Amberley Lodge - Purley

We found the following examples of good practice:

The provider had developed new ways of recording observations about people's health which were shared with healthcare professionals in advance of appointments. This had reduced the need for external visitors to the home and had facilitated good virtual consultations with healthcare professionals.

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. The provider kept in touch with family members and people's friends through regular phone calls, emails and video conferencing.

The provider had arrangements for visitors to meet with people in a visiting pod (designated area for visits) which was a converted room with a giant transparent screen separating the room and an intercom for people to speak with their family. The provider informed us they discussed visiting arrangements with families of people and one designated visitor from each family was allowed inside the visiting pod to sit next to the resident and another family member was allowed to sit on the other side of the visiting pod which had a separate entrance and they could see through the transparent screen and speak via the intercom. The provider informed they did a two-step visitor pod deep cleaning after each visit and visits were timed accordingly. All visitors were asked to complete a COVID-19 screening form on arrival, and had their temperature checked. A COVID-19 lateral flow test was carried out on all visitors and visiting professionals who were not on the national testing programme. All visiting professionals on the national testing programme were asked to show proof of their recent COVID-19 negative test. On entry all staff and visitors were asked to change their face masks in the toilet near the entrance. This was to ensure the safety of staff and people. People were supported to see their family in the garden during summer and markings were done in the garden to ensure social distancing.

To ensure people's well-being the provider performed monthly wellbeing assessments using a tool and people's mental state was monitored. If there was a decline in the mental state of people, they were offered extra support. For example, the activity co-ordinator spent more time with them. The provider had two activity co-ordinators who did individual and group activities. The provider had daily, weekly and monthly activity plans for people and all activities were performed within their social bubble in dedicated activity rooms on each unit. They used an application to tailor activities suitable for each resident. The provider informed due to COVID-19 they had stopped external entertainers.

The provider had built a cabin in their garden which could be set up as a pub or a restaurant for residents to use. This was done to improve the wellbeing of people. They had set up a room which could be used by residents to have a drink or play a board game. They had also set up a spiritual room to use for prayer and to read spiritual books. The provider informed they had a Christmas mass for three residents in the visiting pod where a priest did a blessing.

The provider had an admissions process in place. People had a COVID-19 test within 24 to 48 hours prior to being admitted into the service and were isolated for 14 days following admission to reduce the risk of transmission of COVID-19. The provider informed they gave a virtual tour of their premises for family members before admitting a person to their home.

The home had three clean areas for staff to don and doff (put on and take off) PPE.

Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The provider had ensured staff who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing.

Further information is in the detailed findings below.

Amberley Lodge - Purley is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Amberley Lodge – Purley provides nursing care. CQC regulates both the premises and the care provided and both were looked at during this inspection. The care home specialises in dementia care and end of life care. The service provides care for up to 59 older people requiring residential or nursing care. There were 49 people using the service at the time of our inspection.

The home had 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.

The service was outstandingly caring. Staff were exceptionally kind and caring and demonstrated a real empathy and understanding of people with dementia. Staff knew people well and staff helped people reflect on their past creatively. People received compassionate care in line with best practice for people with dementia. The service had a strong, visible person-centred culture and the registered manager set up a successful ‘wish tree’ project to fulfil people’s wishes, despite their advancing age, dementia and medical conditions. People were supported to maintain relationships and social contacts. People were given the privacy and dignity they needed.

The service was outstandingly responsive and the service was innovative in relation to end of life care. Staff were encouraged to talk about death and dying openly and sensitively with people and the service helped people plan the end of their lives with dignity. Staff had an excellent understanding of the best ways to deliver end of life care following best practice guidelines including ‘Namaste’ care for people with advanced dementia. Staff also followed the personal wishes of people and their relatives when people were at the end of their lives. The service responded rapidly to people’s changing care needs so people experienced a comfortable, dignified and pain-free death. Staff were very able to meet people and relative’s emotional and practical needs when people reached the end of their lives.

