Amberley House - London

Amberley House is a residential care home providing accommodation and personal care for up to 30 people aged 65 and over, some of whom may be living with dementia. At the time of the inspection there were 3 people living at the home. The home is a large adapted detached house. There is a large garden to the rear of the property.

In December 2022 the local authority identified concerns around the quality of care being provided at Amberley House. On 9 December 2022 the local authority placed an embargo on Amberley House not allowing them to accept any new referrals until the quality of care had been improved. The embargo was still in place at the time of this inspection. Since the last inspection people had been supported by the local authority to move to alternative homes if they wished to.

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

At this inspection we found there had been an improvement in the quality of care and the provider had addressed some of the concerns raised during the last inspection. However, we found breaches of regulation around staff training, assessing risk and governance of the home.

We have also made a recommendation around care planning and the use of language when discussing people living with dementia.

People and their relatives told us people were safe living at Amberley House. Whilst we found not all staff had received training in safeguarding, staff were able to explain safeguarding and how they would report any concerns. People received their medicines safely and on time. Staff were recruited safely, and relevant background checks done before staff started work. There had been a lot of work on the premises around decorating and replacing furniture which was on-going. Staff had received training in infection control and understood how to keep people safe. There were no restrictions on visiting.

People were supported to eat and drink, and staff were aware of their likes and dislikes. People were referred to appropriate healthcare in a timely way. Staff knew people well and understood when they became unwell. People were supported to have maximum 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. Staff were supported in their role through regular supervision and appraisal.

Activities for people had improved within the home and people’s interests and what they enjoyed were documented and acted on by staff. Care plans were person centred and contained information that was important to maintain people’s health and wellbeing. There was a complaints process in place. People and relatives knew how to make a complaint.

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 inadequate (published 26 April 2023) and there were breaches of regulation.

This service has been in Special Measures since 26 April 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The provider completed an action plan around regulation 18 (staffing) after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made. However, we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

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

Enforcement

We have identified breaches in relation to staff training, assessing risk and good governance of the home.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Amberley House is a residential care home providing accommodation and personal care for up to 30 people aged 65 and over, some of whom may have dementia. At the time of the inspection there were 14 people living at the home. The home is a large adapted detached residential house. There is a large garden to the rear of the property.

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

People told us they felt safe and cared for living at Amberley House. We observed kind and caring interactions between people and staff throughout the inspection. Despite people’s positive experience we found significant concerns around the quality and safety of care and support.

People's personal risks were not always assessed. Where risks were assessed, risk assessment documents failed to provide adequate guidance to staff. People had not been referred in a timely manner to healthcare professionals when they lost significant amounts of weight. People’s bedrooms and en-suite bathrooms were not always clean, and furniture was in a poor state of disrepair. There were ineffective systems in place to identify and address the issues found during the inspection. The home did not have a cleaner and staff did this as part of their daily shifts which meant staff did not have enough time to spend with, and care for people.

People were not consulted on planning the food menu and had limited choice around what they wanted to eat.

Care plans were not always person centred and failed to document how some people’s health care and support needs should be met. There was no activities coordinator which meant staff were also responsible for leading on activities. People were not consulted about what activities they would like to participate in which meant there were limited activities for people to enjoy.

There was a lack of managerial oversight of the home. There were no audits for some aspects of care and where audits were in place, these failed to identify issues found during the inspection. There were inadequate systems in place to get feedback from people and relatives. There had been a failure to learn from previous CQC inspections or to make and embed positive change.

Medicines were well managed, and people received their medicines safely and on time. Staff were recruited safely, and all appropriate checks completed before they started working at the home. Staff had been trained in safeguarding and understood how to recognise and report any concerns. We were assured the home had good infection control systems and processes.

In relation to mental capacity, people were supported to have maximum 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. Staff told us they felt supported and received regular supervision and appraisal.

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 14 May 2020) and there were 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 we found the provider remained in breach of regulations.

At our last inspection we recommended the provider considered recognised guidance on safe medicines management in care homes. At this inspection we found this had been addressed.

Why we inspected

We received concerns in relation to a lack of stimulation and activities, the quality and choice of food, several people losing weight and lack of referrals to appropriate healthcare professionals and care plans not being up to date. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive 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 requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

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

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.

Enforcement

We have identified 5 breaches of regulation in relation to assessing people’s risks to their health and welfare, the maintenance and cleanliness of the home, how staff were used and deployed within the home, a lack of person-centred care including care planning, food choices, activities and a lack of robust governance of the home.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 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 time frame 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 House – London is a residential care home providing accommodation and personal care for up to 30 people aged 65 and over, some of whom may have dementia. At the time of the inspection there were 24 people living at the home. The home is a large adapted detached residential house. There is a well-appointed, large garden to the rear of the property.

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

People and relatives said they felt Amberley House was a safe place to live. Relatives praised the committed and caring staff team. Staff knew people well and people were treated with dignity and respect. Relatives talked of ‘banter’ and lots of laughing between people and staff. Staff understood how to work with people living with dementia.

There had been significant improvement since the last inspection. However, progress had been slow. Systems to adequately record and address accidents and incidents were not in place. There was a failure to ensure care documents and good management oversight of people’s care records was in place. Audits were not completed to show there was appropriate oversight of the home and to identify any concerns.

People received their medicines safely and on time. However, there remained some concerns around medicines management. We have made a recommendation around medicines. People’s risks were assessed, and staff understood how to minimise peoples known risks. There had been refurbishment of some rooms, furniture and flooring had been replaced in some areas. The home smelled fresh and clean. There was increased infection control measure in response to the coronavirus outbreak. The provider reacted quickly and appropriately to keep people safe.

