Archived: Amberleigh House Care Home

Amberleigh House is registered to provide accommodation for people who require nursing or personal care, and the treatment of disease, disorder or injury. It is a charity owned care home which provides accommodation for up to 38 adults living with dementia. The service is located in the Fazakerley area of Liverpool and is close to local public transport routes. Accommodation is provided at ground level and all rooms have en-suite facilities.

When we last inspected Amberleigh House in February 2017, the service was rated as 'Requires improvement’ in the responsive domain. This was because records associated with people’s individual care needs were not always completed fully. Following this inspection, the provider wrote to us to tell us how they would address these concerns and make improvements to meet the regulations. We reviewed this plan as part of this inspection. We found that the service had not made sufficient enough improvements to meet this breach. We also found an additional breach in relation to safe care and treatment.

There was a manager in post, however they had not yet registered with the Care Quality 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.

The registered provider had made some improvement with regards to record keeping. However, we found there were still issues relating to wound care plans for some people as well as other records which still had some gaps. There were audits in place which identified the need for further improvement in some areas, and this had been followed up with an action plan. However, other audits had not identified some of the other concerns we highlighted during this inspection. The provider was still in breach of regulation relating to record keeping and good governance.

There was a lack of planning and recording to support good wound care for people with pressure sores. Some people had special pressure relief mattresses and the settings of these mattresses had not been recorded. This meant that the home had not adequately protected people from the risk of injury to their skin or worsening pressure sores. We fed this back to the manager at the time of inspection and this was rectified straight away. Additionally, other risk assessments were not always accurate and information varied between the risk assessment and staff knowledge of the risk. This meant we could not be sure the registered provider had a robust procedure with regards to minimising risks to people.

It was not always clear that the Mental Capacity Act 2005 (MCA) was applied correctly and decisions were being made in people's best interests. Most records we viewed in relation to the MCA had specific decisions recorded on them however best interest processes for people were not always considered. Consent was not sought in people’s best interests for some of the care plans we viewed. We have made a recommendation regarding this. When we returned for day two of our inspection, the manager had made some improvements to this process and hads a plan in place to complete the rest.

The high use of agency staff was a concern during our inspection. People and their relatives fed back that this was worrying for them. We did see however, that the use of agency staff had decreased in the last few months, and the manager informed us that additional staff had been recruited and were awaiting further clearance checks.

People told us they mostly felt safe living at the home, however the staffing had been a concern, as was some environmental issues which we raised at the time with the manager.

Medication was safely managed, stored and administered. People received their medications on time. However, there were some issues with recording.

Staff were recruited and selected to work at the home following a recruitment procedure. The manager retained comprehensive records of each staff member, and had undertaken checks on their character and suitability to work at the home. There were some discrepancies with regards to staff members references which we raised at the with the manager.

The home was clean and tidy. There was provision for personal protective equipment stationed around the home, and staff were trained in infection control procedures.

Staff were able to describe the process they would follow to ensure people were protected from harm and abuse. All staff had completed safeguarding training. There was information around the home which described what people should do if they felt they needed to report a concern.

The training matrix showed that staff were trained in all subjects which the provider considered mandatory to their role, and as stated in the provider's training policy. New staff with no experience in health and social care were enrolled on an induction process which was aligned to the principles of the Care Certificate.

Staff received regular supervision and appraisal. We did see some gaps in the recording of this however, the manger was able to explain the reasons for this.

People were supported to eat and drink in accordance with their needs. People, who were assessed as at risk of weight loss had appropriate documentation in place to monitor their food and fluid intake. We did raise at the time that some of these documents were not completed accurately or in full. Where specialist diets were needed for some people, the staff had knowledge of this.

The service worked in conjunction with all medical professionals to ensure people had effective care and treatment. We received feedback from some professionals involved with peoples care which was mostly positive Everyone had records in their files relating to external appointments with healthcare professionals such as GP's, opticians, dentists or chiropodists. The outcome of these appointments was recorded in people's records..

We observed kind and caring interactions between staff and people who lived at the home. Staff spoke kindly and fondly about people, and demonstrated a good knowledge about them, their likes and their needs. People told us they liked the regular staff and felt that they were kind to them.

