We carried out a review of the data available to us about Amber House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Amber House, you can give feedback on this service.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
People’s experience of using this service:The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent
The provider had systems in place to safeguard people from abuse. Staff could recognise and report any safeguarding concerns if they suspected abuse. Relevant risk assessments had been completed. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.
Staff had appropriate skills and knowledge to deliver care and support people in a person-centred way. Staff recruitment was safe and staff understood how to keep people safe.
People told us they were happy with the service they received and felt staff had a clear understanding of their needs and preferences. People were supported with good nutrition and could access appropriate healthcare services.
People were able to see their families as they wanted. There were no restrictions on when people could visit the service. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.
Staff cared about the well-being of people they supported and we received positive feedback about the kindness of staff. People were treated with respect and dignity and their independence was encouraged and supported. Where people required support at the end of their lives, this was carried out with compassion and dignity.
People described a range of activities and events both within the service and the local community, based on their interests and preferences. People and their relatives were supported to receive information in an accessible way either through easy read, large print and pictorial formats to enable them to be involved in their care and support.
Care plans had been developed and were regularly reviewed. These contained relevant information about how to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice.
All areas were clean, tidy and there was effective cleaning taking place to keep people safe from the risk of infection. The rooms we looked at were personalised and decorated in colours of people's choosing The environment supported people to have time on their own and time with other people if they chose this. Cleanliness and health and safety were well managed.
The registered manager and staff team worked together in a positive way to support people to remain as independent as possible and to be safe. Staff told us they were well supported by the registered manager and management team.
Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people's lives.
Rating at the last inspection: At the last inspection the service was rated good (published 21 April 2017).
Why we inspected: This was a scheduled inspection based on the previous rating.
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.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.
This unannounced inspection took place on 14 March 2017. The last inspection of the service took place in 19 November 2014 were it was rated as good overall and was compliant with all of the regulations we assessed at that time. At this inspection we found the service remained Good.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 who used the service were supported safely. People were protected from abuse and poor care by staff who had completed training that taught them to recognise the signs of potential abuse. During discussions it was clear staff were aware of their responsibilities to report any signs of abuse they became aware of. Accidents and incidents were investigated and known risks were mitigated to ensure people remained safe. The registered provider operated safe recruitment practices and deployed suitable numbers of staff to support people in line with their assessed needs. Medicines were ordered, stored and administered safely. People received their medicines as prescribed and protocols had been developed to ensure they were administered consistently.
People received effective care. Staff received effective levels of support, supervision and mentorship. People received care and support from staff who had the skills and experience to carry out their roles effectively. People who used the service told us they were supported to make decisions in their daily lives and consented to the care and support they received. The principles of the Mental Capacity Act 2005 were followed within the service when people lacked capacity to make specific decisions themselves. People’s healthcare needs were met by a range of healthcare professionals and people were supported to attend appointments as required. People were encouraged to eat a varied and balanced diet and were involved with menu planning and food preparation.
People’s needs were met in a caring way. Staff were patient, kind and supported people in a person centred way. It was evident staff had developed caring and supportive relationships with the people they supported. People told us they were treated with dignity and respect by staff. They said their opinions and views were listened too and respected. Staff encouraged people to undertake daily living tasks and supported people to maintain their independence. Private and sensitive information was stored confidentiality and shared appropriately.
People received care that was responsive to their needs. We saw that people’s needs were assessed on an on-going basis. Care plans had been developed to guide staff how to deliver effective care and support consistently and safely. The care plans we saw had been developed in line with the National Institute for Health and Care Excellence guidance. People were encouraged to take part in activities and follow their personal interests. People told us they were able to maintain contact with important people in their lives. The registered provider had a complaints policy that was displayed within the service. People told us they were aware of their right to make complaints.
People received care from a service that was well-led. The registered provider operated quality assurance systems that consisted of audits, checks and feedback from people who used the service. The Care Quality Commission were notified of specific incidents that occurred within the service as required. People who used the service provided feedback on their care through questionnaires and one to one meetings. The registered provider had worked to develop relationships with the local community.
