Amberwood House

The inspection took place on 25 October and was unannounced. The inspection continued on 26 October 2018 and was announced.

The service is registered to provide accommodation and residential and nursing care for up to 54 people aged 18 and over. At the time of our inspection the service was providing residential care to 51 older people.

Amberwood House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the rating of the service had improved to outstanding.

There was a strong emphasis on people eating and drinking well. There was a relaxed atmosphere at meal times. People requiring assistance were helped in a manner which respected their dignity and demonstrated knowledge of their individual needs. A ‘Night Owl’ menu was available for people to have hot or cold food when the chef is not at the home, and a smoothie menu to help increase people’s intake. The chef met regularly with clinical staff to monitor people’s nutritional needs.

Training was tailored to meet staff members’ learning styles and to ensure staff were able to meet people’s needs. We were told that the service had introduced an online training and recording system. This enabled staff to allowed staff to access their own electronic update training and records when it suited them. ‘Dementia Friends’ training was included to enable staff to support people who are living with dementia.. Nursing staff were supported to maintain and develop their clinical skills. A Registered nurse on duty on the second day of inspection had recently attended a ‘Clinical Excellence day’. The provider told us the home had champions at the service to help improve outcomes for people. The service had champions within the home, these included roles relating to health and safety and end of life care..

People’s views were taken in consideration in how the premises was used. The provider told us three of the four smaller lounges on the first and second floors were being refurbished in response to people’s feedback. One lounge had been made into a café, whilst the second was used by people to enjoy arts and crafts.

There was effective engagement with people, and actions taken as a result of the feedback they provided. Meetings with people, staff and relatives took place. Actions from these were updated, reviewed and actioned. We were told one example was that people were involved in a ‘Caring without plastic’ initiative aimed at reducing the amount of plastic in use in the home. The provider told us people had highlighted the large number of aprons used by staff. As a result, biodegradable aprons had been sourced for trial.

The home had made strong links with the community. Coffee mornings were run, open to people, families and carers, as a way to introduce people to the home informally. A new initiative with Prama care called Colten Prama Chat was been developed. This involved telephone befriending with people from Colten Care homes reaching out to those who may be isolated. Staff had participated in a local meeting regarding priorities in the local area for groups including older people. Staff had also sponsored refreshments at a local sporting event, which people attended.

There was a commitment to continuous learning. We were told that lessons from CQC inspections were shared at home manager’s meetings. Nurses forum meetings also took place where information was shared in an open and transparent way.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falling or skin damage staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained and clinical staff.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as warm and inviting. People could express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. Activities took place in the home and were enjoyed by people.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below

This inspection took place on 13 June 2016 and was unannounced.

Amberwood House is registered to provide accommodation with nursing and personal care to up to 54 people. The home specialises in the care of older people. At the time of the inspection there were 50 people using the service.

There was a new manager in place who had applied to the Care Quality Commission to become the 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.

On the day of the inspection there was a calm and happy atmosphere throughout the home. People were going about their day as they wished, and were enjoying engaging with staff and taking part in activities. People who wished to remain in their rooms were supported by Colton Companions. Colton Companions are members of staff who are employed to support people in their rooms to prevent isolation.

There were sufficient staff to keep people safe. People were well looked after and staff were knowledgeable about their needs and how to meet them. Staff were kind and interacted with people in a friendly and respectful way. People, relatives and staff were complimentary about the service and spoke highly about the manager and head of care. One relative informed us, “Staff are brilliant”. Another said, “We are happy, with the support provided, the manager is very professional”.

The service had suitable arrangements in place to help ensure people were safe and protected from abuse. The service had a whistleblowing policy and staff told us they were confident to use it. Records showed all staff had received training in safeguarding of vulnerable adults. We observed posters around the home instructing staff on what action to take if they thought a person was being abused. They also had appropriate recruitment procedure to ensure people were supported by staff with the experience and character required to meet the needs of people.

Care plans provided information about how people wished to be supported and staff were aware of people’s individual care needs and preferences. One person told us “The quality of care here is excellent, we are involved and our permission is always sought”. People’s needs were discussed with them regularly as the initiative ‘resident of the day’ and any changes agreed. All care plans included the person’s written consent to receive care.

