Archived: Amberley Court Care Home

Amberley Court Care Home is a care home providing personal and nursing care to up to 62 people. The service provides support to younger and older adults and people with a physical disability. At the time of our inspection there were 42 people using the service

Amberley Court Care Home accommodates people across 2 floors of the purpose-built building. People had access to lounges, a dining area as well as an enclosed shared garden. The service was going through a number of refurbishments to improve the living environment for people.

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

People were supported by safely recruited staff who had received training in how to support them safely and effectively. Staff were aware of their responsibilities to report and act on any accidents and incidents that took place in the home. People were supported to receive their medication as prescribed by their doctor.

People’s physical and mental health needs were assessed on admission and care plans put in place which provided staff with the information they needed to meet people’s needs and support them in the manner they wished to be supported. People were offered choices at mealtimes and when feedback was received regarding menu choices, people’s views were taken on board and actions were taken.

People were supported to access a variety of healthcare services to assist them in maintaining good health.

Staff presented as kind and caring and respected people’s privacy and dignity. People were involved in the planning of their care and their views of the service were sought.

People were supported by staff who knew about their individual needs and preferences. Activity co-ordinators were in place to support people to take part in activities that were of interest to them and to access the community. Further work was underway to gather more details about what people would like to do and how the service could support them to enjoy those activities.

Plans were in place for a major refurbishment of the home and people were involved in the process and excited to see the changes that were planned to take place.

Staff felt well supported and were complimentary of the new registered manager and the deputy. There were a variety of quality audits in place to provide the registered manager with oversight of the service. The service continued to work alongside a variety of healthcare professionals in order

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 19 March 2020) 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

The 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.

Follow up

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

Amberley Court Care Home is a residential care home providing personal and nursing care to 47 people. The service supports younger and older people, some with a physical disability, brain injury or disorder. The service can support up to 62 people.

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

Systems in place to ensure people received their medicines as prescribed were not consistently followed, resulting in people being at risk of their medicines not being effective. Some medicines had not been stored at the correct temperature, resulting in them being destroyed.

The new manager had the support of a management team and a number of systems and processes were in place to assess, monitor and improve the quality and safety of the services provided. However, staff were not routinely following all of these processes and audits that were in place had failed to identify a number of areas for action. Systems were in place to record and act on accidents and incidents, but these were inconsistently recorded which meant opportunities could be lost to learn lessons from events.

People’s views of the service were not routinely sought and where people had raised concerns, although they felt listened to, they were not confident that action would be taken to address the concerns raised.

Staff did not always keep people’s confidentiality and privacy and dignity was not always maintained.

Staff had received training in how to recognise signs of abuse and where safeguarding issues had been raised they had been reported, investigated and acted on. Staff were aware of the risks to people, but not everyone spoken with felt safe in the home, particularly when supported by agency staff. Risk assessments did not always provide staff with the information they needed to manage risks to people.

There were several staff vacancies which were covered by agency staff. Recruitment was on-going, and a number of permanent appointments had recently been made. There was a dependency tool in place to assess staffing levels, but despite this, people did not always feel staff responded to their needs in a timely manner.

Staff felt well trained and supported in their role, particularly by the new manager and had recently undergone a period of refresher training. Staff had not received formal supervision for some time but were aware the new manager was making arrangements to rectify this and felt they could approach them to discuss any concerns they may have.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff obtained people’s consent prior to supporting them but were not aware of authorisations in place to lawfully deprive people of their liberty. Systems in place to monitor these applications were not effective and a number had expired and had to be reapplied for.

Concerns remained regarding staff respecting people’s privacy and dignity and maintaining confidentiality. People were supported to be involved in decisions regarding their day to day care but were not consistently involved in the planning of their care. People complained at the lack of activities made available to them. Efforts were being made to introduce a variety of activities that would be of interest to people. People told us they would like to access the community more often.

Staff were aware of people’s health care needs and people were supported to access a variety of healthcare services to help maintain good health. Overall, people enjoyed the food on offer and where appropriate, support was offered at mealtimes.

People were supported to make decisions about their care and encouraged to maintain their independence where possible.

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 good (published 15 April 2019)

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines, and management of care. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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.

Enforcement

We have identified breaches in relation to Regulation 12 regarding the management and administration of medicines, Regulation 10 with regard to dignity and respect and Regulation 17 relating to the management and oversight of the service.

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

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.

Amberley Court Care Home is a residential care home that is registered to provide care and accommodation for a maximum of 62 people who require nursing care. People using the service are younger adults, some with a physical disability, brain injury or disorder. 46 People were using the service at the time of the inspection.

People’s experience of using this service:

Staff did not always keep people’s confidentiality and privacy and dignity was not always maintained.

People were supported to have choice and control over their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff to remain safe. There were enough staff available to people and people’s needs were attended to in a timely manner. Risk assessments were in place to minimise any potential risk to people’s wellbeing. Staff were recruited in a safe way. People received their medicines as expected.

People felt that staff assisting them knew their needs. Staff received training and had been provided with an induction, and felt able to approach the registered manager with any concerns. Meals were nutritious and people were kept hydrated. People were supported to maintain their health.

People's care plans reflected their needs and preferences and staff could explain specific care that people required. Complaints were dealt with appropriately in line with the complaints procedure. People participated in activities that were tailored to their needs. End of life plans were in place and acknowledged by staff.

Quality monitoring systems included audits, checks on staff practice and checks on people’s satisfaction with the service they received, using questionnaires. The provider had systems in place to ensure they kept up to date with developments in the sector and changes in the law. People knew the registered manager and felt they were visible around the home and were approachable.

