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Reports


Inspection carried out on 2 September 2019

During a routine inspection

About the service

Amberside is a care home providing care and support for up to 21 older people. At the time of the inspection, the service was supporting nine people. Eight people were present on the day of the inspection and one person was in hospital. The service was newly registered in October 2017 and began admitting people in February 2018, following refurbishment works.

People's experience of using this service

We received positive feedback about the service and the care people received. People and professionals commented positively about the effectiveness and responsiveness of the support people received. There was evidence that people achieved good care outcomes and their comments about the service supported this.

Systems to ensure people were safeguarded from harm had improved. People were supported by staff who had been trained to identify and report concerns. People were safe because potential risks to their health and wellbeing had been mitigated and were being managed effectively. Staffing levels had been increased and there was enough staff to support people safely. People were supported to take their medicines. Lessons were learnt from incidents to prevent recurrence. Staff followed effective processes to prevent the spread of infections.

The registered manager and staff worked hard to ensure people received effective care to meet their needs. People were supported by staff who had completed the provider's mandatory training and additional training in relevant areas. Staff practice was supported by recognised good practice guidelines. People achieved good care outcomes as a result of the support provided by the service.

Staff had respectful, caring and friendly relationships with people they supported. Staff upheld people's dignity and privacy, and they promoted their independence.

People received personalised care and support which met their needs and reflected their

preferences.

There was a positive and open culture. Staff roles and responsibilities were clear, and staff were supported through regular supervision from the registered manager.

The provider’s quality monitoring processes had improved and now evidenced how they continually improve the service.

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 Inadequate (published 5 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 11 December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 5 December 2018

During a routine inspection

What life is like for people using this service:

The service was newly registered in October 2017, and began admitting people in February 2018 following refurbishment works. The service had a registered manager in post and a deputy manager.

Staffing levels did not consider the needs of people living with dementia, mental health or with complex care needs. People had to wait for key areas of support such as meals, drinks and personal care, along with not receiving appropriate support with their behaviour which challenged others. The manager and deputy worked along side staff and had no time to ensure that the overall care people received was safe. This led to a lack of monitoring of people’s hydration, nutrition and pressure area care monitoring. On the first day of our inspection we discussed our findings with the provider. They immediately took action and increased staffing levels accordingly.

People told us they did not always feel safe, and the registered manager had not reviewed people’s needs when incidents occurred. Staff were aware of how to keep people safe from harm and when to report concerns. Staff were not able to review incidents openly to learn lessons when things went wrong. The provider undertook a guarantee to review their safeguarding practises and provide staff with additional training.

Staff were not trained to provide care effectively. The registered manager had not ensured staff received training in key areas such as pressure care, continence and dementia care. This impacted on staff awareness and ability to proactively and positively support people. The provider gave us assurances they would review their training program. On the second day we saw training had been booked and delivered in key areas such as pressure care and medicines management.

People’s consent had not been obtained in line with the legal requirements necessary, particularly where people lacked the capacity to provide this consent. The process to assess a person’s capacity was not followed and documented as required. The registered manager and deputy manager told us they were in the process of reviewing this.

People did not consistently receive care based upon their needs and preferences. Staff were aware of people’s preferences and choices, however staffing levels did not allow this to be delivered. The additional pressures placed on staff meant they were not able to establish meaningful relationships with people. People told us they felt well cared for by staff who treated them with respect and dignity. People were not always provided with range of activities or social inclusion and told us they felt bored at times. On the second day of the inspection we saw increased staffing had a positive effect with staff having more time to spend with people.

We were not confident the registered manager and provider understood their role in engaging with the whole staff team to listen and support them to improve. The registered manager completed some audits and checks of the safety and care in the service. However, these did not identify the issues raised at this inspection, for example with staffing levels, training and personalised care. The provider did not monitor the quality of care in the service. Records we looked at did not always reflect the support provided to people, or rationale for decisions made. We discussed this with the provider who agreed they needed to develop systems to monitor the service closely.

More information is in Detailed Findings below

Rating at this inspection: Inadequate

The overall rating for this service is 'Inadequate' and the service has been placed 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 wit