Amberley Care Home

Amberley Care Home is a care home providing accommodation, personal and nursing care and the treatment of disease, disorder and injury. The service can support up to 72 older and younger people, living with dementia, mental health, physical disability and sensory impairment. At the time of the inspection there were 42 people living at Amberley Care Home.

The home is purpose built and provides care across 3 floors. At the time of this inspection the ground floor accommodated people mainly with nursing needs and the first floor was a residential unit for people with a diagnosis of dementia. The top floor of the home remained vacant.

People’s experience of using this service and what we found

Medicines were now managed safely, and competency assessments were carried out to monitor staff performance. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection.

Risks to people were managed by staff following suitable risk assessments. Referrals were made to other services and health professionals when necessary. Systems were in place to safeguard people from the risk of abuse. Staffing levels were sufficient to meet people’s needs and staff were recruited safely. Conditions attached to Deprivation of Liberty (DoLS) authorisations were recognised, recorded in care plans and were being adhered to.

There was a new registered manager in post. They provided leadership to the team and promoted an open team culture. People, their relatives and staff spoke positively of the manager and the changes they had made in a short space of time. They had started the application process for registration with the Care Quality Commission and became the registered manager soon after this inspection. Staff said the registered manager was accessible and supportive. They confirmed they had seen improvements in the quality of the service provided to people and the morale of the team was higher.

Governance systems were in place to ensure oversight and monitoring of the home. The manager responded positively when we highlighted any concerns and recognised systems could be further improved. The manager was aware recent improvements needed to be fully embedded in staff practice and sustained.

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 12 December 2022) 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

This inspection was carried out to follow up on action we told the provider to take at the last 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.

We carried out an unannounced inspection of this service on 13 and 20 September 2022. Breaches of legal requirements were found, and a Warning Notice was served. 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 consent.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, 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, Effective and Well-led which contain those requirements.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amberley 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.

Amberley Care Home accommodates 72 people across three separate floors, each of which has separate adapted facilities. At the time of this inspection there were 51 people living at the care home. The top floor did not accommodate any residents, but the provider was planning to reinstate these beds.

At the time of this inspection the ground floor accommodated people mainly with nursing needs and the first floor was a residential unit. The manager was planning to change this, with nurses on both floors and a specialised wing on the first floor for people living with a diagnosis of dementia.

People’s experience of using this service and what we found

At this inspection, we found improvements had been made in relation to the quality of person-centred care received by people and staffing deployment. However, further improvements were still required in relation to the safe management of medication, infection control, consent and good governance. The provider continued to be in breach of regulations.

We found medicines were not always managed safely across the service. The provider’s internal medication audits had not been effective in identifying the issues and in driving the necessary improvements. Whilst there were processes in place to help manage the spread of infection, these were not always followed by staff. Risks to people's care had been considered and plans were in place to manage these.

We found inconsistencies in the application of the principles of the Mental Capacity Act. There were policies and systems in the service to support staff with this, but practice differed to these.

The service had failed to identify any conditions that were attached to people's Deprivation of Liberty Safeguard (DoLS) authorisations. Due to this, any conditions were not being complied with. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The manager rectified this after the inspection.

Premise checks and maintenance records were up to date. Required test and safety certificates were in place. Processes in relation to responding to a fire had been revised due to a recent fire inspection and the necessary improvements had been rectified.

Staff we spoke with told us they felt better supported in their roles and by the new manager. Training was being completed and further training planned. Supervisions had been completed; staff found these and the daily heads of service meetings beneficial.

People were complimentary about the activities on offer. The home had made links with a charity and a music therapist had started to visit the home. Quality checks and audits were undertaken but these had not identified the concerns we found with medicines, infection control and conditions attached to DoLS authorisations not being complied with. The provider had made little progress since the last inspection in making the home environment more suitable for people living with a diagnosis of dementia.

The home was keen to work in partnership with professionals and organisations for the benefit of people living at the home. The manager collaborated with this inspection, acted on the issues found or outlined the actions that would be taken to address the concerns we identified.

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 17 August 2021) and there were breaches of regulation. The service remains rated requires improvement. At this inspection whilst we found some improvements had been made, the provider remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 see what action we have asked the provider to take at the end of this full report.

We found no evidence during this inspection that people were at risk of harm from the concerns we identified. Please see the safe, effective, responsive and well-led sections of this full report.

