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Inspection carried out on 26 June 2019

During a routine inspection

About the service

Amberley House – London is a residential care home providing accommodation and personal care for up to 30 people aged 65 and over, some of whom may have dementia. At the time of the inspection there were 29 people living at the home. The home is a large adapted detached residential house. There is a well-appointed, large garden to the rear of the property.

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

People told us that they felt safe living at Amberley House. Feedback from relatives was also positive. However, we found significant concerns around how the home was managed, documentation relating to care, cleanliness and ensuring people’s psychological needs were met.

People’s personal risks were not always assessed. Where risks were assessed, risk assessment documents failed to provide adequate guidance to staff. People received their medicines safely and on time. However, we found that systems to safely monitor medicines were ineffective. Staff recruitment was not always safe or consistent.

People’s bedrooms were not always clean, furniture was often unsafe and in a poor state of repair. Whilst the provider took remedial action when this was pointed out, there were not adequate systems in place to identify this prior to the inspection. Infection control was not always well managed.

Staff did not have enough time to spend with people. There was no system in place to ensure that there was sufficient staffing to make sure people were adequately supported in all aspects of their care.

We observed caring and warm interactions between staff and people. However, we also observed interactions that were not as caring where people’s privacy and dignity was not respected.

Care plans were not person centred and failed to give staff guidance on how to work with people as individuals. People were observed to be sitting in the communal lounge with very few activities or stimulation. There were no formalised activity timetable and people were not supported to follow their interests. People did not always have a choice of what they wanted to eat and were not involved in menu planning.

People were not supported to have maximum choice and control of their lives. People did not always have choice around every day decisions such as, what they wanted to eat or if they wanted to go out.

There was a lack of managerial oversight of the home. There were no effective audits of any aspect of care delivery. Documentation, including care plans and risk assessments, were not always up-to-date. There was no deputy manager in post and the registered manager had no support to maintain an effective level of oversight of the home.

Staff understood safeguarding and how to keep people safe from abuse. Staff received regular training to support them in their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rating at last inspection: At the last inspection the service w

Inspection carried out on 8 February 2017

During a routine inspection

This inspection took place on 8 and 9 February 2017 and was unannounced. At our last inspection in December 2014 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Amberley House is a privately owned care home for older people in Enfield. The home is registered to accommodate 30 older people, some of whom may have a diagnosis of dementia. The registered provider had recently opened a new extension to the property.

There was a newly 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.

People told us they felt safe at the home and risks to people’s safety and been identified, acted on and, where possible, were being reviewed with the person.

Staff were aware of their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about the management and told us they appreciated the clear guidance and support they received.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People told us they enjoyed the food and staff knew about any special diets people required either as a result of a clinical need or a personal preference.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff knew about various types of discrimination and its negative effect on people’s well-being. Staff understood that people’s diversity was important and something that needed to be upheld and valued.

Staff demonstrated a good understanding of peoples’ likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes.

They told us they were happy to raise any concerns they had with any of the staff and management of the home.

People we spoke with confirmed that they were asked about the quality of the service and had made comments about this.

People told us the service took their views into account in order to improve.

Inspection carried out on 16 December 2014

During a routine inspection

This inspection took place on 16 December 2014 and was unannounced. At our last inspection in September 2013 the service met all the regulations we looked at.

Amberley House provides accommodation and personal care for up to 16 older people. There are 15 rooms, one of which is a shared room. A large extension to the property has been built and the provider told us that there would be a further 14 bedrooms available from April 2015.

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 and associated Regulations about how the service is run.

People told us they felt safe at the home and safe with the staff who supported them. They told us that staff were patient, kind and respectful.

People and their relatives said they were satisfied with the numbers of staff and that they didn’t have to wait too long for assistance when they used the call bell.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be minimised.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. They told us that if the person could not make certain decisions then they would have to think about what was in that person’s “best interests” which would involve asking people close to the person as well as other professionals.

People and their relatives said they had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians. We met with the local doctor who was visiting the home on the day of our inspection. They were positive about the registered manager and staff at the home.

Food looked and smelt appetising and the cook was aware of any special diets people required either as a result of a clinical need or a cultural preference.

People told us they liked the staff who supported them and staff listened to them and respected their choices and decisions.

People using the service, their relatives and friends were positive about the registered manager and management of the home. They confirmed that they were asked about the quality of the service and had made comments about this. People felt the service took their views into account in order to improve service delivery.

Inspection carried out on 6 September 2013

During an inspection to make sure that the improvements required had been made

At the last inspection on 9 July 2013, we had some concerns that the manager had not implemented their own infection control policy with regards to the standards of cleanliness in the home.

During this inspection we found all areas of the home to be clean and the provider had fully implemented their infection control policy. We also reviewed the maintenance of the property as we had identified peeling wallpaper, exposed walls and broken furniture and fittings during the last inspection. The provider has since undertaken refurbishment of all identified areas, and staff and the manager were documenting regular checks of the home in the maintenance book. Recent reports of gas, electrical and fire safety were available.

Inspection carried out on 9 July 2013

During a routine inspection

People and their relatives told us that staff were respectful and patient. One person's relatives told us the staff were "so caring and very helpful." Another said their relative was "so well looked after."

Care planning and reviews took place regularly with involvement from people, and relatives were regularly involved in this process. We found that the staff understood people's care needs. People had a choice of suitable and nutritious food which was available in sufficient quantities. Recruitment processes were robust and evidence from staff files showed that appropriate checks were in place before care staff commenced working with people who use the service.

Overall, the home appeared clean and staff understood the requirements of their role to reduce the risk of transmission of infections. We had some concerns that the provider had not implemented their own infection control policy with regards to the standards of cleanliness in the home. Thus, we have asked the provider to address this concern.

Inspection carried out on 6 December 2012

During a routine inspection

We looked at the personal care or treatment records of people who use the service, reviewed information sent to us by other organisations, carried out a visit on 6 December 2012 and observed how people were being cared for. We talked with people who use the service, talked with carers and / or family members, talked with staff and talked with stakeholders

We found that the registered manager had acted in accordance with the consent of people who use the service in respect to the care and treatment provided. We also found that the care and welfare needs of the people using the service were assessed and delivered in line with the support need outlined in their care plans.

The premises were found to be of a suitable design and lay out taking into account the needs of the people who use services. In regards to staffing, we found that the provider had sufficient numbers of suitably qualified, skilled and experienced people in order to safeguard the safety and welfare of the people who use services.

We also found that the provider had taken measures to assess and monitor the quality of the service provided.

Having spoken to people who use services and their representatives, we found that people were complimentary about the service provided and spoke positively about their experiences of the home.

Inspection carried out on 31 May 2012

During a routine inspection

The three people spoken with told us that staff involved them in decisions about care and treatment. They received the care and support they needed. One person’s comments were typical when they said, "Staff understand my needs." The four staff spoken with confirmed they were told about the needs of people.

People spoken with confirmed that they trusted staff and felt safe. A person said, “I am safe.” People said to us that staff were available to help them. People told us and we observed that staff listened to them. Staff responded to any suggestions they made about the service.

Reports under our old system of regulation (including those from before CQC was created)