Amberley Hall Care Home

Amberley Hall Care Home is a service providing nursing and residential care to up to 106 people. The service provides support to people with nursing and residential support care, including for people living with dementia. At the time of our inspection there were 97 people using the service.

The service consisted of 6 units, called Buckingham, Kensington, Sandringham, Balmoral, Windsor and Regency. Each unit was providing either nursing, nursing for people living with dementia, residential care or residential care for people living with dementia. Regency unit was used for people recently discharged from hospital. Staff in this unit worked in partnership with other healthcare professionals, some of whom were based on the unit, to aid people's recovery.

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

Standards of care and support were found to be poor, particularly on the dementia nursing unit. People were not consistently 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. We found examples of restrictive practices in use at the service, with a lack of consideration of least restrictive alternatives.

People did not receive their medicines as prescribed, and we identified gaps in the completion of corresponding records. People were not being protected from the risk of harm, including in the condition and cleanliness of the care environment. People had unsupervised access to items such as razors and personal care products, including prescribed creams placing people at risk, particularly those people living with dementia who were reliant on staff support and oversight to keep them safe.

People were not supported with regular repositioning to prevent them developing pressure ulcers. Where people were at known risk of falls, or at risk of leaving the service without staff being aware, the corresponding records showed gaps in the frequency of welfare checks being completed. People’s basic standards of personal hygiene and presentation were not being consistently met, with areas of the service found to have malodour, and some people found to have unclean nails and teeth.

Response times to call bells and assistive technology to maintain people’s safety was poor. Where people were involved in incidents, sufficient mitigation was not being implemented or followed by staff to prevent the risk of reoccurrence. People were not being supported by sufficient numbers of staff, and this was reinforced by people and relative’s feedback.

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 good (published 17 September 2021).

Why we inspected

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.

This inspection was prompted by a review of the information we held about this service and due to receiving information of concern relating to the safety of people living at the service. A decision was made for us to inspect and example those risks. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to consent, protecting people from the risk of harm or abuse, providing safe care, the governance and oversight of the service, and the number of staff on shift 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, which will help inform when we next inspect. 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.

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.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Amberley Hall is a residential care home and was providing accommodation and personal and nursing care to 89 people at the time of the inspection. The service can support up to 106 people and provides a service to older and younger people, including those with physical disabilities and those living with dementia.

Amberley Hall is divided into six units. The service had one unit for up to 20 people which was used for people recently discharged from hospital. Staff in this unit worked in partnership with other healthcare professionals, some of whom were based on the unit, to aid people's recovery.

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

People and their relatives told us they felt safe. People were safeguarded from the risk of abuse by trained, knowledgeable staff and received safe care and treatment. One person, “I feel very safe here. The staff are always there for me.”

Staff were provided with guidance to support people safely. Risks to people's health, safety and wellbeing had been identified, assessed and reviewed regularly.

Any incidents and accidents at the service were analysed and action taken in response to the findings.

Medicines were managed safely, and infection prevention and control procedures were followed. Staff facilitated visits for relatives and friends.

Recruitment procedures were followed to ensure staff were recruited safely and all relevant pre-employment checks completed. Staffing levels were reviewed regularly to ensure people’s needs were met.

The registered manager used a wide variety of methods to monitor the safety and quality of the service and make improvements where needed. Staff and relatives told us that the registered manager was approachable, and staff were confident that action would be taken if they raised concerns.

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 7 February 2020).

Why we inspected

This was a planned inspection based on our ongoing monitoring of the service.

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.

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 Hall Care Home is a residential care home providing personal and nursing care to 88 people, some of whom are living with dementia at the time of the inspection. The service can support up to 106 people. Amberley Hall is a purposed built care home divided into separate units that provide specialised residential or nursing care. The service also provides intermediate care and rehabilitation in partnership with local clinical commissioning group therapy staff.

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

Improvements had been made to ensure that peoples medicines were managed safely. Staff were able to administer these free from interruption. Topical medicines and creams were stored securely which helped people keep safe. Records of the administration of medicines were concise and complete.

We found people were protected from the risk of acquiring infections and the service was clean. Personal protective equipment was available to staff and all staff were following the latest guidance.

The manager had implemented new systems to ensure that admissions to the service were well planned and comprehensive. The impact of new admissions to the home was assessed holistically and included potential impact on people already living at Amberley Hall care home.

The learning from the impact of a COVID -19 outbreak at the service at the emergence of the pandemic had been used to implement changes to reduce the risks as far as practical of another outbreak. The manager of the service had been proactive in planning for the arrival and implementation of a COVID - 19 vaccination so that people and staff had been provided with accurate information and support so that they could make an informed decision on participation.