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 not changed and it remains requires improvement, based on the findings of this inspection.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of medicines, infection control, consent, and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Amberley Care Home is a care home providing personal and nursing care. The home can support up to 72 people aged 65 and over. The provider had made the decision to keep one floor of the home closed since opening in March 2020.

At the time of the inspection the home could accommodate up to 59 people and 54 people were receiving care and support. Plans were in place to open the second floor of the home.

People’s experience of using this service and what we found

People did not always feel there were enough staff on duty to keep them safe. Staffing levels in relation to care had not increased in line with the number and needs of people using the service. Systems and processes for audit and quality assurance were in place but had not been fully utilised. Areas for improvement had not been fully explored at the time of this inspection.

Communal areas were comfortable, but we did not see these used to their full advantage. Signage and equipment to help support and orientate people living with dementia was minimal. There were no consistent contingency plans in place to replace the absent activity co-ordinator. People told us they were bored on occasions as there was little to do. We have recommended that the provider explores these two areas and makes improvements.

Infection control had been well-managed during the COVID-19 pandemic. The service was clean, spacious and there were no odours. Changes had been made to a lounge environment to ensure people could receive visitors without coming into direct contact with them, when national guidance allowed this. Staff had helped people maintain important relationships with family and friends throughout the pandemic. Families had appreciated the efforts of the home during the COVID-19 pandemic. The service was keen to re-establish partnerships with professionals that had declined during the COVID-19 pandemic.

Premises checks and all maintenance records were up to date. Required test and safety certificates were in place. Systems were in place to protect people from abuse, including safe systems for the administration of medication.

People enjoyed the food on offer. People were complimentary about the care and support provided. People told us that they preferred regular, consistent staff who were more aware of their wants and needs. The meal-time service was more relaxed when catering staff provided assistance. Electronic care plans were informative and guided staff as to people’s care needs and preferences.

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

This was the first rating for the service.

Why we inspected

We undertook this comprehensive inspection to provide the home with a rating and also to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns received about the administration of medicines provided at Amberley Care Home. A decision was made for us to inspect and examine those concerns.

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.

We reviewed the information we held about the service. The rating for the service is requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan for 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.

We found the following examples of good practice.

All visitors registered at reception where they completed a screening questionnaire and had their temperatures taken. At the reception area, visitors had access to personal protective equipment (PPE), sanitiser and handwashing facilities.

The care home had made safe and effective arrangements for people to receive visitors. The home had built a glass “Covid Pod” in the corner of one of its lounges. The pod had a separate entrance from outside where visitors came in. During the visit, people stayed in the main lounge area while relatives stayed in the glass pod. The facility was supported by a two-way intercom and a hearing loop. The pod had to be booked in advance. Domestic staff cleaned the pod between appointments, and it was deep cleaned with a fogging machine overnight.

The care home assessed the infection risk of its facilities and introduced restrictions to help reduce risks and promote social distancing. For example, a maximum of three staff only used the staff room at any one time. Up to two staff or residents used the smoking shelter at any one time. The home had closed a self-contained unit comprised of 13 ensuite bedrooms during the pandemic. This allowed the provider to offer staff overnight accommodation if needed. They also offered rooms to relatives of people reaching the end of their lives.

The home admitted people into the service safely in accordance with national guidance. Following admission, they self-isolated for 14 days. Staff placed a discreet sticker on the door of anyone who was self-isolating or received a positive Covid result. Staff had placed sensor mats in the rooms of self-isolating people prone to wandering to alert them to movements. The home used one-to-one care to mitigate risks further if needed.

Staff had access to a full range of facilities away from the residential units. These included a staff room, a changing room, a shower, lockers and a hairdryer. Staff changed into a uniform when they arrived at work and changed out of their uniforms when they finished their shifts. The home offered staff a laundry service for their uniforms.

The home had two designated infection control and prevention (IPC) champions. The home had developed a comprehensive Covid-19 IPC audit, which the infection control champions completed monthly.

All staff had received additional training on infection control, donning and doffing PPE, handwashing and barrier nursing. The home’s infection control leads used ultraviolet light boxes to complete ad hoc spot checks on hand hygiene and they used ultraviolet torches to complete ad hoc checks on the standard of cleanliness and hygiene in the home.

Staff worked on specific units only. Staff received full pay if they were absent for a Covid related reason. The home used regular agency staff and offered them enough hours of work to help ensure they worked only at this care home.

Further information is in the detailed findings below.