There was information recorded in people's care plans with regards to their likes dislikes and how their care should be delivered which showed the service was providing care in a diverse way.

People confirmed they knew who the manager was and everyone we spoke with said they had noticed an improvement in the service since the new manager had taken up post in July. Team meetings and resident meetings took place. Feedback was gathered from people who used the service and their families, the manager had also attempted to meet relatives one to one to introduce themselves.

We saw all notifications had been sent to CQC.

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

Amberleigh House is registered to provide accommodation for people who require nursing or personal care, and the treatment of disease, disorder or injury. It is a charity owned care home which provides accommodation for up to 38 adults living with dementia. The service is located in the Fazakerley area of Liverpool and is close to local public transport routes. Accommodation is provided at ground level and all rooms have en-suite facilities. During the inspection, there were 35 people living in the home.

When we last inspected Amberleigh House in January 2016 the service was rated as ‘Requires improvement.’ This was because the provider was in breach of regulations in relation to medicines management and compliance with the Mental Capacity Act 2005. Following the inspection the provider sent us an action plan to tell us how they would address these concerns and make improvements to meet the regulations. We reviewed this plan as part of this inspection.

A registered manager was 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.

When we last inspected Amberleigh House in January 2016, the provider was in breach of regulations in respect of the safe management of medicines. During this inspection we found that improvements had been made and the provider was no longer in breach of regulations in relation to medicines management. Records relating to medicine administration were completed fully and for people who required their medicines to be administered covertly (hidden in food or drink); appropriate assessments and agreements were in place. A system was in place to record when topical creams had been administered, though this was not utilised for all creams such as moisturisers.

At our last inspection the provider was in breach of regulations because applications to deprive people of their liberty were not applied for in a timely way. During this inspection, we found that DoLS applications had been made appropriately and records showed that consent was gained in line with the principles of the Mental Capacity Act 2005 (MCA). The provider was no longer in breach of this regulation.

Staff told us they were well supported by the management team and were able to raise any issues. We found however, that supervisions and appraisals were not completed with staff regularly. Records also showed that not all staff had completed training considered mandatory. The registered manager had identified this and developed a plan to make improvements in these areas. A number of training courses had been booked and staff were due to attend these.

We found that not all identified care needs were evidenced as provided, such as regular repositioning to help prevent deterioration of people’s skin integrity. Where repositioning support had been recorded, records reflected that people all received the support at the same time. This meant that accurate records of care were not maintained.

At our last inspection, the caring domain was rated as ‘Requires improvement.’ This was because staff did not always have time to interact with people living in the home in a meaningful way. During this inspection we found that improvements had been made and we observed staff spending time sitting and chatting with people and providing support in a timely way.

The well-led domain was previously rated as ‘Requires improvement.’ This was because there was no registered manager in place, there was no evidence of staff meetings and quality assurance processes were not always effective. We found at this inspection that improvements had been made.

We looked at four personnel files and found that appropriate checks had been completed prior to staff commencing in post. Not all staff files included a full employment history and the registered manager agreed to request written information from these staff.

The registered manager told us the service was fully staffed and staff told us there were usually sufficient numbers of staff on duty. Feedback regarding staffing levels from people living in the home and relatives was mostly positive.

People told us they felt safe living in Amberleigh House and relatives we spoke with agreed the environment was safe for people. Staff had a good understanding of safeguarding processes and how to raise any concerns.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety. These assessments were reviewed regularly to ensure any change in people’s needs was assessed to allow appropriate measures to be put in place.

People living in the home were supported by the staff and external health care professionals to maintain their health and wellbeing. Relatives we spoke with told us that staff always kept them informed about any changes to their family members health or wellbeing and agreed that advice was sought quickly when needed.

Feedback regarding meals was positive and staff knew people’s dietary needs and preferences. A choice of meal was available and we observed people receiving support to eat and drink when required.

Adaptations had been made to the environment to assist people living with dementia with orientation and safety.

Not all people we spoke with were able to talk to us about their experience of living in Amberleigh House, however all relatives we spoke with told us that staff were kind and caring and treated people with respect. We observed people’s dignity and privacy being respected by staff in a number of ways during the inspection.

Care plans were written to guide staff to promote people’s independence when providing support and relatives we spoke with agreed that people’s independence was encouraged. Staff knew the people they were caring for well, including their needs and preferences. This meant that staff could support people in a person centred way.

