Amberley 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 requires improvement. 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 1 regulation in relation to gaining people’s consent.

This service scored 38 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

The provider failed to consistently review and update people's care plans to ensure these continued to reflect their current needs. For example, when people had fallen their care plans had not always been updated to reflect this and what actions were put in place to reduce the risks. Care plans did not always accurately reflect some people’s ongoing medical conditions, and the support and guidance staff required on meeting these. People’s records had not been updated in relation to a deterioration in their needs for example, in response to weight loss.

The provider did not always ensure when reviews of people’s care were undertaken this was done in consultation with people and their representatives. Records showed when monthly reviews were undertaken this was completed by staff and did not reflect people had been involved. A relative told us, “The staff do usually tell us about changes in [person] care, but we have never been invited to a review or seen their care plan.”

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.

The provider failed to ensure people’s support plans included all their needs, including health, personal care, emotional support, social interests, and activities and cultural, religious, and spiritual needs. People's needs were not always assessed, and care and support were not always delivered in line with current standards. The provider failed to ensure people were consistently involved in their care planning and the information recorded was accurate. Some people’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs, such as diabetes and epilepsy.

For people who required enhanced monitoring or support for their safety, there was a lack of evidence this had been consistently provided. Where people remained in their bedroom there was a lack of records to show staff routinely completed welfare checks. This was of particular concern for 1 person who when anxious and distressed chose to go to their room to ‘self-regulate’. However, there was limited evidence to support staff checked on this person after a period of time to ensure they were okay and to provide reassurance.

Where people were unable to make verbal choices regarding their mealtime choice, pictorial menus were not in place nor were they visually shown the options to give them the opportunity to choose at mealtimes. This meant people unable to communicate their preferences were not given the same options as those who were.

For people whose fluids were being monitored due to being at risk of dehydration, there was a lack of evidence to demonstrate their fluid targets were being met or monitored. The provider failed to carry out checks or monitor the completion of these records to ensure people's care and support achieved effective outcomes.

The provider did not use a dependency tool to assess the level of staffing needed to meet the needs of the people using the service. The registered manager told us, if a person needed additional support they would increase staffing levels. However, there was not a robust system in place to periodically assess the needs of people and demonstrate the staffing levels met these.

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.

The lack of effective leadership and accurate records meant information was not always shared with other services and health professionals in a timely way. Where incidents had occurred, this information had not always been shared with partner agencies to share known risks. For example, when people had fallen, or in relation to safeguarding incidents. Feedback from partner agencies confirmed communication could be improved to enable them to support the home more effectively to manage individual risks.

We found regular support was provided by people’s GP practice and weekly contact was maintained to enable staff to discuss any medical concerns. Staff told us and records confirmed a handover was completed before staff started their shift. These included some key information about people’s needs and any concerns staff had about people. For example, where people may not have eaten or drank much.

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.

Systems and processes to ensure care records and risk assessments were reflective of the support people required with their health needs were not robust. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence. For example, how to support people to reduce the risks of falls or to manage their diabetes.

Records demonstrated staff had either not received training or refresher training to support people with their specific health conditions, such as diabetes, strokes, heart failure and supporting people with distressed behaviours. This meant staff were not always equipped with the skills to support people to manage their health and wellbeing.

People or their relatives told us they felt medical referrals were made where necessary, in a timely way, and were happy with this area of support. One relative told us, “The staff are quick to get the GP in or district nurse if they have concerns.” We saw evidence to support people were supported to attend routine healthcare appointments such as, dentist, opticians, and the chiropodist. Visiting professionals confirmed, ‘staff overall made timely referrals’ to them for support.

People told us they were able to make choices and decisions, but not all people were involved in reviewing or consulted about their health and well-being needs.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider failed to ensure systems to review people’s care were effective to improve outcomes for people. For example, action and learning was not always implemented when people had fallen. Monitoring of people’s fluid and food fluid intake was not reviewed to improve effective outcomes. Records of people’s needs were not always updated in response to changes in their needs. This meant there were missed opportunities to monitor risks and improve outcomes for people.

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

The provider was not consistently working within the principles of the Mental Capacity Act 2005 (MCA) and people’s rights under the MCA were not always protected. We identified shortfalls in this area on our last inspection, and the provider had not made the required improvements. For example, some peoples care records stated they lacked capacity to make decisions. However, there was no evidence to support how these judgements had been reached and what decisions people were unable to make.

Some people had equipment monitoring their movements installed for their safety. However, a capacity assessment had not been completed to assess if they could consent to this. Where people lacked capacity, best interests meeting with their representative had not always been undertaken. We found 1 person who was deemed to have capacity signed a consent form stating they did not want equipment monitoring in their bedroom. However, we found this was in place at the time of our inspection.

Staff did not always support people in a manner which respected and promoted their rights. We observed occasions where some people stood up to walk out of the communal lounge who were asked by staff where they were going and asked to sit back down.

The training records showed not all staff had completed training in relation to consent, MCA and DoLS or they had not completed refresher training. However, staff we spoke with could tell us what this legislation and the associated principles meant for people using the service.

People told us their consent was obtained before staff provided their support. One person said, “The staff ask me if it is okay to support me and I always say of course it is.” Another person told us, “I have the freedom to come and go as I please no restrictions are placed on me.” A relative told us, “I have seen and heard staff ask [person] if they can provide support.”