Amberley Court Care Home

Amberley Court is a residential care home providing personal care for up to 39 people. The service provides support to older people over two floors, accessible by stair and passenger lift. At the time of our inspection there were 32 people using the service.

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

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.

Medicines were managed safely within the service. People told us they felt safe living at Amberley Court. Procedures were in place for the reporting of incidents, accidents, and safeguarding concerns to prevent further occurrences.

People spoke positively about the support they received from the staff team and said they were treated with dignity and respect. Family members spoke positively about the service their relatives received. Effective procedures were in place for the safe recruitment of staff. Risks to people's health and wellbeing had been assessed and guidance was available for staff to support people safely.

Regular checks and maintenance of the service took place to provide a safe environment for people to live. Governance systems were in place to monitor and assess the quality of care people were provided with. People were consulted on a regular basis about their views on the service they received and to plan activities and events. Staff felt supported in their role and regular meetings took place to share information about the service. The registered manager worked in partnership with other external agencies and professionals to promote and meet the needs of people living at the service.

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 21 March 2018).

Why we inspected

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

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 not changed and remains good 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 Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Amberley Court 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. Amberley Court accommodates up to 39 people in one building with all bedrooms over two floors. The service provides care and support to older people. At the time of this inspection 29 people were using the service.

A registered manager was 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.

During the last inspection of the service in December 2016 we identified breaches in relation to Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led to a rating of good. During this inspection we found that improvements had been made.

We have made a recommendation within this report in relation to ensuring that records and care planning documents are kept under continual review to ensure that up to date information is available at all times.

Systems were in place to help ensure that people's medicines were managed safely and appropriate storage facilities were in place.

People felt that the service was safe. Staff were aware of the procedures in place for safeguarding people. Staff had received training in relation to safeguarding people.

Staff supported people in a kind and caring manner whilst respecting individual’s privacy and dignity.

People’s living environment was clean and tidy and effective control measures were in place to protect people from infection.

Systems were in place to ensure that people’s rights were maintained under the Mental Capacity Act.

People’s needs were assessed and when a need was identified, care plans had been developed to inform staff as to what support a person needed. Family members felt that they were involved in their relative’s care planning process.

People had access to activities within the service with the support of an activities co-ordinator.

The registered provider had procedures in place that promoted the safe recruitment of staff. This helped ensure that people were supported by staff that were suitable to work with vulnerable people.

A complaints procedure and recording system was in place. People and their relatives knew who to speak to if they wanted to raise a concern about the service.

The CQC were notified as required about incidents and events which had occurred within the service.

People were cared for by staff who had received appropriate training. Staff completed a variety of training relevant to their role and responsibilities. This helped ensure that people receive safe effective care and support.

Ranelagh Grange Care Home is registered to provide accommodation for persons who require personal care. The service accommodates up to 39 people and bedrooms are located on the ground and first floor of the building. There were 16 people using the service at the time of this inspection.

A registered manager was not in post at the time of the inspection visit. However the manager had applied to become the registered manager with the Care Quality Commission and her registration was confirmed following this inspection. 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 last inspection of the service took place in May 2016. During that inspection we found improvements were needed in relation to the management of people’s medicines and the monitoring people’s fluid intake. After the inspection, we issued a requirement action in relation to the breach of the Health and Social Care Act 2008 which we identified.

Following the inspection the registered provider sent us an action plan stating that they had met the relevant legal requirement. During this inspection we found that the registered provider had made improvements in relation to the legal requirement, however we found other concerns in relation to the management of people’s medicines.

Improvements continue to be needed in the management of people’s medicines. Although we found that people’s medicines were safer, improvements were still required to ensure that all medicines were managed safely. This is a continued breach of Regulation 12(1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

We have made a recommendation in relation to checks on people's medication. During this and previous inspections carried out at the service we found on going concerns with the management of people's medication, which were not identified during audits (checks) carried out at the service. Whilst improvements had been made we need to be assured that those improvements are sustained.

