Amber Home Carers Surrey

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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to people’s care not being person-centred and shortfalls in the governance and oversight of the service.

This service scored 33 (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 ensure people received effective care and treatment because they did not assess, review or discuss people’s health, care, wellbeing and communication needs in a meaningful or consistent way.

Relatives told us that people’s assessments and transitions into the service were not always well managed. One relative described the transition as “a complete mess.” Another relative told us they had needed to change their family member’s arrangements because they felt the support was unsafe when they first moved into the service.

People’s needs were not comprehensively assessed or reviewed. Care plans did not provide staff with detailed guidance about how people wished to be supported, what they needed help with, or what approaches would benefit them. Important information about people’s basic day‑to‑day needs and their sensory needs was missing from records. There was no structured approach to reviewing support plans where people’s needs had changed. For example, one person had been diagnosed with a long‑term health condition which was not clearly reflected in their records. Another person had sustained an injury requiring surgery and ongoing monitoring, but their care records did not show the impact this had on them or how staff should support them. Care plans did not demonstrate how people were involved in assessments, reviews or decision‑making about their support.

The provider did not plan or deliver people’s care and treatment with them, and they did not follow legislation or current evidence‑based guidance. People were not supported in line with best practice.

Right Support, Right Care, Right Culture (RSRCRC) guidance was not followed to ensure people could live an ordinary life of their choosing. Throughout our assessment, we observed that neither the service nor individual staff demonstrated an understanding of people’s rights to independence, choice and community inclusion. Staff practice was task‑focused, with an emphasis on observing people rather than supporting them to take part in meaningful activities or make choices about their own lives.

The provider told us they were unaware of the REACH standards. These standards set out the principles for high‑quality supported living and how people’s choices should be promoted and maximised. No training had been provided to staff on RSRCRC or the REACH standards. Staff were unable to describe either set of guidance, how they were implemented in the service, or how they informed the way people were supported.

This demonstrated a lack of understanding of the need to follow evidence‑based, rights‑based best practice to empower people and support them to have a good quality of life. As a result, people’s care was not designed or delivered in a way that upheld their rights, promoted independence, or maximised their opportunities.

The provider did not always work well across teams and services to support people. The lack of robust systems and documentation meant information available to share with other services was not comprehensive. This included information relating to people’s health, distressed behaviour and living arrangements. This had led to other services not being fully aware of the needs of individuals or the support needed across the service to implement change.

Prior to our inspection, we received concerns from professionals as they were not always able to contact the service and did not always receive responses to requests for information. The provider told us they had reviewed their systems in response to this. They said they had ensured professionals were provided with a central telephone number and email address, which could be accessed by the whole management team. Professionals told us this had led to improvement, although the detail and consistency in responses varied due to several staff members dealing with issues. This led to them regularly needing to clarify information or request additional details.

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

People’s health needs were not always recorded or monitored to ensure they were met. One relative told us, “They need to give more updates about health to families. I have to piece things together from looking at records and questioning them.”

People did not have up‑to‑date health action plans in place, meaning staff did not have clear guidance about each person’s health needs. Although some people’s health conditions were monitored, staff were not aware of what the monitoring meant or when and how to seek help from healthcare professionals.

We found restrictions in place for one person regarding their fluid intake which had a significant impact on their mental wellbeing. Records stated this restriction was due to a health condition; however, there was no evidence of how the fluid levels had been set or that a healthcare professional had been involved in this decision. There was no systematic approach to ensure the person received the correct amount of fluids, that levels were not exceeded, or that the impact on their emotional wellbeing was monitored.

The provider did not routinely monitor people’s care and treatment to improve it, and they did not ensure outcomes were positive, consistent or aligned with what people themselves wanted.

People’s aspirations and goals were not discussed with them or planned for. Goals recorded in care plans were functional and focused on maintaining the current situation rather than exploring people’s interests, aspirations or opportunities for growth. As a result, people were not supported to identify goals, extend their experiences or increase the control they had over their own lives.

The provider told us they were aware that goal setting and outcomes was an area of support needing development. They had allocated a senior staff member to take responsibility for care planning. However, there was no strategy or system to show how this would be achieved, implemented or monitored, and no plan for how staff would be trained in this area.

Staff we spoke with told us that people’s goals mainly centred on being “happy and settled”, but they were unable to describe how they explored ways to achieve this or how they supported people to improve their quality of life. This showed staff did not understand how to promote meaningful outcomes or support people to develop skills, interests or independence.

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

We observed staff offered people choices and gained consent prior to supporting people with their day-to-day support, such as where they spent their time in their home, drinks and meals. However, the service had not explored how people could be supported to become further involved in making decisions that enhance their control over their own lives.

Whilst people’s capacity to make decisions had been assessed in some areas, more robust systems were required to ensure any restrictions in place were/remained in people’s best interests. The provider told us they were aware of the need to implement systems in relation to this and were working alongside local authorities and families to complete this process. Although the staff we spoke with told us they had completed training in relation to the Mental Capacity Act 2005, they were unable to tell us what this meant in relation to how they supported people.