Archived: Amberleigh House Care Home

Updated 2 November 2018

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 took place on 18 and 20 September 2018 and was unannounced. The inspection team included two adult social care inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this instance their experience was in relation to supporting older people living with dementia.

Before our inspection we reviewed the information we held about the service. This included the statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We had received a large amount of notifications concerning falls and incidents involving people who lived at the home. There had also been a recent change in manager at the home so we planned our inspection sooner than expected to ensure people were receiving care and support which was meeting their needs.

We also contacted the commissioners of the service and received some mixed feedback from professionals.

We used all of this information to populate our planning tool. This is a document which helps us plan how the inspection should be conducted.

During the inspection we spoke with the manager, the quality manager, the maintenance person, six members of the care staff, seven visitors, and three people who lived at the home.

We looked at the care files of four people receiving support from the service, four staff recruitment files, medicine administration charts and other records relevant to the quality monitoring of the service.

We also observed the delivery of care at various points during the inspection. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 2 November 2018

This inspection took place on 18 and 20 September 2018 and was unannounced.

Amberleigh House is registered to provide accommodation for people who require nursing or personal care, and the treatment of disease, disorder or injury. It is a charity owned care home which provides accommodation for up to 38 adults living with dementia. The service is located in the Fazakerley area of Liverpool and is close to local public transport routes. Accommodation is provided at ground level and all rooms have en-suite facilities.

When we last inspected Amberleigh House in February 2017, the service was rated as 'Requires improvement’ in the responsive domain. This was because records associated with people’s individual care needs were not always completed fully. Following this inspection, the provider wrote to us to tell us how they would address these concerns and make improvements to meet the regulations. We reviewed this plan as part of this inspection. We found that the service had not made sufficient enough improvements to meet this breach. We also found an additional breach in relation to safe care and treatment.

There was a manager in post, however they had not yet registered 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.

The registered provider had made some improvement with regards to record keeping. However, we found there were still issues relating to wound care plans for some people as well as other records which still had some gaps. There were audits in place which identified the need for further improvement in some areas, and this had been followed up with an action plan. However, other audits had not identified some of the other concerns we highlighted during this inspection. The provider was still in breach of regulation relating to record keeping and good governance.

There was a lack of planning and recording to support good wound care for people with pressure sores. Some people had special pressure relief mattresses and the settings of these mattresses had not been recorded. This meant that the home had not adequately protected people from the risk of injury to their skin or worsening pressure sores. We fed this back to the manager at the time of inspection and this was rectified straight away. Additionally, other risk assessments were not always accurate and information varied between the risk assessment and staff knowledge of the risk. This meant we could not be sure the registered provider had a robust procedure with regards to minimising risks to people.

It was not always clear that the Mental Capacity Act 2005 (MCA) was applied correctly and decisions were being made in people's best interests. Most records we viewed in relation to the MCA had specific decisions recorded on them however best interest processes for people were not always considered. Consent was not sought in people’s best interests for some of the care plans we viewed. We have made a recommendation regarding this. When we returned for day two of our inspection, the manager had made some improvements to this process and hads a plan in place to complete the rest.

The high use of agency staff was a concern during our inspection. People and their relatives fed back that this was worrying for them. We did see however, that the use of agency staff had decreased in the last few months, and the manager informed us that additional staff had been recruited and were awaiting further clearance checks.

People told us they mostly felt safe living at the home, however the staffing had been a concern, as was some environmental issues which we raised at the time with the manager.

Medication was safely managed, stored and administered. People received their medications on time. However, there were some issues with recording.

Staff were recruited and selected to work at the home following a recruitment procedure. The manager retained comprehensive records of each staff member, and had undertaken checks on their character and suitability to work at the home. There were some discrepancies with regards to staff members references which we raised at the with the manager.

The home was clean and tidy. There was provision for personal protective equipment stationed around the home, and staff were trained in infection control procedures.

Staff were able to describe the process they would follow to ensure people were protected from harm and abuse. All staff had completed safeguarding training. There was information around the home which described what people should do if they felt they needed to report a concern.

The training matrix showed that staff were trained in all subjects which the provider considered mandatory to their role, and as stated in the provider's training policy. New staff with no experience in health and social care were enrolled on an induction process which was aligned to the principles of the Care Certificate.

Staff received regular supervision and appraisal. We did see some gaps in the recording of this however, the manger was able to explain the reasons for this.

People were supported to eat and drink in accordance with their needs. People, who were assessed as at risk of weight loss had appropriate documentation in place to monitor their food and fluid intake. We did raise at the time that some of these documents were not completed accurately or in full. Where specialist diets were needed for some people, the staff had knowledge of this.

The service worked in conjunction with all medical professionals to ensure people had effective care and treatment. We received feedback from some professionals involved with peoples care which was mostly positive Everyone had records in their files relating to external appointments with healthcare professionals such as GP's, opticians, dentists or chiropodists. The outcome of these appointments was recorded in people's records..

We observed kind and caring interactions between staff and people who lived at the home. Staff spoke kindly and fondly about people, and demonstrated a good knowledge about them, their likes and their needs. People told us they liked the regular staff and felt that they were kind to them.

There was information recorded in people's care plans with regards to their likes dislikes and how their care should be delivered which showed the service was providing care in a diverse way.

People confirmed they knew who the manager was and everyone we spoke with said they had noticed an improvement in the service since the new manager had taken up post in July. Team meetings and resident meetings took place. Feedback was gathered from people who used the service and their families, the manager had also attempted to meet relatives one to one to introduce themselves.

We saw all notifications had been sent to CQC.

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