Arrangements for social activities showed innovation with a weekly fruit market for people at the home. Activities met people’s needs and helped them lead a full life. Relatives and professionals agreed the service was excellent at providing person-centred care.

The service was outstandingly well-led by the registered manager and management team. Managers developed their leadership skills and those of others and the registered manager created a positive atmosphere to work where staff felt well supported. Staff were motivated by and proud of the service with award systems in place to recognise their achievements. Staff had high levels of satisfaction levels relating to equality and inclusion at work. The registered manager and other managers kept their knowledge current attending forums and completing specialist training in leading services for people with dementia. The registered manager developed the values of the service through involving people and staff and the values placed people centrally. Governance was well-embedded in the service with a strong framework of performance monitoring and the service was involved in an internal ‘good to great’ scheme to achieve excellent standards. There was an emphasis on continuous improvement and the views of people, relatives and staff were pivotal to this.

People felt safe with the staff who supported them and staff knew how to safeguard people from abuse and neglect. People received care from the right numbers of staff. Risks relating to people’s care, including those relating to their medical conditions such as diabetes, dementia, mobility and risk of falls, were well managed by staff. Staff understood people’s needs well. People received care from staff who were suitable as the provider carried out the right recruitment checks. People received their medicines safely and the provider was implementing an electronic medication administration recording system with the aim of improving safety. The premises were clean and free from malodours and staff followed appropriate infection control procedures. People lived in premises which were maintained safely and were secure.

People received the support they needed relating to eating and drinking including any specialist support to reduce their risk of malnutrition. Staff took care to ensure mealtimes were a pleasant, unhurried experience for people. The chef had a good knowledge of people’s needs and preferences and followed guidance from professionals such as dietitians and speech and language professionals in preparing food.

People were supported with their day to day health and nurses worked with other healthcare professionals to ensure people’s medical needs were met.

The premises were adapted to people living with dementia based on current research including the use of colour to help people recognise doors and entrances.

Staff received the training and support they needed to understand their roles and responsibilities and staff told us the training was good quality.

People received care in line with the Mental Capacity Act (MCA) and their choices were respected by staff. The provider followed the Deprivation of Liberty Safeguards (DoLS) in lawfully depriving some people of their liberty as part of keeping them safe.

Processes were in place to respond to concerns or complaints and the provider’s complaints policy was shared with people and their relatives so they knew how to raise a concern.

Amberley Lodge Purley provides care for up to 60 older people requiring residential or nursing care, some of whom may be living with dementia.

The home had 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.

We found there was outstanding leadership at Amberley Lodge Purley. The registered manager communicated a strong ethos focusing on striving for excellence, leading by example and always trying to ensure a good quality of life for the people living there. The home had made sustained improvements since 2014 and this was recognised by people using the service, their relatives and other professionals.

People and their relatives were positive about the care and support provided. Staff knew people well and treated them in a kind and dignified manner. We observed positive relationships between staff and people at the service and their relatives throughout our visits.

Any risks to people were identified and they were supported to maintain their welfare and safety. Staff were knowledgeable about safeguarding adult’s procedures and said they would report any concerns they had to the registered manager and other senior staff.

People were supported to have their health needs met. Staff worked well with other healthcare professionals and obtained specialist advice as appropriate to help make sure individual health needs were met. We saw that people’s prescribed medicines were being stored securely and managed safely.

Staff told us they felt valued and appreciated for the work they did by the management team. Staff attended regular training which gave them the knowledge and skills to support people effectively.

Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people no longer had the capacity to consent to aspects of their care, staff worked in people’s best interests and looked to use the least restrictive option.

People and their relatives felt able to speak to the registered manager or other staff to raise any issues or concerns. There were effective systems to monitor the quality of the service and obtain feedback from people and their representatives.

Following our last inspection visit in February 2014, we asked the provider to take action to make improvements around staffing and record keeping. We found this action had been completed.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

Is the service safe?

People told us that they liked living at the home and said they felt safe there. Comments included 'I think it's quite nice', 'Fantastic', 'Never known it to be so good' and 'It's handy, as good as anywhere."

