Archived: Amber House

People’s experience of using this service: People were not kept safe from harm. Risk assessments were not up to date, specific or followed by staff to ensure individuals were safe.

Processes and records were not maintained to ensure people always received their medicines safely as prescribed.

Some people told us they had to wait for staff support. We observed staff not meeting people’s needs in a timely way. This had impacted on people’s dignity and showed not all staff had respect for people.

Care was not always person-centred. Some staff had good knowledge about people’s needs but this was not always captured and reflected in care planning. People’s diverse needs were not always considered.

Staff did not receive appropriate training or assessment of their competency to ensure they had the appropriate skills to meet peoples’ individual needs. Lessons had not been learnt from accidents and incidents to reduce the likelihood of reoccurrence.

People, their relatives and health care professionals had mixed views about the care provided. Person-centred care was not reflected within people’s care plans and associated records.

The provider failed to ensure that improvements were made. This is the fifth time the service has been rated overall as below ‘good’ and the provider had failed to deliver on the action plan following the last inspection. There was no registered manager in post at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Rating at last inspection: Requires improvement (report published June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: CQC took enforcement action and the provider made the decision to close the service.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. The provider will continue providing regular updates to their action plan. If any concerning information is received, we may inspect sooner.

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

'Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) well led to at least good.' At this inspection we found that the service was not consistently safe and we have recommended that the provider look at risk assessments. There was also a continued breach of Regulation 17 (HSCA) 2008 (RA) 2014 because the provider had not kept complete records for each person and quality monitoring had not identified where improvements were needed.

Amber House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 41 older people who may have a dementia type condition in one adapted building.

There was a manager employed at the service who was in the process of registering with the Care Quality Commission. 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.

Risk assessments were not always completed to reflect people's health needs. Risks in the environment had not always been identified and this did not support people in remaining safe.

Staff worked within the principles of the Mental Capacity Act 2005 but did not clearly record how best interest decisions were made.

The manager told us they were dedicated to providing a high standard of care. They had an inclusive style which staff commented upon in a positive way. They worked as a member of the care team supporting staff where necessary. Where things had gone wrong lessons were learned and action taken to prevent reoccurrences.

Our observations showed that people at the service were safe. There had been one recent safeguarding alert which was currently been investigated by East Riding of Yorkshire council safeguarding team. We saw that staff had completed training in safeguarding people and they were able to say what they would do if they had concerns about someone's safety.

There were sufficient numbers of staff on duty on the days of inspection to ensure people's needs were met. People were offered choices around their day to day activities.

Overall, people received their medicines safely. However there had been a recent incident where stocks of medicines had not been ordered in a timely fashion.

The service was clean and tidy with no odours.

Complaints were acted upon in accordance with the services policy.

Staff were trained in subjects considered mandatory by the provider but some training required updating. Staff received supervision to support their practice.

We observed many positive interactions between people and the staff during the two days of inspection. Staff knew people well and were respectful in their approach. Where necessary people had an advocate who supported them.

When people were distressed we observed staff responding appropriately. They were able to access healthcare when needed.

People had care plans in place which were evaluated and reviewed.

Activities were provided at the service.

At this inspection we found that staffing levels were sufficient to meet the needs of people who lived at the home, and that efforts had been made to improve the type and availability of activities, although we considered there was room for further improvement.

The home is registered to provide accommodation and care for up to 41older people, including people who are living with dementia. On the day of the inspection there were 17 people living at the home. The home is situated in Bridlington, a seaside town in the East Riding of Yorkshire. The premises has three floors and a passenger lift operates between all levels. There are a small number of steps between split floor levels so only people able to manage the stairs can be accommodated in the areas that are accessed by steps.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

Care plans included information to guide staff on how to meet people’s assessed care and support needs. However, we noted some anomalies or gaps in recording in care plans, positional change charts and medication records that could have resulted in people not receiving the care they required.

This was a breach of Regulation 17 (1)(2)(c) of the Health and Social Care Act (Regulated Activities) Regulations 2014: Good governance.

We detected some malodours around the premises and we have made a recommendation about this in the report.

People were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No-one living at the home had a DoLS authorisation in place but the registered manager had submitted applications that were being considered by the local authority.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with people who may be vulnerable had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs.

Staff told us they received the training they needed to carry out their roles effectively and confirmed that they received induction training when they were new in post. Staff told us that they were well supported by the registered manager.

Senior staff had received appropriate training on the administration of medication. We checked medication systems and saw that medicines were stored and administered safely.

People who lived at the home and a relative told us that staff were caring and that they respected people's privacy and dignity. We saw that there were positive relationships between people who lived at the home and staff, and that staff had a good understanding of people's individual care and support needs.

A variety of activities were provided and people were encouraged to take part, although people told us they would like to be more involved in the local community. People's family and friends were made welcome at the home.

People told us that they were happy with the food provided and we observed that there was ample choice. We saw that people's nutritional needs had been assessed and individual food and drink requirements were met.

The registered manager was aware of how to use signage, decoration and prompts to assist people in finding their way around the home, and some progress had been made towards making these available.

There were systems in place to seek feedback from people who lived at the home, relatives and staff. People told us they were confident their complaints and concerns would be listened to. Any complaints made to the home had been investigated and appropriate action had been taken to make any required improvements.

Quality audits undertaken by the registered manager and senior managers were designed to identify that systems at the home were protecting people's safety and well-being.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three people who lived at the home, two members of staff and the manager during this inspection.

We checked the care records for three people who lived at the home and saw that they had been reviewed and updated consistently so that staff had up to date information about the people they cared for. People who we spoke with were positive about the care they received and described staff as "Pleasant" and "Professional". One person told us, 'I like it here. The staff are good and I like the meals'.

Staff had received training on safeguarding adults from abuse and the people told us that they felt safe living at the home.

The home was clean and well maintained and we saw that refurbishment was ongoing.

Staff and people who lived at the home told us that there were sufficient numbers of staff on duty. People told us that staff answered call bells as quickly as they could.

Quality audits had been carried out to monitor that systems in the home were being followed consistently to ensure that people received safe and appropriate care. People told us that they would speak to a member of staff or the manager if they had any concerns and were certain that they would be listened to.

We saw that people were supported to be as independent as possible and that people's privacy and dignity were respected by staff. People were encouraged to spend time outside of the home when it was considered safe for them to do so.

Staff were recruited safely and we saw that they were skilled in communicating with people who lived at the home.

People who lived at the home and staff told us that the manager had an 'open door' policy and they were able to speak to her at any time. They felt that the manager would listen to them and act professionally if they shared information of concern with her.