Amberley Care Home

Amberley Care Home is a residential care home providing personal care to up to 25 people. The service provides support to people aged 18 and above, some of whom were living with dementia. At the time of our inspection there were 25 people using the service.

People’s experience of using this service and what we found

People's medicines were not always managed safely. There was a lack of information and guidance to guide staff on how and when to offer people’s ‘when required’ (PRN) medicines and how to apply their topical medicines.

Risks to people's health and safety had not always been identified and managed. People had not always received consistent support to reduce known risks.

The provider had failed to implement effective systems to assess, monitor and improve the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were enough staff to meet people’s needs. Staff were recruited safely. People told us they felt safe.

Staff knew people well; however, records did not provide clear guidance for staff to follow when supporting people.

People were encouraged and supported to eat and drink. Staff worked with other professionals to ensure people received a joined-up approach to their care.

Relatives told us they were kept informed of accidents and incidents involving their loved ones. Staff meetings took place and staff said they found them useful.

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 requires improvement (published 27 January 2022) and there were breaches of regulation. At this inspection we found improvements had not been made and the provider remained in breach of regulations. The overall rating of the service has remained requires improvement.

Why we inspected

The inspection was prompted in part by information regarding an incident involving a person using the service who had died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the safeguarding of people who used the service. This inspection examined those risks.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have found breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Amberley Care Home is a residential care home providing personal care for up to 25 people aged 18 and above, some of whom may live with Dementia. The service was supporting 24 people at the time of the inspection.

The accommodation is purpose built and comprised of a communal ground floor lounge and separate dining room. Some bedrooms were located on the ground floor with additional bedrooms on the first and second floor.

People’s experience of using this service and what we found

The quality assurance checks in place to drive improvement were not robust. They had not ensured the safety of care was sufficiently monitored.

Government guidance on COVID-19 had not been fully implemented.

Risks associated with people’s health and care had been identified but risk management plans were not in place to guide and inform how the risks were mitigated. Recruitment practices did not ensure staff were safely recruited. Improvements were needed to medicine records.

There were processes in place to safeguard people from abuse. We observed some kind and caring interactions between people and staff. People and relatives spoke highly of the staff and the new manager. The home was clean and tidy. People and staff were being tested for COVID-19 regularly and had been supported to have COVID-19 vaccinations.

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

Rating at last inspection

The last rating for this service was requires improvement (published 02 December 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received some safeguarding concerns about the service and made the decision to inspect the service.

We looked at the safe and well led key questions only. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the

service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amberley Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service to keep people safe and to hold the provider to account where it is necessary for us to do so. We have identified breaches in relation to the safe management of COVID-19, the management of risk and governance of the service at this inspection.

Full information about CQC’s regulatory response to the concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Amberley Care Home is a residential care home providing personal care for up to 25 people aged 18 and above, some of whom may live with Dementia. The service was supporting 22 people at the time of the inspection.

People’s experience of using this service and what we found

There were some improvements required in regard to infection control practice relating to COVID-19. For example, where the home was not following government guidelines, there were no risk assessments in place. The home was clean and tidy. People and staff were being tested for COVID-19 regularly.

Improvements had been made since the last inspection in December 2019. There had been improvements in safety and the governance systems and processes. People, relatives and staff expressed confidence in the registered manager. Audits took place to ensure the quality of the service was maintained.

Care plans and risk assessments had been reviewed and updated. Risks to people had been assessed and mitigated. People received their medicines in a safe way. Safeguarding processes were in place to report concerns to relevant professionals. There were enough staff to keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 24 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 03 December 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and their governance systems.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amberley Care Home on our website at www.cqc.org.uk.

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.

Amberley care home is a residential care home providing personal care for up to 25 older people some of whom may live with Dementia. The service was supporting 23 people at the time of the inspection.

People’s experience of using this service and what we found

Systems to monitor the way medicines were administered failed to ensure people had their medicines when they needed them. People were not supported to stay safe as risks were not managed well. Where people had fallen action had not been taken in a timely manner to reduce the risk of further falls. Risks to people were not always recorded in their care records for staff to refer to.

A lack of oversight meant risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were not effective and had not identified the areas for improvement found at this inspection.

People were not always treated with dignity and care records were not personalised and kept up to date. People did not always have meaningful activities to occupy them on a daily basis.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were supported by staff who knew how to report concerns of abuse. Staff had received the training they required for their role, but some staff needed to complete refresher training to update their skills and knowledge. Staff wore gloves and aprons to ensure they protected people from cross infection.

Staff sought people’s consent before providing support. People accessed healthcare services to ensure they received ongoing healthcare support. People were given choices and were involved to make daily decisions around their care. A complaints procedure was in place and people and their relatives knew how to raise concerns.

Rating at last inspection and update.

The last rating for this service was requires improvement (published December 2018) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulation in relation to risk management, and medicines practices and a continued breach in relation to the governance systems and quality assurance monitoring of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Amberley 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. Amberley accommodates up to 25 older people that may live with dementia in one adapted building. At the time of this inspection 23 people were using the service.

There was a registered manager and she was present during our inspection. 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.

Risks to people’s safety were not consistently managed and action was not taken to mitigate those risks to ensure people received safe care. Accidents were not analysed to assess for any patterns and trends and to introduce measures to reduce further risks. Audits of the environment had not been undertaken to ensure all areas of the home were safe for people to use.

Assessments and care plans were not detailed to ensure staff had access to personalised information about people’s abilities, wishes, and support needs and how these should be met. Some records had not been updated to ensure they reflected people’s current needs.

The systems to monitor the quality of the service were not effective and did not ensure shortfalls were identified to ensure improvements could be made.

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

People received their medicines as required, but we identified shortfalls where medicines were not always managed safely. Staff knew how to escalate safeguarding concerns they had about people. People told us they felt safe and there was enough staff to meet their needs.

Staff received an induction to their role but we found gaps in staff training and some staff needed to complete refresher training to maintain their skills and knowledge. Staff had a basic awareness of the Mental capacity act (MCA), and were not aware which people had a Deprivation of liberty authorisation in place. Staff did seek people’s consent before providing support.

Not all aspects of people’s healthcare needs were being met as people did not have access to dentistry services. The registered manager took action following our visit to access this provision and complete the required referrals. Improvements with the environment were required to enable people that lived with dementia to be able orientate themselves within the home.

People described the staff and the manager as caring, kind and told us their dignity and privacy was respected. However, we observed some occasions where staff did not maintain people’s dignity. People told us there were not enough daily opportunities in the home to engage in meaningful activities. Themed events where facilitated such as vintage tea parties and a Halloween party was planned.

People and their relatives knew how to complain and procedures were displayed in the home. However, we found not all complaints had been recorded to enable us to review these and the responses provided.

Systems were in place to gain feedback from people and their relatives. Staff felt supported in their role and thought the manager and provider were approachable.

Staff understood the importance of getting consent from people before they delivered care and we saw arrangements were in place to protect people who were unable to give their consent.

People had a care plan that reflected their needs and their personal routines and preferences. We saw people's needs had been assessed and planned for.

People were happy with their meals, one person said, 'You always have a choice and seconds and if you don't like it they ask you what else you might eat'. Appropriate arrangements were in place to support people who did not eat or drink enough. This meant the risks of dehydration or poor nutrition were reduced.

Staff members said they received support to do their job. People who lived there and visiting relatives were complimentary about staff. One person living there told us, "You won't get nicer staff they are very good'

People had opportunities to voice any complaints and were confident these would be resolved.