Archived: Amber House Residential Home Limited

Amber House is a residential care home that provides accommodation and personal care to a maximum of 18 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 13 people using the service.

Amber House comprises of 2 houses that have been adapted to create 1 home over 2 floors. Amber House has a shared garden, communal dining room, activity room and lounge area, with a shared wet-room and bathroom facilities. The home provides single and shared bedrooms some of which have en-suite bathrooms. There is a lift and stair lift in the home to support access to the first floor.

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

The processes in the home to keep people safe had improved since the last inspection but we found some improvements were still needed to ensure the governance systems in the home were effective in monitoring the quality of service.

Risks to people’s safety were being considered through more regular review. For example, there was now a more robust accidents and incidents process being followed by the staff in the home, to reduce the risk of future occurrence and support improving care delivery.

People’s care plans had been reviewed and updated with more detailed information which meant staff now had access to accurate records to ensure care delivered, met actual need.

Staffing numbers had increased in the home, which meant people’s needs were being responded to in a timely way, which promoted their health and well-being.

Mental Capacity Assessments were now decision specific which meant people were supported to have more choice and control of their lives, staff supported people in their best interests and the policies and procedures in the home supported this.

The provider had acted on our recommendations and made changes in medicine storage and record keeping to support safer medicine management.

Staff training was now up to date and staff were receiving regular supervision.

Feedback from people living in Amber House and their relatives was positive about the staff and the registered manager.

The provider continued to work with other agencies in driving improvements in the home.

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 30 September 2023) 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.

This service has been in Special Measures since 21 August 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of the service on 27 June 2023 where 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; person centred care, need for consent, safe care and treatment and good governance.

We undertook this focused inspection to check the provider 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.

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.

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

Amber House is a residential care home that provides accommodation and personal care to a maximum of 18 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 15 people using the service.

Amber House comprises of 2 houses that have been adapted to create 1 home over 2 floors. Amber House has a shared garden, communal dining room, activity room and lounge area, with a shared wet-room and bathroom facilities. The home provides single and shared bedrooms some of which have en-suite bathrooms. There is a lift and stair lift in the home to support access to the first floor.

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

People told us the home was often short staffed during the day. Staff told us it was sometimes difficult to monitor people’s needs, especially during mealtimes, as there were not always enough staff on duty.

The policies and systems in the service did not always support people to have maximum choice and control of their lives. Staff did not always support people in the least restrictive way possible and in their best interests.

Governance systems in place were not always effective in assessing and monitoring the quality of service to drive improvement.

Care plans and risk assessments were not always updated following an incident or change in need.

Staff did not always receive supervision in line with the provider’s schedules but told us they felt supported in their roles.

Staff mandatory training was not always up to date.

Some areas of non-compliance were being addressed by the provider at the time of our inspection, following an external infection prevention and control audit.

There were some issues identified regarding medicine storage and record keeping and we have made a recommendation to the provider regarding medicine management.

Staff were recruited safely, induction training was in place to support staff to develop the skills, knowledge and behaviours needed to deliver competent care.

People saw healthcare professionals when they needed to and were supported by staff who knew them well.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection

The last rating for this service was requires improvement (published 25 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last 4 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 have found evidence the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this report.

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

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

Enforcement

We have identified breaches in relation to person-centred care, consent, safe care and treatment and governance at this inspection. 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.

We have issued the provider with a warning notice. We will check the provider is taking action to comply

with the legal requirements set out in the warning notice.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect

Amber House is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 18 people in one adapted building, over two floors.

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

People told us they were having to sometimes wait for their care and support as they did not feel there were enough staff deployed in the evenings. Governance systems had been updated but were not yet fully embedded which meant some areas for improvement had not been identified.

People felt safe living at the service. Staff understood how to keep people safe, they were able to manage risks to people’s safety, recognise the signs of abuse and reduce the risk from cross infection. Medicines were administered safely and when things went wrong there were system in place to learn and make changes.

People were supported by staff that had been trained and received guidance in their role. People had access to health professionals and were supported consistently by staff that worked in partnership with other agencies. People had a choice of meals and were having a balanced and healthy diet.

The home had adaptations in place to support people but consideration of the needs of people with dementia was required. We have made a recommendation about adaptations for people living with dementia.

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.