We saw the home environment was safe, clean and well maintained. Further work could take place to make the home more 'dementia friendly' with improved opportunities for engagement and occupation.

Is the service effective?

We saw people's changing care needs were being identified and discussed by care staff through their key worker responsibilities, care plan reviews, handovers, team meetings and supervision sessions with their line manager. New systems had been put in place to ensure that an effective management structure was in place on each floor. Staff were initially worried about the changes taking place with some individuals moving to different floors however positive feedback was received during our second visit to the home. Comments included 'I love the change' and 'I like the results'.

We saw that staff now had access to the training and supervision that helped them do their jobs well.

Is the service caring?

People using the service told us that staff treated them with respect and said they were happy living at the home. Feedback included 'I love it here', 'The staff are quite friendly', 'They're very kind' and 'Very nice."

Staff understood the importance of treating people with dignity and respect and they gave us examples of how they upheld these values. A small number of instances were however noted where people were moved without being properly informed beforehand. This should be seen as a priority for on-going work by the dignity champions appointed on each floor of the home.

Is the service responsive?

We had some mixed feedback from people using the service and their family members or friends about the activities provided within the service or out in the community. Some people were very positive about the activities but others would welcome more things to do particularly outside of the home environment. The service does not currently benefit from having its own vehicle to enable more regular or spontaneous trips out.

People said they knew how to make a complaint and felt able to approach the manager or other senior staff. Family members or friends told us 'they have listened to me' and 'I can go and they do something about it'.

Is the service well-led?

The service had a new manager in post. The turnover of managers at Amberley Lodge Purley has been highlighted in previous inspection reports and remains a key risk for this service.

Family members or friends of people using the service told us 'Issues have fallen between different managers' and 'I think we have had seven or eight managers come and go'. Some individuals reported that they had stopped going to the relatives meetings saying 'There is no point in attending...there is always a new manager and in the end what we suggest is forgotten and is not acted upon."

Staff members spoke about the impact this had on their work saying 'It's not easy to keep changing manager' and 'Very unnerving.' They were however positive about the leadership, support and training now being provided which helped them to meet people's needs. One staff member said 'They're on top of it now' and another said 'fingers crossed, we've been through a lot here."

The home clearly needs to benefit from having a consistent management team in post for a prolonged period of time.

At this inspection we judged that those concerns we had previously raised had been addressed. The majority of the people using the service were not able to contribute to the inspection process due to their complex health needs. However we saw that they were comfortable and engaged with the staff and their surroundings. Many of the staff had worked in the service for some years and we saw that they were very kind and sensitive to people's needs.

We did judge that there might not always be sufficient staff on duty to meet people's needs. This was particularly on the ground floor. We also raised concerns that one person was being deprived of their liberty to move around freely. There was a lack of documentary evidence to show how this decision had been made.

All of the people we spoke with were very happy with the care and support that they received. They told us that the staff were 'kind', 'obliging' and 'couldn't do enough for you'. They said that they were free to spend their days as they wished and there were activities arranged for them if they wanted to join in. The service worked closely with other healthcare professionals in order to meet people's needs. People's relatives confirmed that they were involved in planning people's care and always kept informed of any changes.

Most people enjoyed the food at Amberley Lodge. They told us that there was always a choice and we saw that individual and cultural preferences could be catered for.

We saw that procedures were in place to make sure that people received their medication appropriately and it was managed safely.

There was a programme of staff training in place. There was a process in place to identify any shortfalls and staff were being encouraged to attend training to help them in their roles.Supervision was in place to monitor staff performance.

Records that the service was required to keep as evidence of its commitment to the health and safety of people and staff were in place.

Complaints were responded to appropriately.

During the course of our review, prior to this inspection, we had been informed of two serious safeguarding matters. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. Investigations had judged both these issues to be substantiated. There was ongoing monitoring in place by the local authority. We found evidence to show that the provider had taken the appropriate action by immediately informing the relevant authorities and following their own procedures for responding to them. At the time of our visit there was an interim manager in place. There has also been an improved programme of monitoring by senior personnel within the organisation.