Systems were in place to manage risks, safeguarding matters and medication which ensured people's safety. People were seen to be moved by staff who had the correct skills to use manual handling equipment. Following a manoeuvre a person told us they felt safe and secure whilst being moved, they told us “they always talk with me and tell me what is going to happen and check I am in my chair and comfortable before they [staff] leave me

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. People and visitors were complimentary of the food provided. Where people required specialised diets these were prepared appropriately. People’s choices were seen to be followed, including what size meal they wished, the chef showed us the different sizes of dinner plates, they explained “People often want smaller meals as they don’t like to waste food, they can always have more if they choose”.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. The manager told us “As a new manager to the home, I want to be able to assess and see what improvements need to be made, I have asked for a full audit of the home as a benchmark to work from”.

All incidents and accidents were monitored, trends identified and learning shared with staff and put into practice. Daily meetings were held with heads of departments. The manager informed us the meeting was held daily and overseen by the head of care. They explained it was an opportunity for heads of departments to get together to update, share and discuss what is happening in the home. Items on the agenda also included, admissions, resident of the day, new staff, complaints and concerns.

The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Medication was stored securely with medicines handled and recorded appropriately. Amberwood House had a fire evacuation procedure in place and an up to date resident list which detailed the number of staff required to assist individuals in the case of emergency and these were regularly reviewed. A member of the management team was available on call in case of emergency.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager advised us that one person was subject to Deprivation of Liberty Safeguard (DoLS). We saw documentation that showed that the staff were following the correct procedure.

Is the service effective?

During our visit we observed that staff provided support and engaged with people positively. People appeared relaxed and comfortable in the presence of staff. Speaking with staff it was evident that they understood individuals' care and support needs. We saw that care plans were based on people's assessed needs and that risk assessments had been completed and were regularly reviewed.

Is the service caring?

People told us that they were happy with the care they received and felt their needs had been met. We saw staff treated people in a sensitive, respectful and professional manner. People's privacy and dignity was respected. In people's care plans we saw that there was information about what they needed help with and how staff should support them. One person told us, "The staff are very good and always ask what I want, they do things the way I want them done.' Staff had received training to meet the needs of the people living at the home.

Is the service responsive?

The staff told us that during the handover, all the individuals were discussed which ensured that staff were updated about the support people received were able to refer to individuals care plans. The home had quarterly meetings with the people who lived at the home and one person told us, 'I have made suggestions and they were not ignored". People had access to a range to activities throughout the day. One person told us that the activities coordinators were "Excellent" with "Something always going on'.

Is the service well-led?

The home had quality assurance systems in place. These included daily meetings with the heads of departments, regular peer visits from other home managers within the group at night and monthly quality audits by the providers representative which looked at all aspects of the home's operations. The provider had recently completed their annuals customer satisfaction survey and we saw that overall people's satisfaction levels had increased.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with told us the food was very good and they had a variety of choices each day. One person told us, "They use wonderful ingredients, nothing wrong with the quality of the food."

People told us the home was clean, one person said "They clean my room and ensuite every day." Another person told us " The home is always immaculate."

There were enough staff to meet people's needs. People told us they were supported by staff who took time to help them. One person told us, " You can't fault the staff." There were eight health care assistants supporting 44 people living in the home. There were also two qualified nurses on duty.

People's views and opinions were valued.There were regular meetings, every three months, with people living in the home and family members.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. One person told us " Nothing is too much trouble even when I am not happy they always make it right."

People had concerns about staffing in the home. They told us that although people's basic care needs were met, this did not always happen in a timely way because there were times in the day when there were not enough staff available. People were concerned that quality of care was affected because of staff being under pressure. People expressed concerns about the number of changes in staff in the home which they felt potentially impacted on consistency of care. The home was in the process of implementing a plan which they anticipated would improve staffing in the home and address the concerns raised.

Although people were not always aware of the home's complaints procedure they told us they felt able to talk with the registered manager and staff about any concerns. People were confident that the manager would listen to them and take action to put things right. People valued the manager's open approach to complaints and told us that any issues they had raised had been responded to promptly.