Archived: Amberleigh Manor

At our last inspection on 14 October 2015 the service was found to be non-compliant in areas relating to personalised care, including meaningful activities and infection control. This represented breaches of Regulations 9 & 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, the provider told us what action they were going to take. At this inspection we found significant improvements had been made, particularly regarding cleanliness and infection control. Despite some inconsistencies with the provision of activities, the service was now compliant with the regulations..

At the time of the inspection there was no registered manager in post, which had been a long-standing situation, since the previous registered manager had left the service in October 2013. An acting manager had been appointed but was unable to be present on the day of the inspection. 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. In the absence of the registered manager, a newly appointed business manager was present throughout the inspection.

During our inspection, we observed that people were happy and relaxed with staff and comfortable in their surroundings. One person told us, “I think we are looked after very well.” Another person told us, “Yes, we do feel safe, staff make sure that we are well looked after.”

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their manager. Formal personal development plans, such as annual appraisals, were also in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There was a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

Below is a summary of what we found.

Is the service safe?

The manager and staff we spoke with were aware of the correct procedures to prevent and respond to allegations of abuse.

People living at the home we spoke with told us they sometimes heard staff shouting when providing people's care. This was confirmed by staff although it was unclear whether the shouting was directed at anyone.

On our first visit we found some areas of the home were very cold, including two people's bedrooms.

We found that effective systems were not in place to ensure people were protected against the risk of the spread of infection. Personal Protective Equipment, for example aprons, gloves and eye protection was not always immediately available for staff to use. On our first visit the home was not adequately clean and several areas had a strong, unpleasant smell. We found that a mouse had been seen in a communal area of the home and that adequate measures had not been taken to address this problem.

The building was not adequately maintained and some areas were in poor repair. Hazardous substances, for example cleaning products, were not being stored safely and in line with legal requirements.

We found that there were insufficient numbers of care and other staff and that some working hours had been cut which had caused a risk to the welfare and safety of people at the home.

We notified social services about our concerns regarding the people living in cold rooms.

Social services are involved in monitoring and addressing concerns regarding the safety of people receiving care at the home.

Is the service effective?

On our second visit we found that staff had locked the bedroom doors of people at night and that some were unable to unlock them or use a call buzzer if they needed care. This meant people were not fully protected against the risk of excessive or unlawful restraint at the home and had their liberty deprived.

We notified social services about people's bedroom doors being locked. Social services are involved in monitoring and addressing concerns regarding the safety of people receiving care at the home.

Is the service caring?

We found some bedrooms were comfortable and personalised.

Is the service responsive?

On our second visit we found that staff had locked the bedroom doors of people at night and that some were unable to unlock them or use a call buzzer if they needed care. This meant that they may not be able to summon the assistance of staff at the times they needed.

Is the service well-led?

When we inspected the home on the second day of our inspection on 14 October 2014 we found that the provider had increased the numbers and working hours of staff; that the home was clean and smelled fresh and that repairs were being made to the building.

As part of our inspection we spoke with two visiting families, three people who used the service, one student from college and eleven members of staff. We also looked at three people's records and used other methods to help us understand the experiences of people using the service, who because of their complex needs were not able to tell us about their care.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

The provider had taken steps to provide people with a homely relaxing environment. However there were some outstanding fire safety measures since 05 December 2013 that had not been completed. We can confirm that since our visit on 12 June 2014 the provider has sent us information to acknowledge that they are waiting for the fire officers to check the environment as all fire safety actions are now completed.

We saw people were supported by staff that listened and responded to them appropriately. We observed people moving between the two lounges independently or sitting quietly. Staff were visible throughout the lounge areas and were available to help people at all times.

Staff had now been provided with training in the Mental Capacity Act and for the Deprivation of Liberty Safeguard (DoLS). The Mental Capacity Act 2005 (MCA) is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. The manager told us there was one person who needed a Deprivation of Liberty Safeguard. This is where a person is restricted of their freedom and considerations are made in the person's best interest. This was being appropriately managed and involved the appropriate authorities. When this has been completed the information should be sent to us.

Is it effective?