At the last inspection in May 2016 improvements were noted in the way people’s fluid intake was being recorded, however some charts were not always completed correctly. We made a recommendation that the service reviews the systems in place to record and monitor people’s fluid intake to ensure that accurate information was available at all times. During this inspection we were unable to assess the improvements made. This was because at the time none of the people who used the service required a record of their fluid intake. However documentation for recording people’s fluid intake had been improved so that it captured all the relevant information to ensure an appropriate record was kept.

People told us they felt safe living at the service. The environment was kept clean and free from hazards. Equipment and hazardous substances were safely stored and used appropriately. Staff received training in relation to keeping people safe and they were confident about the action they needed to take if they had any concerns about people’s safety, including safeguarding concerns.

People received the care and support they needed with their healthcare needs. They attended appointments as required with their GP and other health care professionals involved in their care. Prompt referrals were made for people to other professionals when concerns about their health and wellbeing were noted.

Risk assessments had been carried out when planning people’s care and appropriate risk management plans were put in place instructing staff on how to provide people with safe care and support.

People’s dietary needs were understood and met. People told us they liked the food they were offered and that they were given plenty to eat and drink. Mealtimes were a positive experience for people and they had a choice of food and drink and where they ate their meals.

Staff received training and support which they needed to meet people’s needs. Training was provided to staff on an ongoing basis and their competency was checked to make sure they understood and benefited from the training undertaken. Regular staff meetings and one to one supervision sessions enabled staff to explore their training needs and discuss any additional support they needed to carry out their roles effectively.

Care plans included information about people’s abilities to make decisions and where required applications had been made to the local authority for Deprivation of Liberty Safeguards (DoLS) authorisations in respect of people. Staff obtained people’s consent prior to delivering care and support and they respected people’s decisions.

People’s privacy, dignity and confidentiality were respected. Staff had a good understanding of people’s needs, including their preferred gender of carer, routines, wishes, likes and dislikes. Staff approached people in a kind, caring and patient manner. Information about the service including planned changes to the environment and up and coming events was shared with people and their family members in a timely way.

People, family members, staff and external health and social care professionals were complementary about the way the service was managed. People commented on many positive changes made to the service over recent months. They described the management team as approachable and supportive and they had confidence in them. They said there was an open door policy operated at the service which enabled them to speak openly and in confidence with the management team.

Ranelagh Grange Care Home is registered to provide accommodation for persons who require personal care. The service accommodates up to 39 people and bedrooms are located on the ground and first floor of the building. There were 17 people using the service at the time of this inspection.

A registered manager was not in post. The previous registered manager had resigned from their post in March 2016. A new manager had been employed at the service since March 2016 who was in the process of applying to register with the Care Quality Commission. In addition, a new deputy manager had been recruited who had started their role in February 2016. 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.

Inspections of the service took place in October and May 2015. During these inspections we found that the service was not meeting all of the regulations we assessed. We judged the service to be inadequate and the service was placed into special measures. A further inspection of the service took place in January 2016 and we found that there was not enough improvement to take the registered provider out of special measures. At this inspection we found that there was enough improvement to take the provider out of special measures. Whilst we found a number of improvements in most areas, the registered provider had not demonstrated full compliance with the Health and Social care Act 2008 (regulated activities) 2014. You can see what action we have told the provider to take at the end of this report.

In December 2015 we imposed an urgent condition on the registration of the registered provider to restrict admissions to the service until the Care Quality Commission was satisfied that people are receiving safe, effective care. During this inspection on 20 May 2016 we found that sufficient improvements had been made to remove this urgent condition. This condition was removed in June 2016.

Improvements continue to be needed in the management of people’s medicines. Although we found that people’s medicines were safer, improvements were still required to ensure that all medicines were managed safely. We found that improvements were needed in relation to the recording of medicines, assessments for people administering their own creams and the auditing of people’s medicines. This is a continued breach of Regulation 12(1),(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements had been made to the systems in place to record people fluid intake. However, these charts were not always completed appropriately.

