Archived: Amber Banks Care Home

We carried out an unannounced comprehensive inspection of Amber Banks Care Home on 05 and 09 May 2016 because we received information of concern about people’s welfare and safety. We undertook a comprehensive inspection to assess if people who lived at the home were safe. We also checked if staff were caring, effective and responsive in meeting people’s needs. Additionally, we evaluated the leadership and organisation of the home.

Amber Banks provides care and support for a maximum of 46 older people who may live with a physical disability. At the time of our inspection there were 29 people living at the home. Amber Banks is situated in a residential area of Blackpool close to the promenade. All bedrooms offer single room accommodation with en suite facilities. There are communal lounges, dining areas and a back yard, which had a seating and smoking area.

A registered manager was not in place. 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. The previous registered manager left two years ago and there have been seven managers in post since then. The new manager, who started in December 2015, told us they had sent an application to register with CQC in February 2016. However, our systems show we have not received this and the provider had no evidence to demonstrate the new manager had applied to register.

During this inspection, we reviewed staffing levels and skill mixes and found these were insufficient to meet people’s requirements. One person told us there were not enough staff and as a result, “The activities co-ordinator is not happening. The show and cinema doesn’t happen.” We observed there were not enough staff to meet people’s needs with a timely approach. Staff added there were not enough staff to ensure people received safe care and treatment. This included agency staff cover for short notice sickness, which meant staffing was not always adequate to monitor and support people continuously.

The management team had not continuously followed safe recruitment processes to ensure suitable staff were employed. They failed to check people’s full employment histories, criminal records and references at all times. Although the provider had a training programme in place, not all staff received training and supervision to support them in their roles. Their monitoring system and associated records were poorly organised.

We discussed safeguarding individuals from abuse or harm and found staff were knowledgeable about related principles. However, we saw multiple concerns with people’s environmental safety. We identified problems with health and safety, fire and infection control. The management team did not have effective risk assessment processes to protect individuals from potential hazards. The provider failed to have clear oversight of environmental safety and had not maintained living conditions that promoted people’s welfare and security.

We observed the provider failed to ensure people were protected from the unsafe management of their medicines. Staff were not enabled to focus on dispensing medicines without being distracted and medication was not always stored securely. The provider did not have scrutiny of related processes and had not checked these continued to be safe and efficient. Not all staff had medicines training provision, where required, following their employment at Amber Banks.

The provider failed to monitor people effectively against the risks of malnutrition and dehydration. For example, there were no associated risk assessments and there were gaps in records to assess people’s food and fluid intake. Individuals who lived at the home told us the food was poor.

One person said, “I don’t like [the catering system in place]. I get ‘[the catering system] stomach’ [trapped wind] and there’s too much additives.”

Staff demonstrated a good understanding of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). However, there was no recorded consent to people’s overall and decision-specific care. There was no documentation of best interest processes, decision specific care planning or review of mental capacity. The provider had not protected people against the risks of inappropriate or unsafe care.

Staff referred people to other healthcare services when they developed further health needs. Nevertheless, the provider failed to update care records in order to meet their changing requirements. For instance, important hospital appointments were cancelled without any recorded follow-up. Care plans were not always revised after healthcare reviews to ensure support continued to meet the individual’s needs

We found care planning was poor and did not always guide staff to be responsive to each person’s needs. For example, actions to support people were brief and the frequency of support and how this should be done was unclear. We found gaps in records, which failed to ensure people were adequately assessed and monitored. Additionally, the provider failed to respond to people’s needs with a collaborative approach to ensure support was appropriate and met their requirements. For instance, they responded to two people’s complex needs in an unsuitable way, which was not responsive to their needs

Staff were kind, caring and encouraged relatives to visit Amber Banks. However, we noted consistency of staff who understood each individual’s care requirements was not always in place. One person told us there had been a, “Mass exodus of staff.” We observed staff spent minimal time engaging with people and did not always maintain their dignity. There was no evidence people were involved in their care to ensure this was personalised to their needs. Accurate and up-to-date records were not consistently maintained or securely stored to maintain people’s confidentiality.

The provider did not have a clear oversight of the quality and safety of Amber Banks. They failed to ensure premises and equipment were monitored to maintain people’s welfare. For example, there were no environmental safety checks and audits. The provider did not monitor other systems within the home, such as medication, infection control and care planning.

The environment and ethos of the home did not promote people’s welfare. We saw there was a lack of clear leadership and cohesion within the management and staff team. For instance, service organisation, filing systems and communication processes were poor.

There were limited arrangements to assess, monitor and improve quality assurance. For example, the management team had not sought or acted upon feedback from people about their experience of living at Amber Banks. Additionally, the provider failed to follow up on staff concerns or suggestions to improve the home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

As part of the inspection visit we looked at how people were being cared for and supported. How the service worked with other professionals for the benefit of people who live at the home. We looked at how medication was managed to ensure people were receiving medication safely. We looked at how the service was staffed to ensure there were enough staff with the right skills to meet people's needs at Amber Banks. We also looked at quality assurance systems to see how the service developed the services it provided to people. During an inspection of the service in January 2014 the home was found to be failing to comply in the way it recorded information relating to people's needs. The service was issued with a warning notice to improve the way it recorded information. This was to ensure there were accurate records in relation to the care and support people received. As part of this inspection we looked at what action had been taken to improve the way people's needs were being recorded.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, other professionals involved in peoples care and by looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Amber Court.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. One person told us, 'Everyone is so kind and helpful'. Another said, 'It's not like home but I feel safe here, there is always someone around for me'.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve.

Staff we spoke with had knowledge and understanding of individual personal care plans and risk management plans for people they were supporting. One staff member told us, 'All the care plans have changed they are much better to follow'.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant people would be safeguarded as required.

