We carried out a review of the data available to us about Amberley Lodge Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Amberley Lodge Care Home, you can give feedback on this service.
Amberley Lodge Care Home is a residential care home providing personal and nursing care to up to 17 people. The service provides support to older people living with dementia and age-related frailties. At the time of our inspection there were 16 people using the service.
People’s experience of using this service and what we found
People received their medicines by nurses who were trained and competent to administer them safely. Staff mostly practiced good infection control to help protect people from the COVID-19 pandemic, however, a nurse was seen not to wash their hands between administering medicines to people. The registered manager addressed this concern during the inspection.
Quality assurance processes were not always robust to ensure effective managerial oversight of monitoring systems. Audits of care records carried out by the management team had not always identified some inconsistencies in people’s care records. The registered manager rectified the discrepancies during the inspection and told us their plans to further monitor records. Other quality assurance processes were effective in identifying areas for improvement. The management team worked in partnership with professionals to continually learn and develop the service.
People’s health risks were assessed and managed safely. Where people required support with equipment to move and position, staff followed care plans to ensure they were assisted safely. Some people were at risk of choking, risk assessments and care plans detailed how staff should support them with their meals. Professional advice had been followed for people who were assessed to receive a modified diet, for example, pureed food. We observed people being served meals at the correct consistency and staff assisted them in line with their care plan.
People told us they felt safe, their relatives said they felt comfortable to speak with staff or management if they had any worries or concerns. One relative told us, “I feel [person] is safe. I have not had a concern.” Staff received safeguarding training and understood their duty on how to prevent and report potential abuse.
People and their relatives gave positive feedback about the staff. One relative said, “The girls make you feel comfortable, nothing is too much trouble.” One person told us, “They are nice people here, the staff are nice people.”
People’s relatives said they were involved in planning their loved one’s care including life histories for staff to learn about people. One relative told us, “They asked me to bring in photos and were interested in who's who in the family so they can chat to [person] about them. They were interested in finding out about their history. They have really tried to get to know my relative.”
People, their relatives and staff told us they felt comfortable to make suggestions or complain if needed, they were confident the management team would deal with any problems. Relatives told us staff and management kept them up to date with changes to their loved ones. One relative said, “I would thoroughly recommend it to any of my friends. I find it excellent. It’s a very good place to care for people with dementia.”
Staff and the management team worked closely with health and social care professionals to improve people’s care, safety and well-being. Professionals spoke highly of the service. Comments included, “They have lovely care workers there, in [registered manager’s] absence they will contact me too. They are cooperative.” And, “Staff are very caring, I have met everybody now, I have no concerns, nothing to raise a red flag for me.”
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 21 October 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 29 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment and Good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, responsive and well-led.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amberley Lodge Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
The provider had ensured that visiting was facilitated within the home and people were able to maintain contact with their relatives during the COVID-19 outbreak. Visits took place in a designated visiting area and were facilitated in people’s rooms where appropriate. Visitors were guided as to what was required of them on arrival and leaving the service. Visitors were provided with personal protective equipment and undertook a lateral flow test prior to each visit in accordance to current government guidance. People told us staff supported them to maintain contact with their loved ones during the recent outbreak.
People were isolated in accordance with government guidance and staff ensured people were supported to socially distance. Staff understood the impact of isolation on people’s wellbeing and had thought of ways to address this. When people were isolated in their rooms, one-to-one time was utilised to talk or offer person-centred activities such as listening to music or reading the daily newspaper.
Staff and the provider spoke positively of the team’s strengths during the outbreak and how they had worked well together to keep team morale high. One staff member commented, “The support I’ve had has been above and beyond, it felt like they really cared.” Staff had adapted and changed their roles to enable them to support people when colleagues were in isolation and to manage any staffing pressures resulting from the outbreak. This included sharing responsibilities such as cleaning and, when required, the registered manager undertaking the carers role.
The provider had a range of policies to support working practices which were regularly reviewed and updated in accordance with current government guidance. Policies included IPC and coronavirus, admissions and isolation procedures, visiting and vaccination requirements and quality assurance / audit tools.
Amberley Lodge is a care home that provides nursing and personal care for up to 17 people, most of whom are living with dementia. The service is provided in an adapted detached building. At the time of the inspection 17 people were living in the care home.
People’s experience of using this service:
People were at risk of not always receiving a safe service because medicines were not always managed safely and risks to people were not always identified or mitigated. These included risks associated with use of equipment, infection prevention and control measures and choking.