The inspection took place on 19 November 2014 and was unannounced. We previously visited the service on 2, 3, and 17 June 2014. We found that the registered provider did not meet the regulations that we assessed in respect of consent, care and support, keeping people safe, medicines, staff recruitment, staffing levels, staff support, supervision, monitoring the quality of the service and the reporting of notifiable incidents and we asked them to take action. Following the inspection the registered provider sent us an action plan telling us about the improvements they were going to make. At this inspection we found that appropriate action had been taken to make the identified improvements.
The service is registered to provide accommodation for persons who require nursing and personal care and treatment of disease, disorder or injury. Amber House can accommodate up to five people with a learning disability and mental health diagnosis.
The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 8 June 2011. 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 had previously visited the service on 2, 3, and 17 June 2014 we found that the registered manager was working part time at the home. A new manager had been appointed in late July 2014 to manage the day to day running of the service. The new manager has applied to become the registered manager of the service and when the registration process has been completed the current registered manager intends to de register from this role.
When people were assessed as lacking capacity to make their own decisions, meetings were held with relatives and health and social care professionals to plan care that was in the person’s best interests.
People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health based professionals in the community.
People spoken with said staff were caring and they were happy with the care they received. They had access to the local community and planned preferred activities.
People lived in a safe environment. Staff knew how to protect people from abuse and equipment used in the service was checked and maintained. Staff made sure that risk assessments were carried out and took steps to minimise risks without taking away people’s rights to make decisions.
Medicines were stored, administered and disposed of safety. Training records showed the staff had received training in the safe handling and administration of medicines. Staff administering medicines had also had competency checks before being approved to administer medicines.
People’s nutritional needs had been assessed and people told us they were satisfied with the meals provided by the service.
Staff had been recruited following the service’s policies and procedures to ensure that that only people considered suitable to work with vulnerable people had been employed.
Staffing levels had been increased day and night to meet people’s needs. Staff received training and support to enable them to carry out their tasks in a skilled and confident way.
The management arrangements at the service were more consistent than we had seen at the last inspection. A manager had been appointed in July to deal with the day to day management of the service along with a further two deputy managers and this meant there was a manager on duty over a seven day period.
The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns.
We considered the findings of our inspection to answer questions we always ask:
Is the service caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?
This is a summary of what we found:
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
The practices in the home did not protect the people who used the service, staff or visitors from the risk of harm. Serious concerns were raised regarding the lack of guidance and training for staff to support people safely and to manage their behaviour appropriately when it was challenging.
Some incidents had resulted in verbal and physical abuse between people who used the service. These had not always been reported to the local authority safeguarding team and the Commission had not been informed. It is important that we are informed of these incidents so we can monitor how they are managed.
Not all staff had received training in how to manage safeguarding concerns in order to protect vulnerable people from the risk of abuse or harm.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
We found that people's medicines were not always managed safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.
Is the service effective?
There was little direction and support for staff and the support to people who used the service was inconsistent and unstructured. The service was for people with complex needs around their learning disability and or their mental health and often people presented with behaviours that challenged the service. Yet systems had not been put in place for all persons to safely manage these behaviours, to recognise triggers or to encourage positive behaviour. From observations during the visit and discussions with members of staff we found that some staff were not confident in delivering aspects of the care people required.
There were gaps in the staff training and development programmes as some staff had not received training to meet the specialist needs of the people who used the service. Staff told us they felt isolated and at times had been left to manage situations they did not feel confident about.
Risks were not always appropriately assessed or responded to, and we found that the provider did not take all of the required steps when dealing with allegations of abuse. People told us they were generally happy with the care they received and their needs had been met but this was sometimes impacted by a lack of staff.
We found staff had not completed training in The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This legislation protects people's rights to be involved in making decisions about their lives and where they do not have the capacity to do so, then safeguards must be put in place and followed to ensure decisions are made that are in the person's best interests.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.
Is the service caring?
We found that staff were supportive and attentive to people who used the service. People were given choices. We observed staff speak to people in a friendly and professional way.