Rating at last inspection: The rating for the service at our last inspection was ‘Requires Improvement’ with our last report published on 23 August 2017.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets. At the last inspection the key questions around Safe, Caring and Well led were rated ‘requires improvement’. This was due to concerns around staffing and staff knowledge around safeguarding procedures, lack of confidentiality and respecting people's wishes and lack of consistency in management and staff's response to this. At this inspection we found that some issues around confidentiality and staff members responses to people remained, but other concerns had been resolved.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Amberley Court Nursing Home provides accommodation, nursing and personal care for up to 62 people with physical disabilities. There were 49 people living at the service at the time of our inspection.

There was 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.

People were supported by staff who had received training in how to recognise signs of abuse but not all staff were aware of their responsibilities to report concerns in a timely manner. Staffing levels across the home were based on people’s dependency levels but staff sickness was having an impact on people’s care needs being met in a timely manner.

New staff rotas and allocation systems were in place to address concerns raised to ensure people’s care needs were safely and effectively met.

Where accidents or incidents had taken place, action was taken and lessons were learnt. People were supported to take their medicines as prescribed by their GP.

People were supported by staff who received a comprehensive induction which provided them with the skills they needed to meet the needs of the people they supported. Staff were given the opportunity to discuss any concerns they may have at supervision and staff meetings.

Staff had access to training and additional training was sought to improve staffs learning in a variety of areas.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to have sufficient amounts to eat and drink and access healthcare professionals to ensure their health and well being.

There was a lack of confidentiality across the home which was a concern to both people living at the home and staff alike. People were supported by staff who they described as kind and caring but not all felt they were treated with respect.

People were involved in the planning of their care. Staff were aware of people’s interests and hobbies and what was important to them. Plans were in place to recruit additional staff to support people to pursue activities that were of interest to them.

People’s opinion of the service was regularly sought and people told us they felt listened to. Where complaints had been received, they were investigated and acted upon.

Changes introduced by the registered manager to improve the quality of service were welcomed by the people living in the home and staff were aware of her vision for the service.

There were a number of quality audits in place to assist the registered manager in identifying any areas of improvement within the home. Where concerns had been raised, lessons were learnt and actions put in place to rectify issues.

Amberley Court Nursing Home provides accommodation, nursing and personal care for up to 62 people with physical disabilities. The service had 15 Enhanced Assessment Beds (EAB). These beds are allocated to people who have been discharged from hospital but need extra support before they return home. There were 57 people living at the service at the time of our inspection.

There was a new manager in post who had not yet registered with the Commission. 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 were supported by staff who had been trained in how to recognise signs of abuse and were aware of what actions they should take should they suspect someone was at risk of harm. Staff were aware of the risks to people on a daily basis and how to manage those risks. Where accidents or incidents had taken place, action was taken and lessons were learnt.

People were supported by sufficient numbers of skilled staff who had been recruited safely. People did not always receive their medicines as prescribed.

Staff benefitted from an induction that prepared them for their role and received training that provided them with the skills they needed to meet the needs of the people they supported. Staff had not regularly received supervision and were not given the opportunity to formally discuss their learning and any concerns they may have.

People were supported by staff who obtained their consent prior to supporting them.

People were supported to have sufficient amounts to eat and drink. People’s dietary needs and preferences were adhered to.

People’s healthcare needs were met and they were supported to access a variety of healthcare professionals to ensure their health and wellbeing.

People were supported by staff who were kind and caring but people’s dignity was not always respected. People were supported to make their own decisions and to maintain their independence.

Staff were aware of people’s interests, how they wished to be supported and what was important to them. Plans were in place to provide more support to people to pursue activities that were of interest to them. People were aware of how to make complaints and where complaints had been raised, they were investigated and actions taken.

Changes in management had created a period of unsettlement at the service and not all staff were fully on board or aware of the manager’s vision for the service. The manager was praised by staff for her commitment to the people living at the service.

There were a number of quality audits in place to identify any areas of improvement that were required within the service. Where areas where identified, action plans were put in place to address any issues.

People were supported to access other health and social care services that they needed and the provider worked in co-operation with others involved in people's care and treatment.

The home was purpose built and the premises were suitable for the needs of the people who used it. Each person had a room of their own with a toilet and wash basin ensuite. Bathrooms were accessible and there were a range of communal rooms and accessible outside space for people to enjoy. Plans are in progress to improve the therapeutic and leisure facilities available at the home.

People were not put at risk of harm from unsafe or unsuitable equipment. Equipment including people's personal equipment was kept in good order and regularly inspected and tested. People told us: 'They have got the electric beds now, which is great" and 'They have arranged for me to have a new wheelchair because this one keeps breaking, I'm just waiting for it to arrive.'

People had their health and welfare needs met by sufficient numbers of appropriate staff. Nursing staff were supported by care assistants and the home employed a range of ancillary staff and also activities coordinators.

We found that people's needs were assessed and people had plans of care that were individual to them and addressed their needs. People told us that they were well looked after. One person said " I'm very happy, everyone knows my routine, I've got no complaints."

The design and layout of the premises were generally suitable for people who used it and people also had access to computers. The equipment that people needed was adequate, sufficient and safe to be used. One relative told us that installation of physical therapy and exercise equipment at the home would benefit their family member.

Nurses led the shifts in each of the four units and were supported by care assistants. Staff told us they felt supported in their job. Training systems had been improved. People spoke highly of staff, one person said "these guys are just great!"

There were systems in place for checking the quality of the service but staff training records were not easy to check.