged. People's rooms were clean and tidy. We observed any spillages being quickly cleaned up by the domestic staff. We observed all staff following personal protective equipment guidance including gloves and aprons.

Staff were not always following the correct processes for ordering and administering medicines. There had been no follow up training or competency assessments for staff who had been authorised to administer medicines on behalf of a nurse. Staff were aware of medicines which needed to be given before food and other medicines. However, the medicine charts did not always reflect this, and we could not be assured the medicine was being administered as per the manufacturer’s instructions. There was not a process in place for staff to follow when people were prescribed time sensitive medicines such as antibiotics. During the onsite assessment, a person had not received their antibiotics for 24 hours, as staff had not collected them urgently. The registered manager sent us a copy of the process put in place for staff to follow to reduce the risk of this happening again.

People told us they received their medicines as prescribed. One person told us, "They give me my medication on time and I know what it is for”, another told us, "the staff give me my inhalers and medication I am on oxygen all the time."

Staff told us the new managers were working hard to make positive changes to the service and identify areas for improvement. Staff told us people sometimes went without their medicine as the general practitioner (GP) and pharmacy caused delays despite staff regularly contacting both. One person had missed a days’ worth of medicines at the time of the inspection. It was unclear if people were receiving regular medicines reviews. Staff told us the medical practice pharmacist undertook a review of new people’s medicines over the phone but were not aware if regular medicines were being reviewed. The new clinical lead told us they were reviewing all the care plans and risk assessments and completing competency checks on all medicines trained staff. They had also arranged meetings with the GP practice to address the issues identified above.