Staff were well trained and supported through regular supervision and appraisal. People were provided with a choice of what they wanted to eat and drink. People were supported to have maximum 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 were involved in planning their care where they were able. There were residents, staff and relatives’ meetings where feedback could be given. The home worked well in partnership with other healthcare professionals to ensure their care needs were met.

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 Inadequate (published 14 October 2019) and there were multiple breaches of regulation. We took enforcement action due to the significant concerns found. We imposed conditions on the providers registration. This meant the provider had to send us monthly reports on how they were addressing the issues found during the last inspection.

This service has been in Special Measures since 14 October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

At this inspection we have found evidence that the provider still needs to make improvements. Please see the safe and well-led sections of this full report.

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of 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 monitor the service and to hold providers to account where it is necessary for us to do so.

At this inspection we have found there have been significant improvements. We have withdrawn the requirement for the provider to send us monthly reports.

However, at this inspection we have identified two breaches in relation to recording accidents and incidents and management oversight of the home.

Please see the action we have told the provider to take at the end of this report.

Amberley House – London is a residential care home providing accommodation and personal care for up to 30 people aged 65 and over, some of whom may have dementia. At the time of the inspection there were 29 people living at the home. The home is a large adapted detached residential house. There is a well-appointed, large garden to the rear of the property.

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

People told us that they felt safe living at Amberley House. Feedback from relatives was also positive. However, we found significant concerns around how the home was managed, documentation relating to care, cleanliness and ensuring people’s psychological needs were met.

People’s personal risks were not always assessed. Where risks were assessed, risk assessment documents failed to provide adequate guidance to staff. People received their medicines safely and on time. However, we found that systems to safely monitor medicines were ineffective. Staff recruitment was not always safe or consistent.

People’s bedrooms were not always clean, furniture was often unsafe and in a poor state of repair. Whilst the provider took remedial action when this was pointed out, there were not adequate systems in place to identify this prior to the inspection. Infection control was not always well managed.

Staff did not have enough time to spend with people. There was no system in place to ensure that there was sufficient staffing to make sure people were adequately supported in all aspects of their care.

We observed caring and warm interactions between staff and people. However, we also observed interactions that were not as caring where people’s privacy and dignity was not respected.

Care plans were not person centred and failed to give staff guidance on how to work with people as individuals. People were observed to be sitting in the communal lounge with very few activities or stimulation. There were no formalised activity timetable and people were not supported to follow their interests. People did not always have a choice of what they wanted to eat and were not involved in menu planning.

People were not supported to have maximum choice and control of their lives. People did not always have choice around every day decisions such as, what they wanted to eat or if they wanted to go out.

There was a lack of managerial oversight of the home. There were no effective audits of any aspect of care delivery. Documentation, including care plans and risk assessments, were not always up-to-date. There was no deputy manager in post and the registered manager had no support to maintain an effective level of oversight of the home.

Staff understood safeguarding and how to keep people safe from abuse. Staff received regular training to support them in their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

Rating at last inspection: At the last inspection the service was rated Good (Report was published on 24 March 2017).

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We have identified six breaches of regulation around person centred care, staffing, premises and equipment, safe care and treatment and good governance. The failings found are detailed in the main body of the report.

With regards to the breach found regarding fit and proper persons employed, regulation 19, please see the action we have told the provider to take at the end of this report.

We are taking enforcement action and will report on this when it is completed. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Amberley House is a privately owned care home for older people in Enfield. The home is registered to accommodate 30 older people, some of whom may have a diagnosis of dementia. The registered provider had recently opened a new extension to the property.

There was a newly 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.

People told us they felt safe at the home and risks to people’s safety and been identified, acted on and, where possible, were being reviewed with the person.

Staff were aware of their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about the management and told us they appreciated the clear guidance and support they received.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People told us they enjoyed the food and staff knew about any special diets people required either as a result of a clinical need or a personal preference.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff knew about various types of discrimination and its negative effect on people’s well-being. Staff understood that people’s diversity was important and something that needed to be upheld and valued.

Staff demonstrated a good understanding of peoples’ likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes.

They told us they were happy to raise any concerns they had with any of the staff and management of the home.

People we spoke with confirmed that they were asked about the quality of the service and had made comments about this.

People told us the service took their views into account in order to improve.

During this inspection we found all areas of the home to be clean and the provider had fully implemented their infection control policy. We also reviewed the maintenance of the property as we had identified peeling wallpaper, exposed walls and broken furniture and fittings during the last inspection. The provider has since undertaken refurbishment of all identified areas, and staff and the manager were documenting regular checks of the home in the maintenance book. Recent reports of gas, electrical and fire safety were available.

Care planning and reviews took place regularly with involvement from people, and relatives were regularly involved in this process. We found that the staff understood people's care needs. People had a choice of suitable and nutritious food which was available in sufficient quantities. Recruitment processes were robust and evidence from staff files showed that appropriate checks were in place before care staff commenced working with people who use the service.

Overall, the home appeared clean and staff understood the requirements of their role to reduce the risk of transmission of infections. We had some concerns that the provider had not implemented their own infection control policy with regards to the standards of cleanliness in the home. Thus, we have asked the provider to address this concern.

We found that the registered manager had acted in accordance with the consent of people who use the service in respect to the care and treatment provided. We also found that the care and welfare needs of the people using the service were assessed and delivered in line with the support need outlined in their care plans.

The premises were found to be of a suitable design and lay out taking into account the needs of the people who use services. In regards to staffing, we found that the provider had sufficient numbers of suitably qualified, skilled and experienced people in order to safeguard the safety and welfare of the people who use services.

We also found that the provider had taken measures to assess and monitor the quality of the service provided.

Having spoken to people who use services and their representatives, we found that people were complimentary about the service provided and spoke positively about their experiences of the home.