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the service effective?

People's health and personal care needs were assessed with them and they were involved in developing their plans of care where possible. Specialist dietary, mobility and equipment needs had been identified in care plans where required. There was also an ongoing review process to ensure people's needs were continuously monitored and changes made when needed. This meant the home was responding to the changing needs of people using the service in their best interest.

In order to ensure people received access to a range of supporting healthcare services, staff regularly reviewed when health checks were due. People we spoke with told us, 'It's quite alright here, my optician has seen me and I was taken to see my GP last week, I enjoy being here'. Also, 'The staff make arrangements to see my GP and dentist, M'. is taking me to the dentist as I am having terrible trouble with toothache at the moment'.

Personal history profiles were in place providing an individual picture of each person which staff said had been a useful tool to understand peoples backgrounds, their likes and dislikes.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with told us, 'They are so very patient with me, and it's nice to feel cared for'.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

We spent time in various areas of the home where we observed staff interacting with people. We saw they were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. Two people living at the home were involved in a heated discussion at one point. We saw a staff member sit down with them and distracted them in a way which was sensitive and diffused the situation.

When speaking with staff it was clear they genuinely cared for people they supported. One staff member said, 'I just love this job. It's different every day and every day there are challenges. As a staff team we all support each other'.

Is the service responsive?

The service worked with other agencies including social services, nurses and healthcare professionals to make sure people received care and support in a coherent way. This meant people received the right care and support to meet their individual needs and remain as independent as possible.

People using the home, their relatives, friends and other professionals involved with the service received six monthly satisfaction surveys. The results were used to inform the development and quality of the service. Any issues highlighted were looked at and responded to in order to ensure the home was meeting quality standards.

Staffing levels were based upon the needs of people using the service. The provider might like to note that in order to respond to changes in dependency levels of residents, the management team should be reviewing numbers of staff and skills mix on a continuous basis. This would ensure there were enough suitably qualified staff on duty to meet the needs of residents at any time of the day or night.

The service had listened to people views in relation to the meal system introduced. They had implemented an additional meal choice at lunchtime prepared by the cook. They had also listened to people and introduced a continental style breakfast as part of the development of meal choices. One person told us, 'They take the meals seriously and I think the choice is great. I can have what I want really'. Some other people told us they did not like the 'Appetito' (pre-packed frozen main meal) although they acknowledged there was always a choice available to them.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had developed its quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving. This had included a recent medication audit where shortfalls had been identified and actioned.

Staff told us they were clear about their roles and responsibilities. Staff had an understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

There were a range of audits and systems put in place in by the manager and provider to monitor the quality of the service being provided.

We spoke with a range of professionals about the services provided at Amber Banks care home. They included the Fire and Rescue Service, Health and Safety and Blackpool Council monitoring team. The Fire and Rescue service had removed their enforcement notice on 14/01/14 because the service was now compliant with the fire and safety regulations. The Health and Safety officer told us the provider had taken action to address the areas of concern they highlighted. They told us the manager was working closely with their department seeking advice and guidance and implementing changes as required. Blackpool Council contracts monitoring team told us there have been improvements made and the manager and the provider have been working hard to improve the services they are providing for people.

We found care plan records were still unsatisfactory. There was no evidence to show us that people were involved in their care planning process. Reviews were not always undertaken. The pre assessment process still did not identify the needs of people who had a history of alcohol and substance misuse. Some care plans had inaccurate and out of date information in them.

However people we spoke with and their relatives gave favourable feedback that the home met their needs. These are some of their comments;

'It's absolutely fantastic here. If I had to go back to some other homes who looked after me'I just couldn't and the people here are so cheerful.'

'Since the new manager came things have got much better, the place is brighter and the cleaning better and the staff, particularly the foreign staff are very good.'

'It's very nice here. The people are good to you .The staff are nice and I've been here about 9 months.'

'I like the people and look forward to things like having my hair done and I never hear a cross word here.'

People we spoke with told us they had pleasant en suite rooms, that food and drinks, though being reviewed at present, were always available. There were mixed views about the quality of food which was due to some changes not being liked by some of the people we spoke with.

The provider had updated their Statement of Purpose to reflect the assessed needs of the people. At the time of the inspection there remained no registered manager in post since Dec 2011. However the new manager had submitted her application two days after this inspection.

We observed the care and support people received, and spent time with people in the communal lounges of the home, over lunch and in the smoking area at the rear of the home. We saw that people were not protected from the risks posed to them when using the outside smoking area. People we spoke with told us they did not feel safe using the smoking area.

The staff were seen to work in a warm and friendly manner. We observed staff were attentive and caring. People living in the home enjoyed flexible routines dependent upon their individual needs and preferences.

There were plans to relocate the existing kitchen and arrange for an external caterer to provide the meals at the home. There was a 6 week consultation process in place to seek the views of the people who lived at the home.

We looked at the staffing rotas over a three week period and this showed us there were sufficient staff on duty with a range of skills and experience to meet the needs of the people who lived at the home. On the day of the inspection two members of staff had phoned in sick. The deputy had made arrangements for additional staff to cover.

We looked at the recruitment and selection procedures and did not see that staff were always recruited safely. We looked at staff training and development and saw that staff were supported with their training and development.

Care plan records were brief and contained limited information regarding people`s needs. Some were out of date. Risk assessments were not always in place to support the needs of some of the people who lived at Amber Banks.

An area of improvement actions identified at the last inspection had since been addressed. There were new systems in place with additional equipment and resources that had assisted with the home's management of infection control.

When we looked at care plans, risk assessments and care reviews we saw that they were not signed by people. Some of the care records were brief or contained limited information about meeting care needs. Amberbanks Care Home should continue with their reviews of care planning and risk assessment procedures.