Archived: Amberleigh

The service provides short break respite care, including accommodation and support, for up to six people at any one time with multiple learning disabilities. At the time of inspection, a total of 18 people received short break respite services at Amberleigh. People stayed at Amberleigh for varying lengths of time; ranging from one night each week to occasional blocks of 14 consecutive nights, depending on their assessed needs and their family’s requirements. Most of the people who used the service had complex learning and physical disabilities with limited or no verbal communication skills. Many of the people required one or more staff members to support them if they went out into the community.

The service had 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.

Responses to the latest relative’s questionnaire showed relative’s felt Amberleigh was providing a good service and there were lots of positive comments, particularly about the staff. The majority of relatives said they were kept well informed and they were able to contact staff and management if they wanted to discuss anything. One person commented “Overall Amberleigh provides an invaluable respite service with the resources available”.

People’s relatives told us the management and staff were very caring. A relative said “Staff are not just there for the money. They are all absolutely lovely, approachable and caring. You can tell they genuinely care”. We observed staff interacted with people in a friendly and considerate manner and respected their choices. Staff were very patient and took time to try to understand people’s wishes and preferences even though they could not express themselves verbally. No one was made to do anything they did not want to.

Relatives told us the service was effective in meeting people’s needs. One relative said “I would say they meet all their needs. All aspects of personal care, bathing and meals. Staff have been trained to do their epilepsy medicines and seizures are dealt with absolutely brilliantly”. Staff received comprehensive training and supervision to ensure they had the knowledge and skills to provide the care and support people needed. The service also worked in close partnership with local health and social care professionals and sought specialist support and advice when needed. This helped to ensure people’s health and wellbeing was maintained.

There were sufficient numbers of staff to meet people’s needs and to keep them safe from avoidable harm. When we inspected there were four people receiving respite care and four members of staff to support them. We observed a member of staff was always available when people needed assistance. Staff had time to engage socially with people as well as meet people’s personal care needs. One member of staff said “On the whole we have a good amount of cover with lots of social stuff regardless of people’s needs. We do things like playing catch, colouring or go out if staffing allows”.

The provider had an effective quality assurance system which ensured the service maintained good standards of care and promoted continuing improvements.

Amberleigh is in the process of transitioning from local authority control to a new social enterprise organisation, along with the other Somerset local authority learning disability services. There is a property development improvement plan for Amberleigh and other services at the Isaacs Close site, this is due to commence in early 2017. The development is a complete new build of accommodation; the plans to achieve the development will necessitate the relocation of services, as a result Amberleigh will be relocating to temporary premises in the New Year.

People’s relatives and staff had been briefed about the changes. The registered manager planned to hold an open day for people, relatives and staff to view the temporary accommodation prior to the move. They said the long term plans for the respite service were under discussion and had yet to be finalised.

A single adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. This summary describes what we observed, what staff told us, the records we looked at and what a relative we spoke with told us.

Is the service safe?

The service was experiencing pressures relating to staffing. We found that staff were under pressure, in particular, due to three staff leaving recently, a staff vacancy and staff sickness. We saw measures were in place to address this, and the situation was being monitored. The measures included the use of relief and agency staff and plans for a local recruitment drive. A relative we spoke with told us they "were happy with the care provided" and would "not allow the person to use the service if they had any concerns", but would prefer better continuity of staff and more activities.

During our visit we had a tour of the service. We looked at the communal areas, bedrooms, kitchen and laundry. We found the environment to be clean and tidy. Records were maintained in relation to infection control. On the day of our visit we saw staff cleaned bedrooms when someone went home. This included the cleaning of mattresses and pillows. Cleaning records were kept for each room. We saw that personal protective equipment was available. For example, disposable gloves. We found the service undertook an annual 'Infection Prevention and Control Programme Audit'. Next due in December 2014.

Records showed staff received training in safeguarding vulnerable adults and children. Safeguarding and whistleblowing policies were in place. Staff we spoke with were able to give us examples of signs they would look for which might indicate possible abuse. Staff were clear about their roles and responsibilities in preventing and reporting abuse. We saw there were posters in each bedroom guiding people who use the service on what to look for and what to do if they had worries or concerns. These were in a format aimed at being suitable for the people who use the service.

