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Inspection carried out on 25 April 2018

During a routine inspection

Amber House is registered with the Care Quality Commission (CQC) to provide accommodation and personal care for up to a maximum of 13 people who may have learning disabilities or autistic spectrum disorder. It is situated in the village of Broughton, close to local amenities. The service also provides support to one person living in their own home in the community, supporting them with activities and promoting their independent living skills.

Accommodation is provided over two floors, in single bedrooms with en suite facilities. There are a range of separate lounges and a large dining area situated on the ground floor. Enclosed gardens to the side and rear of the service are easily accessible.

This comprehensive inspection took place on 25 April and the 8 May 2018 and was unannounced. At the last inspection on 17 and 18 August 2017 the service was found to be non-compliant with regulations; 9, person –centred care, 11, consent, 12, safe care and treatment, 15, premises and equipment, 17, good governance and 18, staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans were insufficiently detailed to enable staff to meet people's needs, there were restrictions in people's lives that had not been agreed as in their best interest and people did not always have risks to their safety mitigated. It was also because elements of the environment were unsafe, quality assurance systems and oversight of people's needs were ineffective and staffing recruitment checks were insufficiently robust.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and the timescales this would be achieved to improve the key questions, is the service safe, effective, responsive and well-led? We received a comprehensive action plan and regular updates, which demonstrated the progress made with the improvement programme. At this inspection we looked at the previous breaches of regulations and the action plan to check that improvements had been made and sustained over a period of time. We found significant improvements had been made in all areas.

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.

In our last report of 17 and 18 of August 2017 we reported that a management company had been contracted by the provider to support the necessary changes required. The management company purchased the service since then and became the nominated individual.

The new provider, registered manager and staff had worked hard to make improvements. People, relatives, staff and professionals provided only positive feedback about the service and the improvements made. The leadership and management had improved, with both working alongside staff and taking an active role in the running of the service. Everyone spoke highly of the management team and said they were approachable and supportive.

Quality assurance systems had been fully implemented and maintained since the last inspection and we saw action had been taken when issues had been identified. The provider had worked hard at implementing many positive changes and was committed to ensuring improvements were sustained and developed further, to ensure people received high quality care.

A robust recruitment process was in place, which ensured staff had the necessary skills and experience and were suitable to work with people who used the service. Staff received the training and support they needed to carry out their roles and meet people’s needs. The provider monitored staffing levels regularly, to ensure staffing levels were sufficient and staff deployment was effective.

Staff knew how to safeguard people from the risk of harm a

Inspection carried out on 17 August 2017

During a routine inspection

Amber House is registered with the Care Quality Commission (CQC) to provide accommodation and personal care for a maximum of 13 people. It is situated in the village of Broughton, close to local amenities.

Accommodation is provided over two floors, in single bedrooms with en suite facilities. There is a large sitting room set out into two separate areas, a small sitting area and a dining/activities area. Two further lounges are situated on the ground floor. Enclosed gardens to the side and rear of the building are easily accessible. There is also a supported living house called Redbourne House. We undertook this inspection on 17 and 18 August 2017. The last inspection was carried out on 29 and 30 March and 3 April 2017 where the service was found to be non-compliant with the regulations 8, 9, 10, 11, 12, 13, 15, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) as well as regulation 18 of the registration regulations. Due to concerns found during the inspection, the overall rating for the service was 'Inadequate' and the service was therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying

the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection in March and April 2017, we met with the provider and have requested an interim action plan. We also requested, and have received, weekly updates to assure us actions have been taken to address the concerns.

After the focused inspection March and April 2017, the provider contracted the support of a management company to help them make the required improvements and achieve compliance with the regulations. We met with the consultant who represented the management company at this inspection. We refer to them as, ‘the consultant’ throughout this report.

During this inspection we found the provider’s quality assurance systems continued to be ineffective. The governance systems operated by the provider failed to cover all aspects of care delivery and did not identify areas of the service that required improvement. The provider did not have oversight of the service as required and was not consulted regarding people’s care and support.

People who used the service did not always receive their medicines as prescribed. Instructions to staff about when medicines should be administered were not clear.

Staff had not always completed the necessary training to deliver the care and support the people who used the service required.

People’s care plans did not always contain suitable guidance to ensure staff co

Inspection carried out on 29 March 2017

During a routine inspection

Amber House is registered with the Care Quality Commission (CQC) to provide accommodation and personal care for a maximum of 13 people. It is situated in the village of Broughton, close to local amenities.