Rating at last inspection (and update)

The last rating for this service was requires improvement (Published 8 February 2020)

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 undertook this targeted inspection to check whether the requirement notice we previously served had been acted upon in relation to Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following concerns raised to the CQC earlier in the current pandemic relating to the use of personal protective equipment (PPE) and the management of risks to people, we also looked at the infection control and prevention measures in place and how risks to people were managed. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amberley Hall 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 Hall is a residential care home and was providing accommodation and personal and nursing care to 94 people, five of whom were receiving respite care, at the time of the inspection. The service can support up to 106 people and provides a service to older and younger people, including those with physical disabilities and those living with dementia.

Amberley Hall is divided into six units. The service had one unit for up to 20 people which was used for people recently discharged from hospital. Staff in this unit worked in partnership with other healthcare professionals, some of whom were based on the unit, to aid people’s recovery.

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

People who used the service, and their relatives, were very happy with the care and support provided and spoke highly of the staff and the manager. One person commented, “The staff are always asking if they can do any more for me. My folder is there on the bed. The staff say I can look at it if I want to…. [When I first arrived] the staff knew exactly what to do for me.””

We identified some concerns with the way medicines were managed. Storage of some medicines required improvement and some staff practice, when giving people their medicines, placed people at risk. Records relating to medicines management were not always fully completed.

Risks were mostly well assessed and well managed. However, some risks relating to pressure care, infection control and choking had not been reduced enough and had the potential to place people at risk of harm. Audits, although plentiful, had not identified the issues we found. The provider began to address these concerns immediately we brought them to their attention.

The staff teams in the individual units worked collaboratively and well; staff felt supported and their views were sought and acted upon. Staff were recruited safely and were clear about their safeguarding responsibilities. Staffing levels reflected the provider’s own assessed safe number and people felt there were enough staff.

Staff were trained to carry out their roles and received a good induction when they were first employed. Access to health and nursing care was good and feedback from healthcare professionals was very positive.

Staff showed a good understanding of consent issues, but the manager acknowledged that some records needed reviewing. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests.

The environment was suitable for people, including those living with dementia and those people on respite stays whilst they recovered from illness or injury.

Staff were patient, kind and caring towards the people who used the service and their relatives. Staff promoted people’s independence and upheld their dignity. Feedback about the staff was very positive.

The service enabled people to follow their own hobbies and interests. Activities were varied, appropriate and inclusive. Complaints were managed in accordance with the provider’s policy and action taken promptly. End of life care was good, and we observed prompt responses to people's changing needs.

Although the inspection identified some areas for improvement, the provider began to take action as soon as issues were identified. Their response was encouraging and gave us confidence in them and in the newly appointed manager.

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 good (published 09 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulation in relation to the management of medicines at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will continue to do to improve the standards of quality and safety. 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.

Following the inspection the provider wrote to us to say what they would do to meet the legal requirements. We undertook an unannounced focused inspection on 7 July 2016 to check that our warning notice had been complied with. At that inspection, we found that the provider had taken sufficient action to achieve compliance with the Warning Notice.

We undertook this unannounced comprehensive inspection in January 2017 to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. At this inspection, we found improvements had been made in the required areas and the provider was no longer in breach of the regulations.

You can read the report for previous inspections, by selecting the 'All reports' link for 'Amberley Hall Care Home' on our website at www.cqc.org.uk

Amberley Hall Care Home is registered to provide accommodation for up to 106 people who require nursing and personal care. We spent time in four of the six units within the home. This included the units providing nursing care or specialising in care for people living with dementia. During our inspection, we spent time on the Windsor, Kensington, Regency and Buckingham units. There were 102 people living within the home.

This unannounced inspection took place on 11 and 12 January 2017.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us that they felt safe living at the service. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff knew who to report any concerns to. People received their medication as prescribed.

There were sufficient numbers of suitably qualified staff employed at the service. The provider’s recruitment process ensured that only staff that had been deemed suitable to work with people at the service were employed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager was knowledgeable about when a request for a DoLS application would be required. Applications had been submitted appropriately to the relevant local authority.

Staff respected and maintained people’s privacy. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. People’s dignity was respected and that their care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Most care records were detailed and up to date so that staff were provided with guidelines to care for people in the right way. Where records were not up to date, there was a plan in progress to address this.

People were supported to access a range of health care professionals. Risk assessments were in place to ensure that people could be safely supported at all times.

People were provided with a varied menu and had a range of meals and healthy options to choose from. There was a sufficient quantity of food and drinks and snacks made available to people.

Staff provided people’s care in a respectful, caring, kind and compassionate way. Staff supported people to take part in their chosen activities to prevent them from becoming socially isolated.

The service had a complaints procedure available for people and their relatives to use and staff were aware of the procedure. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

There was an open culture within the service and people were freely able to talk and raise any issues with the registered manager and staff team. People, staff and relatives were provided with several ways that they could comment on the quality of their care.