People were supported by staff that were caring and understood their individual needs. People could make choices for themselves and were supported by staff that protected their privacy and were respectful.

People were supported to identify their individual needs and preferences and staff supported people in a person-centred way. Staff were responsive to individual needs and provided opportunities for people to engage in activities of their choice. People and relatives told us they understood how to make complaints. Where needed care at the end of people’s life had been discussed and their future wishes documented.

People, relatives and staff told us they thought highly of the service and the management team. People, relatives, staff and other professionals were asked for their views on the service and these contributed to overall improvement plans. The registered manager understood their responsibilities and encouraged partnership working and a learning environment.

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 19 February 2019) and there were multiple 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 was a planned inspection based on the previous rating.

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.

There is a registered manager in post. The registered manager is also the provider. 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.

Following the last inspection on 7 August 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well led to at least good. We asked the provider to take action to make improvements in relation to staffing, capacity and consent and governance of the home we found these actions had not always been completed.

We found 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; the policies and systems in the service did not support this practice.

The systems the provider had in place were not always effective in identifying concerns in the home. The medicines audit had not identified concerns around unaccounted for tablets and medicines not being on the MAR chart when needed. The audit had also not identified one person was not receiving their medicines as prescribed. Medicines were not always managed in a safe way and staff competency was not always checked in this area. The infection control audit had also not identified concerns with mould. When concerns had been identified we found the action taken had not ensured the home had improved as we found the same concerns had occurred for several months.

The provider sough feedback from people and relatives however this information was not always used to make changes to the home. There was no system in place to ensure staff suitability to work with people. The provider told us when things went wrong in the home they used the information so lessons could be learnt however they were unable to demonstrate this to us during and after our inspection.

When people had behaviours that may challenge there was no clear guidance in place for staff to follow and they offered an inconsistent approach. Other risks to people were considered and reviewed.

Staff had received training in safeguarding and demonstrated an understanding of when people may be at risk of potential harm. There were procedures in place for this. People enjoyed the food and were given the opportunity to participate in activities they enjoyed. When needed people had access to health professional. They were supported by staff they liked and who knew them well. We found people were encouraged to remain independent and make choices how to spend their day. Their privacy and dignity was maintained. Both people and relatives felt involved with their care and this was reviewed when needed.

There were complaints procedures in place and people knew how to complain. The provider notified us of significant events that had occurred within the home and the rating was displayed in the home in line with our requirements. There were sufficient staff to support people.

This is the second consecutive time the service has been rated Requires Improvement.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was completed over two days. The first day was unannounced and second day was announced due to the registered manager being out the country on the first day. The service was registered to provide accommodation for up to 18 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 16 people were using the service. At our last inspection in September 2015, the provider was rated good. At this inspection we found some areas which required improvement.

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. The registered manager was also the provider of the service.

The provider did not always notify us of events which reflected when people were at risk of harm. Not all the staff were able to provide us with the assurance they understood how to protect people from harm and the reporting process. Audits had been completed in some areas, however they had not always identified areas of concerns and therefore the improvements had not been made.

Medicines had been managed safety; however some documentation was not available to provide information to support people who had ‘as required’ medicine. There was not always enough staff to support people’s needs and respond when they required support. The provider had not considered the risks to people at certain times of the day, when other people were having their care needs met.

People’s capacity had been considered, however there was no formalised assessment to reflect how the decision had been made. The information had not considered how the person could contribute to their decision making. Best interests decisions had not been made with the relevant people to ensure the decision was the least restrictive. Some people were deprived of their liberty and the authorisations had been sought from the local authority.

People were able to make their preferences known, which had been documented in the care records. People were encouraged to make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns.

People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained.

Risk assessments had been completed and guidance provided. The provider ensured appropriate checks before people worked at the service. The fire procedures and maintenance had been completed and each person had their own evacuation plan.

We saw people had a choice of food and when required support and advice around health and nutrition had been considered. Support from health professionals was requested and available when needed. We saw that the previous rating was displayed in the reception of the home and following our visit also placed on the website as required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found people using the service were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs or concerns.

We saw the home could demonstrate how arrangements to seek people's consent to care or treatment had been agreed in the person's best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the d'cor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

People told us that care and support was provided by skilled staff who knew their needs well. We found the service was well led because we saw the provider managed risk to the service effectively.