Amber House Residential Home

Date of inspection: 10 June to 22 June 2026. This inspection took place to follow up on enforcement action from the previous inspection. The service is residential home providing personal care to older adults, some of whom may be living with dementia.

The provider was previously in breach of the legal regulation in relation to person centred care, consent, safe care and treatment, safe and effective staff and good governance. Improvements were found on this inspection, and the provider was no longer in breach of these regulations.
Safeguarding processes had strengthened, with staff demonstrating improved understanding and prompt reporting. Risks were managed well through improved, accurate documentation. The environment was safer and better maintained. Staffing had improved but remained an area for development. Cleanliness had strengthened, supported by better organisation. Medicines management had improved, but documentation gaps showed the need for stronger oversight.

People’s needs were assessed and reviewed effectively. Care and treatment were supported by more frequent reviews and clearer, more consistent documentation. Multidisciplinary working had strengthened. People were supported to manage their health and wellbeing, although oral health recording still required improvement. The monitoring of people’s outcomes remained an area for development. Mental capacity assessments were in place, but more work was needed to ensure people who may not be able to make decisions for themselves were fully assessed.

Staff consistently showed kindness, empathy and respect, and people told us their privacy and dignity were upheld. People were supported as individuals. People were supported to maintain independence and had choice and control over how they lived and received their care. Staff responded promptly and sensitively to people’s needs. Staff felt supported, valued and confident.

People experienced person‑centred care. Care was joined‑up and flexible. People received information in formats suited to their needs. Engagement processes had improved, but not everyone was aware of opportunities to give feedback or attend meetings. People could access the care, support and treatment they needed. Better‑quality information helped staff understand diverse needs and tailor care for people at risk of inequalities. However, end‑of‑life planning remained under‑developed.

Leaders and staff shared a clearer vision. Leadership was developing, but further work was still needed to strengthen capability and consistency. People and staff felt able to speak up. Staff worked in an inclusive environment However, governance systems needed further improvement, with unclear audits and inconsistent follow-up. Although, the provider worked collaboratively with external partners and had made significant progress, improving the overall quality of care.
 

Amber House residential home provides personal care to older adults, some of whom may be living with dementia.

The inspection took place on 15 and 17 December 2025 and was undertaken to provide the service with its first rating under the new provider and to review concerns about the quality and safety of the service.

There were limited assurances about people’s safety because key systems and processes designed to support safe care were not fully embedded or detailed enough. The recent transition from paper to electronic care planning had resulted in important information not being transferred across, leaving some care plans incomplete. This meant risks were not always clearly identified or managed, including instances where people were not consistently supported with the correct moving and handling equipment. However, most people told us they felt safe and did not express concerns about the safety of their care.

Staffing levels did not always adequately meet people’s needs, and staff reported feeling rushed, which affected their ability to consistently deliver high‑quality, person‑centred care. However, staff were kind, compassionate, and committed, and continued to support people as best they could in challenging circumstances.

Staff received training, but there was no effective system to monitor training compliance, meaning the provider could not be assured that all staff were up to date with essential training. In addition, not all people had mental capacity assessments in place, and some required Deprivation of Liberty Safeguards (DoLS) authorisations which had not been applied for. The provider responded positively to our findings and began taking action to address these shortfalls.

People had limited access to meaningful activities, reducing opportunities for engagement and stimulation. Environmental safety checks were not carried out regularly or contained insufficient detail, although the provider had started work to improve this area.

Governance arrangements required improvement, as recent changes and disruption within the management team meant new managers were in post without the full training or support needed. This affected oversight and the provider’s ability to ensure the service was consistently well‑led. Despite these challenges, people appeared content, and staff continued to demonstrate kindness, compassion, and a genuine commitment to those they supported.

The provider was in breach of the legal regulation relating to safe care and treatment, staffing, consent to care, person-centred care and governance at the service. In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward. We have also asked the provider for an action plan in response to the concerns found at this assessment.