All relatives told us they were made welcome when they visited and that they could visit their family member in private if they wished to. For people who had no family or friends to represent them, contact details for a local advocacy service were available for people to access.

Care plans reflected people’s individual needs and were detailed and informative. They reflected people’s choice and preferences and included information regarding the person’s life history. Pre-admission assessments were completed to people’s needs could be met effectively from the day the person moved into the home.

A schedule of planned activities was on display within the home, provided by an activity coordinator and volunteers. People had access to a shared minibus and trips to local attractions were arranged regularly, as well as external entertainers visiting the home.

Records we viewed showed that relative meetings took place regularly, as well as the family forum meetings. People told us they felt listened to and one relative told us, “The home is always asking [your views]; they are interested in what you think.”

There was a complaints procedure in place within the home and all people we spoke with knew how to raise any concerns they had.

We looked at the quality monitoring systems in place and found that systems in place were effective in monitoring the quality and safety of the service. Audits identified actions required for improvement and it was recorded when these actions had been completed. The provider maintained oversight of the service through regular clinical governance reports, internal quality assurance team visits and were notified of any significant incidents within the home.

Feedback regarding the management of the home was positive from all people we spoke with. Staff told us they were well supported, enjoyed working in the home and would be happy for their family members to be supported there.

The ratings from our previous inspection were not displayed within the home as required. We discussed this with the registered manager who arranged for the ratings to be displayed in the foyer of the home before the end of the inspection.

The manager had notified CQC of events and incidents that occurred in the home in accordance with our statutory notifications.

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

Amberleigh House is a purpose-built home that provides residential and nursing care for a maximum of 38 older people. The home specialises in providing care for people living with dementia. At the time of the inspection 36 people were living at the home.

A registered manager was not 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.

We saw not all risk had been reviewed according to the home's monthly schedule. The interim manager and a nurse told us that the review of risk had been affected by the need to use agency nurses who did not have sufficient knowledge of people to complete the task.

We found that some of the records relating to covert medicines were not signed by a doctor and lacked sufficient detail to safely inform staff who were unfamiliar with the person.

All of the people that we spoke with told us that they felt the home was safe. Records indicated that all staff had received training in adult safeguarding in 2015. Staff were clear about what action they would take if they suspected abuse.

During the inspection we saw that there were sufficient staff on duty to meet people's needs, but we received different views regarding the suitability of staffing levels at the home.

We looked at staff records and were able to confirm that staff had been recruited safely following the completion of appropriate checks. Each record that we looked at contained references and a Disclosure and barring Service (DBS) check. A DBS check provides evidence that a person is suited to working with vulnerable adults.

The home completed regular checks of safety equipment and procedures. We saw evidence that emergency lighting, alarms and evacuation times had been tested and recorded. External organisations were used to service and test fire extinguishers, gas safety and electrical safety. The home had a file containing important information and guidance for use in emergency situations or when the building needed to be evacuated.

We looked at arrangements for the storage and administration of medicines. We observed staff

Staff had the knowledge and skills to meet people's needs. They were trained in a number of relevant topics including safeguarding, administration of medicines, health and safety and food hygiene. Staff were required to refresh their mandatory (required) training each year. The training records that we saw indicated that over 90% of training was up to date. Staff also had access to additional training in relevant topics.

Staff were given access to regular supervision, but we were told that the frequency of supervision varied. The records that we saw indicated that supervisions did not always take place as planned. Each of the staff that we spoke with told us that they felt well supported by the provider and able to access informal supervision if they needed it.

We found that the home was not operating in accordance with the principles of the Mental Capacity Act 2005 (MCA) because, although the home had assessed people's capacity it had failed to submit all of the necessary requests to restrict people's liberty within the correct timescales. We were shown evidence that requests were in the process of being submitted.

People were supported to maintain good health by staff. Health checks were undertaken on a regular basis and staff were vigilant in monitoring general health and indications of pain.

The design of the building meant that it was initially difficult to navigate and was poorly lit in places. Some areas had been recently decorated and areas were being created to support reminiscence therapy. Bedrooms were not clearly numbered and other signage was limited. This meant that people who were new to the service or were living with dementia would have difficulty finding their way around.