We saw a lack of evidence to show that all people's preferences, interests, aspirations and individual needs were recorded or that care and support was provided in accordance with people's wishes and feelings.
Is the service responsive?
People had access to a range of health and social care professionals for support and treatment.
Staff we spoke with told us they did not have access to key information about people's care needs. They told us they were at times supporting people based on verbal information received from head office, other staff or previous knowledge of their needs. This meant people may not always receive effective care.
We saw some staff had completed essential training but other training was overdue. We found staff had not attended training linked to the healthcare needs of people living at Amber House to help them support people's needs appropriately.
Sufficient numbers of care workers were not always provided to respond to people's health and welfare needs.
Safe recruitment practices in line with the provider's policy and procedures had not always been followed to ensure new staff were safe to work with people who used the service.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.
Is the service well-led?
There was no clear leadership in the service. Staff were given conflicting guidance from the management team and this guidance was not always written down which led to confusion and inconsistency with the care provided. There was a lack of policies and procedures for staff to refer to in the service.
The acting manager had been appointed from within the organisation, but following a high turnover of senior staff, they told us their workload had increased considerably and they needed additional support in order to fulfil their role.
There was no system in place to make sure that the acting manager and staff learnt from events such as accidents and incidents, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learnt from mistakes.
We found the service did not have an effective quality assurance system in place.
There was some documentary evidence to show the views and opinions of people who used the service and staff were sought as part of the quality assurance process. But there was little evidence that the provider was taking action to address the shortfalls identified. This lack of documentary evidence made it difficult to establish if the service was being managed in people's best interest.
Turnover of staff was very high and staff absence due to sickness was also significant. Although this was monitored by the provider there was little evidence of any action taken to improve staff sickness rates and staff retention.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.
What people who used the service and those that matter to them said about the care and support they received:
People told us they did not feel safe at the service. One person told us, 'I don't like being alone with Xxx, they hurt me sometimes when staff aren't around.'
One person told us they liked the staff and another person said they did not feel safe with one staff member. We reported this to the acting manager. People told us about the staff changes and what this meant, one person said, 'I haven't had any psychology since they left in January. I miss it.' They also told us, 'I miss the old staff, but the new staff are nice.'
We have raised our concerns about the care of people at the service with the local authority safeguarding team and with commissioners. We are working with all relevant authorities to protect and improve people's care.
You can see our judgements on the front page of this report.
We found that staffing provision had improved and that the person who used the service received a consistent group of staff. The person who used the service told us they were satisfied with the staff and care provided.
We found that staff had not had adequate training to meet people's needs safely.
People who used the service told us they were satisfied with the care and support they received.
We found that the service worked well with other agencies. Comments from people who used the service included, 'Carmand work really well with other agencies, I am involved and sit in on the meetings.'
People who used the service told us they received their medicines when they needed them.
People we spoke with told us they liked living at the home. Comments included, 'The home is kept clean and tidy and it is well maintained. We found the needs of people who used the service were not always met and they were put at risk due to the design of the premises, excessive hot water temperatures and poor management of waste.
We found there may not be enough qualified, skilled and experienced staff to meet people's needs. People who used the service told us that they liked the staff but some felt that there was not enough staff.
We found that arrangements were in place to ensure staff would receive appropriate professional development.
We found that there was a comprehensive system in place to monitor the quality of the service. There was evidence that learning from incidents took place.
Comments included "All the staff are ok", "Like all the staff" and "Like it here."
More negative comments included "Quite a lot of things go wrong", "Not happy here" and "Haven't had any room checks yet."
When asked about the environment and catering facilities there were also mixed answers. Comments included "Have my own bedroom key"," Staff say they don't clean it's not in their job description", "Only get enough shopping for one week" and "Repair jobs don't get done."
We asked people using the service how they contacted the manager and senior staff. They told us they attended meetings to discuss their care needs and they could contact senior staff by telephone and by e-mail. They told us senior staff took a long time to return calls after messages were left but that they always attended meetings.
We received comments such as "Happy with staff" and "Staff are friendly and supportive".
Everyone we spoke with told us they helped prepare meals when they could and the food was good.