Quality assurance systems, including audits, were not always effective and did not identify some of the shortfalls we found during the inspection, including risk management, medicines management and infection control and prevention.
People were supported by staff who had the skills and knowledge to meet their needs. People's care needs were being met in line with their personal preferences. The service responded when people’s needs changed and worked well with other health professionals who spoke positively about the service.
People were supported to make decisions about their care. Where people did not have capacity to make decisions, legal processes were followed.
Staff felt they were valued and respected by the registered manager who was described as ‘excellent’ and who sought their involvement to improve and develop the service.
Staff were caring, kind and compassionate, and took opportunities to promote people’s independence.
Rating at last inspection: The last rating for this service was good (published March 2017).
Why we inspected: This was a planned inspection. The service was rated Requires Improvement overall. This was based on the findings at this inspection.
Enforcement
We have identified breaches in relation to the management of medicines and risks, infection prevention and control, and good governance. Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re inspection programme. If we receive any concerning information we may inspect sooner.
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Amberley Lodge Care Home is registered to provide accommodation and nursing care for up to 17 people with a variety of health care needs, including dementia. At the time of our inspection, there were 17 people living at the home. Amberley Lodge Care Home is a detached property close to the centre of Worthing with easy access to shops and the seafront. Communal areas included a lounge leading to a conservatory with access to a rear garden. The garden has a sheltered courtyard complete with a seating area. There is an additional small dining/sitting room near the kitchen. All rooms were single occupancy. The ambience was warm and inviting.
The home 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 the last inspection on 3 and 4 November 2015 we identified four breaches of Regulations associated with the premises, staff supervision and training, food preferences and personalised care. Recommendations were also made in relation to improving how staff were deployed and staff training in medicine administration, Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We also recommended the provider improved how they assessed the competencies of staff who administered medicines to people and to review how they monitored the quality of the service provided to people. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider has now met all the legal requirements.
At the last inspection, we observed the premises were not always clean or properly maintained. This was in breach of Regulation 15 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found noticeable improvements had been made to the home environment which had been service user led. This included the widening of corridors and personalised pictures hung in the lounge and throughout the communal areas. The home was clean and tidy throughout, routinely maintained and monitored by the registered manager, therefore this regulation was now met.
At the last inspection, we noted gaps in staff supervision, appraisals and training. This was in breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found staff received regular supervisions, appraisals and training in all relevant subjects to enable them to carry out their role and responsibilities. Therefore, this regulation was now met.
At the last inspection, we found people’s preferences about food choices had not always been considered. We also found some people had not been assessed as needing a specific diet therefore their needs not being met in this area. This was in breach of Regulation 14 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found improvements and actions had been taken by the provider to ensure people were appropriately assessed regarding specific diets and their food preferences considered. Therefore, this regulation was now met.
At the last inspection, we found people did not always receive personalised care that was responsive to their needs. We found some people were at risk of social isolation due to a lack of social activities and stimulation offered to them. We also found care plans failed to reflect how people and their relatives were involved in decisions made about their care and treatment. This was in breach of Regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found improvements and actions had been taken by the provider to ensure people were offered personalised care and this was reflected within their care records. Therefore this regulation was now met.
At the previous inspection we found people’s needs were not always responded to by staff in a timely manner due to how staff were deployed. At this inspection, we observed there were sufficient knowledgeable staff on duty to meet people’s needs.
Medicines were managed safely and only nurses on duty administered medicines to people. The last inspection highlighted nurses' competencies in administrating medicines were not routinely checked. The provider had since taken action and now the necessary checks were in place.
People’s capacity to consent to care was considered and the home worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation to Liberties Safeguards. This included training for all staff on both subjects which was a recommendation at our previous inspection.
Relatives told us their family members were safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk from harm. Staff knew people well and kind, caring relationships had been developed. People were treated with dignity and respect. Staff knocked on people’s doors before entering to promote privacy.
Care plans reflected information relevant to each individual and their abilities, including people's communication and health needs. Staff were vigilant to changes in people's health needs and their support was reviewed when required. If people required input from other health and social care professionals, this was arranged.
People were offered activities to attend within the home. All complaints were treated seriously and were overseen by the registered manager. People and their relatives were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and treatment. Relatives were also encouraged to give their feedback on how they viewed the service. Staff understood their role and responsibilities.
The registered manager demonstrated a 'hands-on' approach and knew people well. They had implemented a range of audit processes to measure the overall quality of the service provided to people and to make improvements.
