Amberley House Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulations in relation to people’s safe care and treatment and person-centred care.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Although assessments of people’s care needs were completed these were not effective. People’s care plans and risk assessments were conflicting and did not always reflect actual needs. We found repeated problems with how assessed needs were met in practice. For example, 1 person required the use of pressure relieving equipment, which was clearly described in their care plan. However, this equipment was not used on the day of our assessment.

One person explained they had recently been admitted to the service due to being unwell. The person felt they had improved and physiotherapy would have helped them further improve, to possibly return to their home. However, their diagnosis, prognosis and needs had not been discussed with them and the person stated they were, “not sure what’s happening next”.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

During the assessment we reviewed records and spoke with a healthcare professional. The professional told us they had provided guidance for staff but, “They [Amberley House Care Home] are not following guidance” and were “not confident” 1 person was receiving food and fluid as recommended.

Where expert guidance had been provided, care was not delivered in line with this evidence-based guidance and placed people at risk of harm, malnutrition and dehydration. We reviewed the records of what 1 person ate during the day and found staff did not consistently record the amount of food eaten. There were gaps in recording which may indicate people did not receive food or drinks for long periods of time.

Care plans did not always clearly direct staff on the amount of food and fluid people should consume when people were at risk of malnutrition or dehydration. For example, Information to direct staff on how much a person should drink in a 24-hour period to prevent dehydration and increase the risk of associated health concerns was not recorded. One person had an indwelling urinary catheter that was reported to be “problematic”. Fluid charts showed the person had been offered and drank small amounts on some days; there was no evidence this had been monitored, and actions taken to ensure the person received adequate drinks.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

During the first of our assessment visits, we shared concerns with the registered manager that people were not always receiving care as directed in their care plan. On the second day of our assessment, we heard handover meetings shared some information regarding people, their physical and mental health condition and clinical information. However, staff were not informed about dietary requirements or to use pressure relieving equipment for people at risk of pressure damage. One agency staff member had not worked at the service previously and therefore would not have been aware of people’s needs.

Staff handover forms contained inaccurate information relating to people’s dietary and mobility needs.

Information was not always shared with professionals involved in people’s care and treatment, to ensure any changes were reported in a timely manner. One health care professional told us, “They are not forthcoming with information.”

The service employed a variety of different staff, such as nurses, carers and domestic staff. Staff were aware of their individual roles and acted accordingly.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were not always supported to maintain a varied diet. We reviewed records of a residents meeting. People had raised concerns that there was, “not much choice” at mealtimes and 1 person stated they would, “like to be offered a nice rice dish or more fish”. During the assessment people’s feedback regarding food choices was mixed, 1 person stated they could choose from a daily menu, whilst others stated the food was often cold. One person’s relative told us they had previously returned food that had been served to their relative as it was “inedible.”

During our assessment, we observed lunch was served to some people inthe lounge and other people received their meal in their bedroom. A member of staff explained that people who had bedrooms upstairs were served first and then staff served lunch to people on the ground floor. One staff member said lunch was, "running very late today, don't know why, normally 12.30pm." In the lounge, a person whose bedroom was located upstairs, was finishing their lunch, whilst other people next to them in the lounge had not been served. Staff told us the person who was almost finished eating, "feels bad because [they] had already eaten" and other people had yet to be served.

People’s mealtime experiences were generally poor. In the lounge meals were served while the television was onand staff were seen walking through to the kitchen. One person was beingassistedwith their meal, the plate was balanced on the arm of theirchair,and the member of staff did not talk with the person while helping them with their meal.

The dining room had 3 tables and 11 chairs, on the first day of the inspection,the kitchen areain the dining room,wasnot clean, 2 large plaster boards were lent against the wall. The dining room was seen to be used only used by staff on their break.Twelve boxes of continence products were stored against wall.A member of staff said no one was asked if they wanted to go into the dining room and that people "Were asked to go into the dining room after the extension was built, but that was quite a while ago and now they are not asked". This didnotensure people received mealsin a calm, quiet environment that promoted good nutrition and hydration.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

During the assessment we spoke with a physiotherapist who was visiting a person who required the daily use of wrist splints. The physiotherapist told us they had shown some staff who were present how to put the wrist splints correctly on the person. We reviewed the care plan and found there was no information in the care plan to direct staff who had not seen the physiotherapist demonstrate how to put the splints on. Staff confirmed this information was not in the care plan. This meant staff may not have provided care and treatment in line with guidance to reduce health deterioration and outcomes.

One person was at risk of malnutrition and staff recorded what the person had consumed throughout the day. We reviewed the records and found there were gaps in which the person may not have eaten, and the actual amounts recorded lacked detail. This meant there was no effective monitoring of the person’s intake to ensure they received adequate diet to prevent further risk of malnutrition.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The management team had completed some mental capacity assessments and best interest decisions for people when needed. However, capacity assessments had not always considered all relevant aspects of people’s care. For example, when people were repositioned regularly there was no evidence to show this was in their best interests when they could not consent to this and may refuse support that could result in further skin damage. Care plans did not direct staff on the actions they should take if a person refused some aspects of their care.

However, people raised no concerns with how they consented to their care. We observed staff were kind to people and asked people if they required assistance.