Archived: Amber House

Amber House is a residential care home providing accommodation and personal care for up to 22 people with a learning disability, or autistic spectrum disorder. At the time of inspection, 15 people were using the service.

Amber house was registered for the support of up to 22 people. This is larger than current best practice guidance. The service consists of three buildings which have been combined. Two of the buildings are joined at ground floor level by a covered annex which serves as an entrance to all buildings. There is a small conservatory area, dining room, activity room, and a garden area that people can access.

People’s experience of using this service and what we found

The service had developed a closed culture under the current management structure, which placed people at risk of harm. Where people had experienced potential abuse, the registered manager had not informed key agencies to ensure investigations were undertaken and plans put in place to keep people safe.

Risks in relation to people's care was not always sufficiently detailed to ensure people were cared for in a safe way. There was not always accurate guidance in place for staff about how to manage or reduce risk.

The dependency needs of people were not considered to establish the required staffing levels to meet these needs. The deployment of staff did not account for people’s individual needs. Staff told us they needed more advanced training in managing behaviours that may challenge them. Other areas of training were overdue.

Care records were not always accurately detailed, or sufficient to ensure people's needs and preferences were documented. Documentation procedures did not enable staff to have effective oversight of people's care. This placed people at risk of harm. There was a lack of oversight and learning in relation to incidents and accidents.

People received their prescribed medicines, however, some documentation required additional detail where medicines were given 'as required'. Procedures needed to be more robust to ensure medicines were secured safely.

The provider's systems for monitoring and improving the quality of the service had not been effective. Issues identified at our last inspection remained and we identified further concerns. There was a lack of strong leadership, consistency and oversight at the service. Regulatory responsibilities had not been met.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care did not maximise people’s choice, control and Independence. Daily routines were designed to support the collective needs of the group, rather than deliver tailored care. This meant that care was not person-centred and did not promotes people’s dignity, privacy and human rights. The culture, values, attitudes and behaviours of leaders and care staff did not ensure people using the service led confident, inclusive and empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 22 October 2019) and there were multiple breaches of regulation. The provider completed an improvement plan after the last inspection to show what they would do and by when. At this inspection we found improvements had not been made and the provider remained in breach of regulations.

Why we inspected

The inspection was prompted due to concerns we received about the failure to protect people from avoidable harm or abuse, poor staff culture and governance. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amber House on our website at www.cqc.org.uk.

Enforcement

Following the inspection we issued a Notice of Proposal to cancel the providers registration. The provider made representations which were not upheld. We subsequently issued a Notice of Decision to cancel the providers registration, and this service is no longer in operation.

The local authority worked closely with the provider to ensure people were supported to move into alternative accommodation.

Amber House is a residential care home providing accommodation and personal care for up to 22 people with a learning disability, or autistic spectrum disorder.

Amber house was registered for the support of up to 22 people. 18 people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs or anything else outside to indicate it was a care home.

People’s experience of using this service and what we found

The 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. However, The service didn’t always apply the full principles and values of Registering the Right Support and other best practice guidance. Further work was needed to ensure people’s independence was promoted as much as possible, and that opportunities such as the use of information technology were developed.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support did not always focus on them having as many opportunities as possible to gain new skills and become more independent. Staffing levels were impacting on some aspects of this; there were not always sufficient staff to support people to be more independent or to take part in day to day activity of their choosing.

Following the inspection, the provider did increase staffing levels. They did not however have a dependency tool to calculate staffing levels. Without this the provider was unable to demonstrate there were enough staff on duty.

Care plans needed to include details of decisions people could still make for themselves to maximise choice and independence. Staff tried to support people to have maximum choice and control of their lives and support them in the least restrictive way possible. However, staffing levels impacted on this.

Governance systems were not sufficiently robust or regularly completed to identify issues.

People’s nutritional needs were met and monitored. People were referred to health and social care professionals as required.

People told us that staff were caring, and we observed positive interactions between people and staff. Staff received training relevant to their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (Published 11 September 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to staffing, safe care and treatment, person-centred care, governance, and reporting procedures. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The last inspection was in June 2016, and the service was rated 'Good' in all key questions. At this inspection in July 2018, we found three breaches of regulation. This was related to person centred care, assessment of risk and governance.

Amber 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.

The care home accommodates up to 22 people in one adapted building. At the time of this inspection there were 16 people living in the service.

There was a registered manager in post. 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.

The provider's governance systems had failed to identify the areas we found as requiring improvement. Auditing systems needed to be improved upon to ensure all areas of people's care was considered.

Risk assessments relating to people's care were not always sufficiently detailed, or reviewed regularly to ensure they were still relevant. Some did not contain sufficient detail to guide staff in how to mitigate risks.

Risks relating to the environment had not been identified by the provider, however, they acted promptly to address these.

Care plans were not standardised across the service. Some contained historical information that was no longer relevant, and inaccurate information about people's needs. Care plans were not reviewed regularly to ensure they contained up to date information about people's current needs.

Care plans in relation to people’s end of life care needed to be more detailed to ensure the full scope of people’s wishes were known.

People received their medicines safely, however, some improvements were needed in how the service stored temperature sensitive medicines and in documentation.

There was sufficient numbers of staff to support people safely, and to enable people to access the community and pursue their hobbies and interests.

Staff took appropriate precautions to ensure people were protected from the risk of acquired infections.

Staff had regular supervision and they had been trained to meet people's individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people's consent prior to care and support being provided. People were supported to have maximum choice and control of their lives.

People had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People were supported by caring, friendly and respectful staff.

The provider had an effective system to handle complaints and concerns.

The manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service.