The registered manager was keen to work alongside external agencies such as the dementia ‘In-Reach Team’ to enhance the lives of people and their families living with dementia. Their achievements had been recently recognised at the West Sussex Care Accolade awards ceremony where they had won the runners up position.
The inspection took place on 3 and 4 November 2015 and was unannounced.
Amberley Lodge Care Home is registered to provide accommodation and nursing care for up to 17 people with a variety of health care needs, including dementia. At the time of our inspection, there were 16 people living at the home. Amberley Lodge Care Home is an older style detached property close to the centre of Worthing with easy access to shops and the seafront. Communal areas include a lounge leading to a sun-lounge, a further small sitting/dining room and a rear garden with a sheltered courtyard area and seating. All rooms were single occupancy.
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.
Premises were not always managed to keep people safe. Some trunking had come loose exposing loose wires in one part of the home and there was extremely poor lighting in the ground floor bathroom. There was only one bathroom available for people to have a shower. An upstairs bathroom had been decommissioned as the bath was unsuitable for people who had limited mobility. Generally, the home was clean and tidy. There were sufficient staff on duty, but they were not always deployed in a way that meant people’s needs were responded to promptly. People felt safe and any risks to them were assessed and managed appropriately. Safe recruitment practices were followed. Medicines were managed safely, although competency checks for staff had not been undertaken.
Staff had received training considered essential to their work, but records were not available to confirm this. Additional training opportunities for staff were available from an external organisation, but not all staff had accessed this. Staff had received at least one supervision in the year, although the provider’s policy stated that supervision meetings should occur every two months. No staff had received an annual appraisal and formal staff meetings had not been planned. However, staff communicated with each other at handover meetings. Care staff had achieved appropriate vocational or professional qualifications and new staff followed the Care Certificate, a universally recognised qualification.
Consent to care and treatment was sought in line with legislation and guidance and staff had received training in this area. However, not all staff had a thorough understanding of the legislation in relation to consent to care and treatment.
People were supported to have sufficient to eat and drink and to maintain a balanced diet. Some people’s preferences with regard to food choices were not always taken account of. Special diets were catered for. People had access to a range of healthcare professionals. Some areas of the home were warm and inviting, however, other areas were starker with narrow corridors and a lack of helpful signage for people living with dementia.
Staff knew people well and kind, caring relationships had been developed. People were encouraged to express their views and staff supported people in a caring and reassuring way. People were treated with dignity and respect. Staff knocked on people’s doors before entering to promote privacy.
People did not always receive care that was personalised to meet their needs. Activities were organised for people and staff tried to involve people in these. However, some people had little mental stimulation during the day or access to meaningful activities. Care plans provided detailed information about people and were reviewed and updated every month. There was a complaints policy in place, however, this was in need of updating. No complaints had been received within the year.
People’s views were obtained through informal means and the registered manager met with people every day to check on their wellbeing. People and their relatives were asked for their views in a questionnaire. However, this referenced the CQC fundamental standards and would not have been easily understood by the majority of people. Generally, people and their relatives felt the home was well-run and staff felt supported by management. There was a range of audits in place to measure the quality of care delivered, including environmental checks. However, the environmental checks were not always effective in identifying areas of concern such as cleaning and maintenance issues.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.
We spoke with the manager and the provider, two nurses, two care staff, the chef, the housekeeper and the cleaner. One member of staff told us that the strength of the Amberley Lodge was that 'it is like a family home.'
We reviewed care records for three people using the service. We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans updated to reflect a person's current needs.
People had a varied diet and were given the support and encouragement they needed to eat and drink.
People were protected from the risk of the unsafe management of medication because staff were trained, procedures were in place and audits undertaken.
There were effective systems in place to ensure people were safe because staff were subject to rigorous recruitment procedures and a thorough induction.
During our visit we spoke with two people who used the service however due to the nature of their disability conversation was limited; and three members of staff and the proprietor. We also spoke with a General Practitioner. We spent time observing how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.
All the people we saw looked happy living at Amberley Lodge Care Home. People told us that it was a nice place, and that the staff were good. One person said the food was good and another said they always get a lot of vegetables and that they were 'very lucky'. A General Practitioner who was visiting the home told us they did not visit the home often but thought the home was not bad and that the staff team was a good.
We saw that care plans were person centre and people's care assessments looked at people's goals and the support they required. Care plans had details of people's likes and dislikes.
We spoke with three members of staff who were on duty. They demonstrated they knew about the level of care that each person required. They also told us they were well supported by the manager.
We spoke with the provider who explained how the quality of service provision has been assessed and monitored.