One person told us 'We have a choice of hot or cold drinks and we are always reminded of the menu by staff and we have choices with our meals. The food is always nice here and all the staff are polite, courteous and helpful. If I need to ask for anything staff are always there to help me.'

Another person told us 'There is always a choice if you do not like one meal you are always offered another. The food is cooked here and it is very good'.

The activities coordinator worked with people providing activities on an individual basis and also provided people with group activities during the day.

People at the home who spoke with us, told us they thought staff were helpful and had received training so that they knew what to do help them. This was supported by the relatives who also spoke with us.

One relative told us 'Staff are helpful and respond to my parent's needs. My own parent is unable to follow an activity but they are included when they listen to the music and the general chatter between people and the activities coordinator'.

Staff were provided with the opportunity to discuss any concerns they may have about the service at staff meetings and supervisions were underway.

Is the service caring?

People we spoke with told us they were happy with the care and service they received and they felt their needs were being met. One person told us 'Staff are not too bad here, they treat us right.'

Another person told us they felt safe at the home and all staff were very helpful. They told us 'I like it here and when the hairdresser visits I get my hair done. I find staff speak to me and other people with respect. I have no issues with them. I have a nice bedroom and I have brought in some of my personal belongings from home. My room is kept clean and tidy by the domestics here and the handyman does the repairs. I am treated well.'

We found in the event of an emergency staff received training to deal with transfers to hospital and we saw emergency contact details for management support was available to support staff also.

Is the service responsive?

A complaints procedure was available to people and their family representatives. The complaints policy was displayed near to the entrance of the home so that people would know how to make a complaint. This included what actions the provider would take, the anticipated time scales for a response to the complaint and who else they could contact if the complaint remained unresolved. We spoke with two family members. They told us they would be able to use it if they had any concerns that were not resolved by talking with staff at the time. This meant there was an effective complaints system in place. We saw comments and complaints people made were responded to appropriately.

Is the service well led?

During this inspection, support for the home was being provided by a senior manager and a new deputy manager was appointed to work at the home. We were informed that the registered manager was leaving. It is important to inform us in writing so that our register can be kept up to date about the person in daily charge of the service.

Below is a summary of what we found. To see the evidence supporting our summary please read the full report.

From reading people's care records, we found that, for many people, where they were unable to make informed choices about important life decisions their best interests were not always being fully considered.

We saw evidence on records, and from speaking with staff, that activities provided for people had improved. We found that care plans guided staff to meet people's welfare and safety needs.

We directly observed that systems were in place to reduce the risk and spread of infection. Records we read confirmed this.

From reading people's care records, we found that, for many people, where they were unable to make informed choices about important life decisions their best interests were not always being fully considered. We also found that care plans did not fully guide staff to meet all people's welfare and safety needs.

Although people told us that the premises were kept clean and tidy, we found that not all systems were in place to reduce the risk and spread of infection.

We found that the provider was addressing the risks to people resulting from not having full access to the emergency call bell system.

The relatives we spoke with told us they had noticed increased staffing levels within the previous week and we saw evidence that previous low staffing levels were being steadily addressed.

People felt that their needs were generally met and one relative told us, 'Staff include [my relative] in conversation.' However, one person we spoke with, and those staff we spoke with, felt that more activities could be offered. We also found that care plans did not fully guide staff to meet people's welfare and safety needs.

Although people told us that the premises were kept clean, tidy and hygienic, we found that not all systems were in place to reduce the risk and spread of infection.

The decoration of corridors at the service had been designed to address the needs of people with dementia. However, we found that people could be at risk through not having full access to the emergency call bell system.

The people we spoke with told us they thought there were enough staff to meet their needs. However, we found there were no systems in place for deciding sufficient staffing levels.

Although people felt that their needs were generally met they did feel that more activities could be offered and this view was supported by staff.

People told us they felt safe at Amberleigh Manor. One person's close friend told us, 'Care is very good here'and the carers.' Staff had received training that kept people safe and the people we spoke with felt that staff were well trained to meet their needs. Records we saw supported this.

People were asked for their views, and comments that they made were acted on. One person told us, 'I can't fault them'they look after me.'