Amberwood House

Updated 21 June 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection site visit took place on 25 October 2018 and was unannounced. The inspection continued on the 26 October 2018 and was announced. The inspection was carried out by an inspector, specialist nurse advisor and expert by experience on day one and one inspector on day two. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their experience related to older people and people with dementia.

Before the inspection we reviewed all the information we held about the service. This included notifications the home had sent us. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive. We contacted the local authority quality assurance team and safeguarding team to obtain their views about the service.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with seven people who used the service and five relatives. We met with four health and social care professionals and eight staff which consisted of care staff, domestic, kitchen and nursing staff.

We spoke with the registered manager, clinical lead, clinical manager and operations manager. We reviewed 11 people’s care files, four medicine administration records, policies, risk assessments, health and safety records, consent to care and treatment, quality audits and the 2018 relative’s survey results. We looked at five staff files, the recruitment process, complaints, training and supervision records.

We walked around the building and observed care practice and interactions between care staff and people who live there. We used the Short Observational Framework for Inspection (SOFI) at meal times. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We asked the clinical lead to send us information after the visit. This included policies and the an action plan regarding activities. They agreed to submit this by 1 November 2018 and did so via email.

Updated 21 June 2019

The inspection took place on 25 October and was unannounced. The inspection continued on 26 October 2018 and was announced.

The service is registered to provide accommodation and residential and nursing care for up to 54 people aged 18 and over. At the time of our inspection the service was providing residential care to 51 older people.

Amberwood House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the rating of the service had improved to outstanding.

There was a strong emphasis on people eating and drinking well. There was a relaxed atmosphere at meal times. People requiring assistance were helped in a manner which respected their dignity and demonstrated knowledge of their individual needs. A ‘Night Owl’ menu was available for people to have hot or cold food when the chef is not at the home, and a smoothie menu to help increase people’s intake. The chef met regularly with clinical staff to monitor people’s nutritional needs.

Training was tailored to meet staff members’ learning styles and to ensure staff were able to meet people’s needs. We were told that the service had introduced an online training and recording system. This enabled staff to allowed staff to access their own electronic update training and records when it suited them. ‘Dementia Friends’ training was included to enable staff to support people who are living with dementia.. Nursing staff were supported to maintain and develop their clinical skills. A Registered nurse on duty on the second day of inspection had recently attended a ‘Clinical Excellence day’. The provider told us the home had champions at the service to help improve outcomes for people. The service had champions within the home, these included roles relating to health and safety and end of life care..

People’s views were taken in consideration in how the premises was used. The provider told us three of the four smaller lounges on the first and second floors were being refurbished in response to people’s feedback. One lounge had been made into a café, whilst the second was used by people to enjoy arts and crafts.

There was effective engagement with people, and actions taken as a result of the feedback they provided. Meetings with people, staff and relatives took place. Actions from these were updated, reviewed and actioned. We were told one example was that people were involved in a ‘Caring without plastic’ initiative aimed at reducing the amount of plastic in use in the home. The provider told us people had highlighted the large number of aprons used by staff. As a result, biodegradable aprons had been sourced for trial.

The home had made strong links with the community. Coffee mornings were run, open to people, families and carers, as a way to introduce people to the home informally. A new initiative with Prama care called Colten Prama Chat was been developed. This involved telephone befriending with people from Colten Care homes reaching out to those who may be isolated. Staff had participated in a local meeting regarding priorities in the local area for groups including older people. Staff had also sponsored refreshments at a local sporting event, which people attended.

There was a commitment to continuous learning. We were told that lessons from CQC inspections were shared at home manager’s meetings. Nurses forum meetings also took place where information was shared in an open and transparent way.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falling or skin damage staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained and clinical staff.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as warm and inviting. People could express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. Activities took place in the home and were enjoyed by people.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below