Throughout the inspection we observed staff interacting with people in a manner that demonstrated care, understanding and compassion, although some people were left without support for prolonged periods Staff knew each person well and were able to identify their care needs in detail.

Staff involved people in discussions about their care and encouraged them to make decisions. Throughout the inspection we observed staff taking time to explain to people what they were doing and what alternatives were available. Staff gave people information in simple terms and offered basic choices. Visiting relatives spoke positively about the staff's approach to the provision of care.

People contributed to the assessment process and the planning of care. The delivery of care was personalised and respected people’s views and preferences. Care needs were documented and reviewed, but the use of agency staff had limited the frequency of reviews.

At the time of the inspection the home did not have a registered manager in post. A permanent manager had been appointed from within the organisation and was in the process of applying to be the registered manager. An interim manager was managing the home.

The interim manager was aware of the day to day culture within the home and the challenges that staff faced in maintaining safety and quality.

Staff clearly knew their roles and what was expected of them. They were motivated to provide good quality, safe care, but did express concern about staffing levels and the impact that this had on their ability to complete important tasks.

The home had a number of quality assurance systems in place including a monthly manager's report and a clinical governance report. The clinical governance report required the manager to provide information on issues like weight loss, falls and other incidents. The previous quality audit process was conducted by a regional manager. Neither process had identified a solution to the difficulties in reviewing care plans and risk assessments.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to medicines management and the need for consent.

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

As part of the inspection we spoke with two people who use the service, five people whose relatives used the service, the manager and four members of staff. We also reviewed records relating to the management of the home which included, nine care plans, daily care records and records relating to the management and administration of medicines. Below is a summary of what we found. The summary describes what we were told by staff, relatives of people who use the service, what we observed and the records we looked at.

Is the service safe?

We observed people who lived at the home being treated with dignity and respect. Safeguarding procedures were robust and staff members had received ongoing training in safeguarding awareness, the Mental Capacity Act [MCA] and Depravation of Liberty Safeguards [DoLS]. This meant staff members were able to keep people safe and protect their welfare. Any incidents or accidents had been recorded appropriately and were discussed at regular meetings held for managers and staff members. This ensured that all staff learnt from such events with the aim of improving the quality of service provided to people living at the home. We observed the care home to be clean and hygienic and all equipment and appliances in the home were checked and serviced regularly and so prevented putting people at unnecessary risk of harm or injury.

Is the service effective?

People living at the Amberleigh house received a pre-admission assessment. As far as possible, people or their families were involved in the care planning process. We observed care plans were focused on the person`s individual wishes and preferences which reflected a person centred approach to providing care. The layout of the service allowed people who lived there to move around freely and safely.

Is the service caring?

During our inspection we observed people who lived in the home being cared for, and supported by, staff members who were patient and helpful. One person we spoke to said, "It's lovely here, I couldn't fault it at all." Another person commented; "We are very happy with everything, when we leave [her] here, we never have any worries at all." Staff members were knowledgeable about the needs and wishes of all people living at the home and support was delivered in a way that met those needs.

Is the service responsive?

We saw a record of complaints that had been received at the care home. We looked at how one complaint had been handled and could see it had been responded to appropriately in an open and timely manner. Consequently people and their families were assured that complaints were acted on positively and we observed action was taken when necessary.

Is the service well-led?

As part of a quality assurance system at the service, the provider arranged both internal and external audits. Any identified issues were addressed via an action plan without delay and, as a result, the service was continually improving. The provider held regular meetings for staff members which ensured they were kept aware of their roles and responsibilities. Supervisions and appraisals were held for staff members which enabled them to raise any issues they had.

Policies and procedures were in place to help ensure that people's medication was being managed appropriately and that they were being given their medicines as prescribed.

We found that the service operated an effective recruitment and selection process.

We found that records relating to the care, staffing and the management of the service were accurate and fit for purpose.

This service cares for people with a range of dementia conditions and conversation with most residents was limited due to their complex needs. We therefore spent much of the time in the communal areas making observations of how people were being cared for. We observed staff assisting people with personal care. We saw that staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

We spoke with one person about the care and support they received. They said they were happy living at the service and said that the staff were "always polite and very kind".