Archived: Amberley House Care Home - Stoke-on-Trent

Amberley House Care Home – Stoke-on-Trent is a care home providing personal and nursing care to up to 74 people. At the time of the inspection there were 46 people living there. There are three separate units accommodating people with differing needs. Some of the people living in the home are living with dementia, mental and physical disabilities.

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

The provider had consistently failed to make improvements that were effective or sustained. People were exposed to an extended period of poor-quality care and the service had continued to be rated less-than-good. Systems to monitor the safety and quality of care were ineffective and did not always identify areas for improvement.

People were not always being protected from the risk of cross infection. Risks to people’s health and well-being were not always adequately assessed and planned for. Care files contained inconsistencies which put people at risk of receiving inconsistent care. Lessons were not always learned when things went wrong. Medicines were not always managed safely. Staff were not always deployed effectively so they did not always have time to spend with people and to keep up to date with people’s changing needs.

People were protected from intentional abuse by staff who knew how to recognise and report concerns. The provider worked in partnership with the local safeguarding authority to report and act upon concerns raised. The provider acted upon their duty of candour responsibilities.

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 25 September 2019) and there were three breaches of regulation. The provider was required to send us monthly updates about actions they had taken following the last inspection which we reviewed and was used to help us plan this this inspection. The update was about how they supported people to feedback about their care, medicines checks and action taken in response to medicine error. At this inspection, enough improvement had not been made or sustained and the provider was still in breach of regulations.

This service has been rated requires improvement for the last six consecutive comprehensive inspections. This will be the seventh consecutive time the provider has failed to achieve a good rating in safe and well-led.

Why we inspected

We received concerns in relation to how people were being supported with their nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement overall, however the rating for well-led has deteriorated to inadequate. This is based on the findings at this inspection.

Enforcement

We have identified continued breaches in relation to the safe care and treatment of people and the monitoring and sustainability of quality and safety at this home.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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 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 House Care Home is a care home providing personal and nursing care to 64 people aged 65 and over at the time of the inspection. The service can support up to 74 people. Amberley House Care Home accommodates people across three wings over two floors. Some of the people living in the home are living with dementia, mental and physical disabilities.

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

People's basic care needs were met by staff however staff were not always able to sit with people and offer flexible care. This meant people did not always have time with staff other than when they were offering personal care and support.

Medicines records were incomplete and did not always give guidance for people’s ‘as required’ medicines. This meant people may not always have received their medicines as prescribed and in a safe way.

People were not always supported to have choice over what they ate. People were supported by staff at meal times to ensure they maintained a balanced diet in accordance with their needs. The provider had identified they needed to continue to work on people's dining experience to ensure this was improved.

People had comprehensive risk assessments in place which explored how they would like to be supported and people were supported by regular staff. However, staff did not always have the time to read people's care plans or direct access to people’s care notes. This meant we could not be assured people always received care in line with their care plans.

The management team regularly monitored the quality of the service however audits had not identified the areas of concern we found during our inspection such as medicines records not being completed accurately and people being consistently being offered choice. This meant we could not be assured audits were effective at identifying where improvements to people’s care were required.

People were supported by kind staff to access a variety of healthcare professionals in a timely way. People were encouraged to remain independent and their dignity was respected. People were supported to communicate with staff where English was not their first language.

People were supported to have some 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.

People felt able to raise concerns with staff and the management team. Where people were at risk of abuse, staff reported concerns to the local authority and the management team completed investigations. Accident, incidents and complaints were also reviewed by the management team to reduce the risk of these reoccurring and to improve people's care and support.

People, relatives, staff and professionals were encouraged by the management team to give feedback about the service to continue to drive improvements in care. The management team acted on feedback to improve people's experience of receiving support.

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 October 2018) and there were multiple breaches 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 made or sustained and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 06 July 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to people being offered person centred care based on their preferences, the safe management of medicines and the continued monitoring and sustainability of quality 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 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.

At this inspection we found improvements had not been made and the provider was not meeting the regulations for staffing, safe care and treatment, and governance arrangements. You can see what action we asked the provider to take at the end of this report.

Amberley House Care Home 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 House Care Home accommodates up to 71 people in one adapted building. At the time of the inspection there were 62 people using the service.

There was not a registered manager in post at the time of 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.

People were not supported by sufficient staff to meet their needs. Risks to people’s safety were not always planned for and staff did not always follow guidance to keep people safe. People were not always safeguarded from potential abuse. Governance systems were not always effective in identifying concerns and driving improvements.

Staff had received training, however further work was required to ensure this was kept up to date and staff competency was checked effectively. Improvements were needed to ensure the environment was suitable for people living with dementia. People did not always receive consistent care.

People received support from staff that were caring, however improvements were needed to make sure that this was consistent. People’s preferences were not always understood by staff. People were not consistently supported to follow their interests or religion.

People were not always supported to have maximum choice and control of their lives and staff were not always aware of how to support them in the least restrictive way possible; the policies and systems in the service were not always supportive of this practice People were not consistently supported to meet their dietary needs. People were not always supported to make decisions and their communication needs were not always met. People were respected, however sometimes care was received that was not always dignified.

People were supported to take their prescribed medicines. People were protected from the risk of cross infection. Staff were safely recruited. People were supported to maintain their health and well-being.

People were supported to identify how they wanted to be cared for at the end of their lives. People understood how to make a complaint and these were responded to and used to make improvements.

Notifications were submitted as required and the manager understood their responsibilities. We found people; their relatives and staff felt supported by the manager and were able to be involved in their care.