Accommodation is provided over two floors, in single bedrooms with en suite facilities. There is a large sitting room set out into two separate areas, a small sitting area and a dining/activities area. Two further lounges are situated on the ground floor. Enclosed gardens to the side and rear of the building are easily accessible.

We undertook this inspection on 29 and 30 March and 3 April 2017. The last inspection was carried out on 1 February 2016 where the service was found to be compliant with the regulations looked at with the exception of well-led. This was because the manager in post had not yet registered with the CQC.

The service now had a registered manager in post as required by a condition of their registration. 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.

Due to concerns found during the inspection, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection, we met with the registered provider and have requested an interim action plan. We also requested, and have received, weekly updates to assure us actions have been taken to address the concerns. We found multiple concerns and are considering our regulatory response. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the provider to take at the back of the full version of the report.

We found concerns with how the service was governed. The CQC had not always received notifications of incidents which affected the welfare of people who used the service.

There was no effective quality monitoring system in place and audits completed had not been effective in identifying shortfalls within the service.

We found accidents had been logged, which highlighted specific issues but lacked analysis to ensure lessons were learned to prevent re

Inspection carried out on 1 February 2016

During a routine inspection

Amber House is registered with the Care Quality Commission (CQC) to provide accommodation and personal care for up to 13 people who may have learning disabilities or autistic spectrum disorder. Each person has their own en-suite bedroom comprising of bathing and toileting facilities. There is choice of communal areas available for people to use and the garden is easily accessible. At the time of the inspection there were 6 people using the service. At the time of this inspection there were also a group of people accessing the service for day-care support, however the support provided to them did not adversely impact at this time on the people using the service who have separate bedrooms elsewhere in the building.

We undertook this unannounced inspection on 01 and 04 February 2016. At the last inspection on 14 and 15 July 2015, we found the registered provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe care of people who used the service, staff training, providing person centred care, obtaining consent and working within the requirements of the Mental Capacity Act 2005 (MCA). A warning notice was issued due to risks associated with failing to monitor and assess the quality of service provision. The registered provider subsequently sent us an action plan that showed us how they were going to going to put things right.

At the time of this inspection there was no registered manager in post and the acting manager was awaiting an interview with the CQC for their suitability and capabilities to be assessed as a registered manager for the service. A registered manager is a person who has registered with the 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.

During this inspection we found improvements had been made in all domains. We have changed the rating in the three key domains which were previously rated as Requires Improvement to Good. We have changed the rating for the Well-led domain from Inadequate to Requires Improvement. This domain cannot be rated higher than Requires Improvement, as the rules for rating this as good requires there to be a registered manager in post and we want to monitor the improvements to make sure they are sustained over a period of time.

We found people were protected from the risk of abuse or harm. Staff were aware of the need to report potential issues of abuse and policies and procedures were available to guide them when making referrals to the local safeguarding team. Risk assessments were available for people concerning the management of behaviours that might challenge the service and we saw these had been developed and improved since our last inspection of the service.

There was evidence that staff with the right skills had been safely recruited in sufficient numbers. We saw that training had been developed to ensure staff had the appropriate skills and knowledge to meet people's needs. We were told the service had not yet achieved its target of providing a regular programme of supervision and appraisals for all staff, but that arrangements were in place to address this issue.

We found people’s health and wellbeing was appropriately supported and that people had access to a range of medical professionals and that all had been registered with a local dentist since our last inspection. The local community learning disability team told us the service worked well and involved them when this was required. We found people’s nutritional needs were met and that a choice of meals was provided. People’s dietary intake and weight were monitored where this was needed.

We observed people were treated with dignity and respect and that support was provided in a planned and person centred way. We saw that

Inspection carried out on 14, 15 July 2015

During a routine inspection

We undertook this unannounced inspection on 14 and 15 July 2015. The last inspection was undertaken in February 2014 when the service was compliant with the regulations looked at.

Amber House is registered with the Care Quality Commission [CQC] to provide accommodation and personal care for up to 13 people who may have learning disabilities or autistic spectrum disorder. Each person has their own en-suite bedrooms which comprises of bathing and toileting facilities. There is choice of communal areas available for people to use and the garden is easily accessible.

At the time of the inspection there was no registered manager is in post; the deputy manager had been promoted to the post of acting manager. They intended to submit an application to the CQC for registration following an assessment as to their capability and suitability to undertake the role of registered manager by the provider. A registered manager is a person who has registered with the 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.

