Amberley Hall Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The provider ensured staff reported all accidents and incidents, these were reviewed and signed off by management and where required incidents were investigated, lessons were learnt and actions were implemented.

We reviewed the complaints log and found all complaints were investigated thoroughly. Where complaints were anonymous and held little information, these were still investigated and lessons learnt to monitor areas that were reported as a concern.

People felt able to raise concerns and staff told us how they responded to incidents. A staff member told us “I record any incidents or accidents and report them to my senior or manager. I feel comfortable raising safety concerns when needed. I feel incidents are investigated properly. After an incident, we have a debrief to discuss what happened and how we can prevent it happening again.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The provider worked closely with the local hospital and had several bedrooms used to discharge people from the hospital and support them with rehabilitation before going home. There was a lot of admissions and discharges within the service. However, they ensured thorough pre-admission assessments were always conducted and when people left the service appropriate referrals were made.

Staff told us they always received communication when a new person is admitted into the service and they have time to review their care plan. Staff felt able to raise referrals where required a staff member told us, “Depending on the situation, I may contact the GP, NHS 111, 999, district nurses, SALT (speech and language therapy), dietitian, physiotherapist, occupational therapist or emergency services.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. We found where incidents met a safeguarding threshold these were reported promptly to the local authority safeguarding team and investigated where safe to do so. We found staff had received safeguarding training and could tell us the signs of abuse they look out for.

A staff member told us, “I look for any form of abuse like physical, mental, emotional, financial, etc, I look for any signs of bruises, any behaviour changes, I report to nurses in charge or management and document.” People told us they felt safe. Feedback we received was “oh yeah I feel safe.” Another person said “I feel safe. They are very good and always look after me and I have respect for them.”

The provider ensured where people lacked capacity to consent and were deprived of their liberty, processes were in place to ensure applications were made under the deprivation of liberty safeguards (DoLS.) This ensured restrictions were lawfully authorised and the providerchased responses up where required and where applications were authorised with conditions these were clearly documented in peoples care plans.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. We reviewed peoples care plans and found where people had specific health conditions, they had care plans detailing what these were and the risks they imposed and how staff were to support them. We found where people had a history of seizures care plans were created and informed staff of the warning signs, type of seizure the person experienced and how they were to support that individual during and post seizure. Where people were at risk of their skin breaking down and required to be repositioned by staff, care plans were detailed on how to mitigate the risks and care notes evidenced care plans were actively being followed.

People told us staff supported them to manage risks while promoting their independence, a person told us “They support me with the risk of falling. I have only had 2 since I have been here. I only go down to the dining room for lunch. They come and get me. I walk down the corridor as far as I can and they follow me with a wheelchair. I like to go as far as I can for as long as I can.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We observed the environment to be safe and safety checks were conducted daily. We found 1 bath required to be serviced and the provider introduced a check that would be completed by maintenance monthly to ensure service dates did not lapse in future. Health and safety audits were conducted, and every person had a clear Personal Emergency Evacuation Plan (PEEP) which informed staff where to take a person in the event of a fire. Staff told us how easy it was for them to report concerns on the environment by scanning QR codes placed in different parts of the service.

A staff member told us “I check the premises and equipment during my shifts and report any faults or hazards to my senior or manager. Concerns are dealt with promptly to help keep everyone safe. I have received fire safety training and take part in fire drills. There is a trained fire warden on shift, and I have been shown the fire evacuation procedures and equipment.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. We reviewed staff recruitment files and found appropriate checks were conducted prior to employment being commenced to ensure staff were suitable to support vulnerable people. Risk assessments were in place for staff with known medical conditions to ensure staff were safe and supported while at work.

The provider had a dependency tool that was used to ensure there were adequate level of qualified and skilled staff to support people’s individual needs. Staff felt the staffing levels were safe, although certain times in the mornings and evenings were busier. However, when asked for support it was provided. We reviewed staffs’ rotas and these reflected the level of staffing on the dependency tool.

Staff received regular supervisions and appraisals and were given the opportunity to develop within the service. The provider had a training matrix which compliance was actively monitored, and specific training was completed that met people’s individual needs.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider ensured IPC audits were conducted and had clear processes in place to ensure the environment was cleaned on a daily basis. Cleaning schedules were completed and signed off by the housekeeper and management. Staff told us they had access to Personal Protective Equipment (PPE.) We observed the environment to be clean, and people felt it was to a good standard, 1 person told us, “Oh yeah they come in often and always make sure it Is nice and clean.”

The provider kept an infection control register and where potential outbreaks of infection were identified these were reported to UK health security agency.

Where people had specific health conditions that increased their risk of developing infections, such as upper respiratory infections or urinary tract infections, care plans were in place. These guided staff on preventative measures, the individual signs and symptoms to monitor, and the actions required to ensure people received appropriate support and treatment if an infection occurred.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

We observed a staff member using a pill crusher and pill cutter that had not been cleaned and still had debris from previous tablets on them. This increased a risk of harm to people. Management conducted a supervision with this staff member while we were on site. We found a person had not used a PRN (when required) medicine within 6 months and there was no evidence of this being reviewed with their GP. We found another person’s PRN protocol did not record the time between doses this could increase the risk of a person becoming overdosed. The provider showed evidence of the timings between this PRN medicine, but the risk was not mitigated. The provider acknowledged these areas and informed us they had a pharmacy consultant joining the service and were reviewing their supplied pharmacy and the system used to improve PRN protocols.

However, we found medication competencies were thorough and conducted frequently. The clinical rooms were well organised, secure and staff kept keys on them at all times. Controlled drugs were managed well, and Audits were conducted to identify any errors. People had risk assessments in place for emollients and medication care plans.