People had comprehensive care and support plans, and specific risk assessments in place. We saw reviews had not all been completed in line with the service's policy. We saw up-dates in response to changes were recorded. The manager told us that a review of all care records was underway and would be completed within 6 to 8 weeks.

The manager understood their responsibilities to people using the service in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). We found they were aware of the action they were required to take in order to ensure they responded appropriately to recent changes in the law.

Is the service effective?

We saw that people had access to the specialist support they required during their short respite stays. We saw that information was shared when meetings with professionals were held outside of their visits.

People's support needs, and their likes and dislikes were identified within their support plans. Staff we spoke with could tell us the support people needed to meet their personal care, mobility and social needs. Staff were knowledgeable about people's communication needs.

People had access to a range of activities whilst at Amberleigh, however, this was affected by the amount of staff available.

Is the service caring?

We observed staff interacting with people in a kind and professional manner. We saw they were aware of items which were of significance to an individual, and could give us examples of how they supported people to make choices.

We found systems were in place to share information with people's families and carers, and to provide feedback on how a person's stay had been. A relative we spoke with told us they were pleased with this and found the staff "kind, friendly and professional".

Is the service responsive?

We found that daily records of the care and support were maintained. We saw that people's relatives were required to complete a form on each visit, notifying the service of any changes in the person's health, and their care and treatment needs. We saw records reflected information they had been given.

We saw that people's support needs and their likes and dislikes were taken into account when planning activities. We saw that people using the service had access to a range of activities. Staff told us that at times people's access to activities was reduced, depending on staff availability.

Is the service well-led?

We found a number of quality assurance measures were in place to monitor the service. For example, checks on electrical equipment, fire checks and infection control checks.

People's representative's views on the service were sought. We found that on the admission form there was a quality assurance section. This asked for feedback from family, on the person's last visit. Records showed that discussions had been held to find the most helpful way to gather specific feedback. The manager sent us a copy of the questionnaire which they assured us would be sent out quarterly, from this month.

The service had experienced changes in management over recent years, and the loss of three team members in the last month. Staff concerns had been raised and measures were in place to monitor the situation and to support the whole team.

We saw there was a plan in place to manage a range of emergency situations. For example: in the event of a power failure, pandemic flu and fire. In the event of a staffing crisis guidance was given on the action to be taken.

Support plans were comprehensive setting out the care needs of people and providing clear guidance to staff. There were behaviour support plans and risk assessments so that staff could respond professionally to potential risks to people's health and welfare. The service had identified cultural and religious needs so these could be met effectively. Staff enabled people to make choices about how their needs were to be met.

The service had addressed the shortfalls in the environment which we identified at our last inspection. There were good arrangements for the management of infection and risk of cross infections. However we noted a shortfall in the lack of infection control audits.

Staff were well supported through one to one supervision, team meetings and training. There were comprehensive audits to monitor the health and safety of people using the service. Representatives told us they felt able to comment on the service their relatives received. One told us they had registered a concern and had a "positive response". There were no formal arrangements for the service to seek views from people who used the service and others about the quality of the service.

We observed that people were able to move freely around the home and access the communal areas. Staff engaged with the people well and supported them sensitively. We observed staff provided reassurance with consideration and respect for people. We saw staff were supportive of them and responded to their requests.

We observed the atmosphere of the service was relaxed and informal.

We spoke with three members of staff working at Amberleigh. One staff member told us 'It's a good service; we can make positive changes for people.' Another staff member told us 'Every day here is different, as everyone is an individual.'

We found the lounge, kitchen and dining areas of the home were well decorated, clean and comfortable. We found furniture and fittings to be of a good standard. We saw that the corridor and the floor in one bedroom needed maintenance. We also found that there was no heating in the conservatory which meant it could not be used.

We have made a compliance action requiring the provider to take appropriate action to address these areas.