We found the registered provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in regard to safe care, staff training, providing person centred care, obtaining consent and working within the requirements of the Mental Capacity Act 2005 [MCA] and assessing and monitoring the quality of service provision.

Staff could describe the different types of abuse they may witness or become aware of, however, their training had not been updated in line with current good practice guidelines. Risk assessments in people’s care plans were not clear enough for staff to follow and did not provide enough information to keep people safe. Despite accidents and incidents being recorded, there had been no analysis of this information to establish trends and patterns so systems could be put in place and risk assessments rewritten to keep people safe.

We found that the provider had not followed the principles of MCA. People living at the home were subject to restrictive practice which had not been identified or managed in line with MCA and the Deprivation of Liberty Safeguards [DoLS.]

People’s care plans lacked evidence they had been involved with its formulation and had agreed the care and treatment they received. This meant people could be receiving care and treatment which was not of their choosing or preference.

Staff had received some training but the majority was out of date and not relevant to the people who they cared for. Staff had not been given the opportunity to undertake training which was specific to meet the needs of the people who used the service. This meant that people could be cared for by staff who lacked the training to effectively meet their needs.

The registered provider did not have the monitoring systems in place to ensure people were consulted about the running of the service or the service was being effectively managed to ensure it was safe, effective, caring, responsive and well-led.

There were enough staff on duty to meet people’s needs and they had been recruited safely. People were cared for by staff who were kind and caring and who they enjoyed good relationships with. People were provided with food which was wholesome and nutritious and was of their choosing.

People were provided with activities on a daily basis and staff supported them to access the community and be part of it.

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

Inspection carried out on 4 February 2014

During an inspection to make sure that the improvements required had been made

At the last inspection on the 25 October 2013 we had concerns about the environment and asked the provider to take action in this area. This was because window restrictors were not fitted to some first floor windows, some of the flooring created a trip hazard and fire alarms had not been tested with adequate frequency. During this inspection we found that improvements had been made.

We did not speak to any of the people who used the service during this inspection.

Inspection carried out on 25 October 2013

During a routine inspection

At the time of the inspection there were three people accommodated in the home. Due to their very complex needs two people were unable to tell us about the care they received and we were unable to observe the care provided for any significant length of time.

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan and in a way that was intended to ensure people�s safety and welfare. People told us they were well cared for.

Medicines were handled appropriately, safely administered and kept safely.

People we spoke with told us they liked living at the home. Comments included, �My bedroom is nice.� However people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. This was because window restrictors were not fitted at some first floor windows, some of the flooring created a trip hazard and fire alarms had not been tested with adequate frequency.

There was a complaints system available but the complaints procedure may not have been in a suitable format for all the people accommodated to understand. Records of complaints were not available at the time of the inspection. People told us they were satisfied with the care and could talk to the staff.

Inspection carried out on 14 December 2012

During a routine inspection

The service commenced operation in its present form from August 2012 following registration with the Care Quality Commission. We reviewed evidence of the systems in place to manage risks and ensure the quality of care that people received on the day of our visit, although we found there was just one person who used the service.

The person who used the service had complex needs and we used mainly observation and other non-verbal methods to help us understand their experiences.

We saw that when staff helped the person they spoke calmly and provided clear information about alternatives and choices. Staff were sensitive to the person�s needs and provided appropriate reassurance and guidance.

We found that staff had received training in safeguarding people from abuse and in managing behaviour that challenged services. Guidance and support were provided for staff in supporting people with behavioural issues so that they were kept safe.

We saw evidence that staff received adequate training which helped them to care for the people with learning disabilities or autistic spectrum disorder so that their needs were met.

The provider had developed arrangements for quality assurance of the service through surveys and audits, although some aspects of these arrangements were still to commence.

Inspection carried out on 9 March 2012

During an inspection in response to concerns

People we spoke with told us they were well cared for and the care staff were very caring; comments included �(it�s) Very nice here, staff are lovely. We are well looked after. We all look after each other. It is like a family. Get everything I need� and �I get all the help I need and I am content.� One person told us they were involved with their care plan and had attended reviews.

People also told us �I feel safe here. If I had any worries I could talk to staff, they would sort them out� and �No worries at all, if I had any the carers would sort them. They look after me.� People also told us they would see the manger if they had any concerns or worries.

One person told us they administered their own medication, but this was held safely by the staff. They told us they signed when they had taken their medication and were involved with the ordering of any new or repeat medication. They told us they were happy with this.