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. The service remains requires improvement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amberley Hall Care Home on our website at www.cqc.org.uk

Amberley Hall Care Home provides accommodation and support to a maximum of 106 older people, some of whom are living with dementia. The home provides a mixture of nursing and residential care. We focused this inspection on two of the five units that are at the home, these were the Regency unit and the Windsor unit. The Regency unit provides care for people living with dementia who require residential care and the Windsor provides care for people living with dementia and who require nursing care.

At the time of this inspection, the home 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 and associated Regulations about how the service is run.

At the previous comprehensive inspection effective monitoring systems were not in place to ensure quality and safe care. This had resulted in people receiving poor care and being at risk of harm.

At this inspection we saw that there were effective systems in place that had been developed since our last visit. These were to monitor the quality and safety of people living at the home, and to reduce the risk of harm and poor care. The registered manager had identified where improvements had been needed and actions had been undertaken to achieve this, which was proactive and positive. The registered manager had, as a result of this also identified where they would like to make future improvements and a plan was in place for this.

The Warning Notice we issued was complied with.

Amberley Hall Care Home is a care home that provides accommodation, personal care and nursing care for up to 106 people. The home is split into six separate units. These are the Kensington unit that provides care for people with nursing needs, the Windsor unit that provides care for people living with dementia who have nursing needs, the Regency unit that provides care for people living with dementia with residential needs, the Balmoral and Buckingham units that provide care for people with residential needs and the Sandringham unit that provides care for people who are reaching the end of their lives. On the day of our inspection, we spent time on the Windsor, Kensington, Regency and Buckingham units. There were total a of 94 people living within the home.

The current manager had been employed at the home since September 2015. They had not yet registered with us but told us that they planned to do so shortly. 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 and associated Regulations about how the home is run.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People who could provide us with feedback felt safe living at Amberley Hall Care Home and were happy living there. They were given choice about how they wanted to live their lives, were listened to and respected and had plenty of activities to participate in to enhance their wellbeing. However, not everyone who was living with dementia had the same experience.

There was a lack of stimulation for people who were living with dementia and they were not always treated with dignity and respect. There were not enough staff to meet their needs and provide them with personalised care. The staff did not always follow the principles of the Mental Capacity Act when making decisions on behalf of people. Therefore, people’s rights may not have been protected.

The staff were kind and caring but some lacked the skills to engage with people who were living with dementia effectively. Some staff lacked robust supervision which contributed to some of them displaying poor care practice. Risks to people’s safety were not always managed well and some people did not receive their medicines when they needed them. This left them at risk of harm.

People received enough to eat and were supported to maintain their health. The equipment that people used and the premises they lived in had been well maintained.

The provider had not taken timely action to make sure that people received the care they needed, when they needed it. There was a lack of oversight of the quality of care that was being provided on some units. The current systems in place to monitor the quality of the care provided were not effective. This had been recognised and a number of improvements were being implemented.

Care plans contained the information that enabled staff to provide appropriate and safe care and support. People we spoke with who used the service told us that they were provided with the assistance they needed. One person told us 'Staff are really excellent here and always ready to help.' Another person said 'I have no complaints at all, everything is just wonderful.'

Records showed us that staff received training and supervision on a regular basis and staff told us that they felt fully supported by senior management. This ensured that staff had the relevant training to meet the needs of people and that the manager was aware of any training areas that needed reviewing.

We saw that an assessment of the quality of the service was regularly carried out. People told us that there were regular meetings where they voiced their opinions about the care and support that was provided. The auditing systems that were in place helped to develop any new procedures that supported the safety and wellbeing of people living in the home.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind.

Staff members were trained and were supported to provide an appropriate standard of care and support. Improvements were being made to ensure that all staff received regular supervision and a yearly appraisal and took part in planned staff meetings.

People spoken with were aware of the complaints system. Complaints were dealt with appropriately and people were able to access and use the complaints system in a format that met their needs.

People who we spoke with said that they were satisfied with the standard of support and care they received. They told us that they felt, 'Comfortable' while lying in bed and sitting in their chairs. People also told us that they always had enough to eat and drink. We saw that people had access to cold and hot drinks and were supported with taking these.

From information provided by the home's internal audit and thorough speaking with senior clinical and managerial staff of the home, we found that there was a significant increase of numbers of people acquiring pressure ulcers while living at the home. This increase notably commenced since July 2012 which affected 11 of the current 104 people who used the service.

Staff who we spoke with said that since the change of management of the home in September 2012, they were given clearer direction, guidance and improved training and support to be able to provide safer care to people who were at risk of developing pressure ulcers.

Improved quality assurance systems were now in place to report, monitor and review people's health care needs.