Amberley House Care Home provides nursing care to up to 74 people. At the time of the inspection 54 people were using the service. The service was split into three areas, a nursing care area, an area for people living with dementia and a special care unit.

There was a registered manager in post. 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 of harm to people were assessed however people's risk assessments were not always followed to ensure they remained safe. Not all the equipment that people had been assessed as requiring was being used safely.

The systems the provider had in place to monitor and improve the service were not consistently effective.

People had comprehensive care plans to inform staff how to support them when at times they were anxious or aggressive. Staff had received training to be able to support people safely at these times.

People's medicines were stored and managed safely and there were sufficient numbers of staff to keep people safe. New staff had been recruited through safe recruitment procedures to ensure they were fit and of good character.

The principles of The Mental Capacity Act 2005 (MCA) were being followed to ensure people's rights were being upheld. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves

People were being cared for by staff who were supported and trained to fulfil their roles effectively.

People's health care and nutritional needs were met. People had access to a range of health care professionals when they became unwell or their health needs changed.

People were treated with dignity and respect and their right to privacy was upheld. People's right to make choices was respected.

People received care that was personalised and met their individual preferences. There were hobbies and activities available to people who wished to join in.

The provider had a complaints procedure and people knew who to speak to if they had any concerns about their care.

There had been improvements to the quality of the service since the last inspection and staff and people who used the service told us that the registered manager had affected change.

Amberley House provides nursing care to up to 74 people. At the time of the inspection 71 people were using the service. The service was split into three areas, a nursing care area, an area for people living with dementia and a special care unit.

There was a new manager in post who was yet to register with us. 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.

The manager had identified areas that required improvement but had not acted to make the desired improvement in relation to insufficient staff. Systems in place to monitor and improve the service were ineffective.

Relatives and people told us they knew how to complain but were not confident that complaints would be acted on.

People were at risk of unsafe care as there were insufficient suitably trained staff to meet the needs of people who used the service. People had to wait to have their care needs met and staff were unable to spend quality time with people in some areas of the service.

Risks to people were assessed but risk assessments were not always followed to minimise the risks of incidents occurring again.

The provider did not consistently work within the guidelines of The Mental Capacity Act 2005 (MCA) to ensure that where people lacked mental capacity they were supported to make decisions with their legal representative.

Although staff felt supported they had not received all the training they required to keep themselves and other people safe from harm whilst working with people who may become anxious and aggressive.

People's privacy was not always respected and people were not always treated with dignity and respect as staff did not have the time to spend quality time talking to people.

People did not always receive care that reflected their needs and preferences as there were insufficient staff to ensure that people's emotional needs were met.

People were encouraged to engage in hobbies and interests. Individual and group activities were organised.

People received health care support when they needed it and were supported to maintain a healthy diet.

People’s medicines were stored and administered safely by trained staff.

Staff knew what to do if they suspected a person had been abused. The manager reported incidents of suspected abuse to the local authority for further investigation.

Safe recruitment procedures were followed to ensure that new prospective staff were fit work with people.

The service was registered to provide accommodation and nursing care for up to 74 people. At the time of our inspection 72 people were using the service. People who used the service had physical health and/or mental health needs.

The service had a registered manager. 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.

Staff were not always deployed effectively to meet people’s needs and we saw that people had to wait for the support they required. People's risks were assessed though the management plans in place were not always followed to ensure people were kept safe.

Staff were aware of how to recognise the different types of abuse that may occur and how to report concerns. Systems were in place to protect people from avoidable harm and abuse and these were used when required. People’s medicines were managed safely so that they received their medicines as prescribed.

People's meal time experiences were mixed and people did not always have a choice about their food. People were not always supported and encouraged to make their own decisions about their day to day care. When people were unable to make more major decisions we saw that current legislation and guidance was followed to ensure that people’s legal and human rights were respected.

Staff were trained to deliver effective care to the people who used the service. People had access to healthcare professionals and were supported to monitor their health needs.

People’s privacy and dignity was not always respected and confidential information was not kept securely. People told us they were treated with kindness and compassion by staff and we saw some examples of this.

People did not always receive personalised care that met their preferences. Care plans contained information about people's history and preferences but this information was not always used to provide individualised support.

People and relatives knew how to make complaints and we saw that complaints were dealt with in line the provider's procedure.

People, relatives and staff had mixed views about the whether the management were approachable and supportive. The registered manager offered a number of ways for people to share their experiences and feedback.

The management team and provider completed quality checks and acted upon any issues identified. However, the quality checking systems had not identified some areas which required improvement.

People told us they were happy with the care they received and staff were responsive to their needs. One person told us, 'It's gorgeous here. Staff do exactly what I need and the way I want it done'. Another person told us, 'Staff treat me well. They do their very best for me'.

Staff we spoke with were aware of the safeguarding procedures to follow if they had any concerns. People told us that they were treated well by the staff and they treated them in a caring way.

The provider had made improvements to ensure that there were enough suitably qualified staff to provide support to people who used the service.

We found that records were stored safely and securely. Records were well organised, accurate and up to date.

People and their relatives were involved in making decisions about their care. The assessment of people's care and support included a discussion with people and their relatives about their choices and preferences. Care plans provided sufficient information to ensure staff had clear guidance and information on how to support people and keep them safe. The training of staff ensured people were supported by staff with the necessary skills and knowledge.

There were processes in place to monitor risks to the quality and safety of care. There was evidence that learning from incidents took place and appropriate changes made. The provider asked for people's and relatives opinions and feedback on the care and support received. We found that all areas of the home were clean and suitable for people to live in and for care to be provided.

Our observations during the inspection supported that care staff sometimes could not keep up with people's support needs.