We made a recommendation that the service reviews the systems in place to record and monitor people’s fluid intake to ensure that accurate information is available at all times.

Improvements had been made to how the service monitored the environment and the care and support people required. However, further improvements were needed to as to how people’s medicines and fluid were monitored.

We have made a recommendation that the service develops a more robust and effective monitoring system to ensure that any issues highlighted are managed quickly.

New care planning documents had been introduced to record and plan for people’s needs and wishes. These documents demonstrated that people’s needs had been assessed and planned for.

Risk assessments had been developed in line with people’s care plans which meant that known risks to people had been considered and were planned for.

There was an improvement to the overall understanding of staff with regard to the Mental Capacity Act 2005. People’s care plans had been developed to include information about people’s decision making abilities and in addition, where required applications had been made to the local authority for Deprivation of Liberty Safeguards (DoLS). This demonstrated that people’s rights were better protected under the Mental Capacity Act 2005.

Improvements had been made in relation to the support and training available to the staff team. Staff had received supervision for their role. In addition, training had been identified, planned and delivered to improve staff knowledge in safe and best practice for their role.

Improvements had been made to people’s living environment. Changes had been made to the décor and new flooring and furniture had been purchased for the communal living areas. We found the service to be clean, tidy and free from offensive odour. Furniture in the communal lounge and dining areas had been rearranged to create a more comfortable and relaxed environment for people to sit and have their meals.

People had a choice of meals and they were happy with the foods available to them. Staff were aware of people’s dietary needs and wishes and they ensured people received the diet they required to meet their needs.

Improvements had been made to ensure that people’s privacy and dignity were maintained. The manager had carried out discussions with staff as to how to ensure that people received care and support in a respectful manner. In addition, regular observations of staff practices took place. Throughout our inspection we saw good interactions between staff and the people they supported with lots of laughter and chatting taking place.

People were spoken to in a quiet caring manner and all personal care and support was carried out in private. People’s personal records were securely stored and only available to staff who needed to access them. We saw people being choices as to what they would like to eat and drink, where they would like to sit and staff respected individual’s decisions. Where people needed support to make decisions, staff were seen to gently offer what options were available to them.

People were happy with the service they received. They told us that they felt safe and that all of their needs were being met by the staff team. People’s comments included “I’m more than happy. You can always get a drink, you just ask the staff and they will get you one”, “The food is good and you can always ask for something different if you don’t like what is on the menu”, “They [staff] are all lovely to me, they are ever so kind”, “I want for nothing they [staff] know me so well” and “Very nice indeed all of them [staff]” and Staff are polite, caring and happy to support with everything”.

The provider had prepared an action plan to make improvements within these areas. At this inspection undertaken in March 2014 we saw that improvements had been made.

Appropriate medication management practices were in place to protect people who lived at the home from risks associated with the unsafe use and management of medicine.

Care files and new format documentation had been implemented. Files were well organised and care plans along with risk assessments were person centred in their approach.

We found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. There had been improvements in relation to the management of records but it did not enable the provider to meet the regulation completely. We saw evidence that incidents were being recorded for a person who had behavioural episodes but the behavioural monitoring tool (ABC chart) had not been reflected with the information. This meant that the monitoring of triggers and de-escalation methods were not consistently being recorded.

We also saw evidence that a person was prescribed medication and did not have a completed medication care plan within their file.

At the last inspection in May 2013 we had concerns regarding the care and welfare of people who lived at the home, the maintenance of accurate records and the medicines management.

The provider had prepared an action plan to improve within these areas; this visit was undertaken to review the action plan and completion of improvements.

Unfortunately the previous manager left in June 2013 and a new manager had been appointed in November 2013.

At this inspection we saw that some improvements had been made but this had not fully impacted on the services ability to meet the regulation requirements being reviewed

We found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

Out of 26 care files eight still required to be reviewed to ensure accuracy of the information held to support people safely. Of the files which had been reviewed there was still evidence of incomplete documentation and information to guide care workers on how to support individual people's needs.

Appropriate medication management practices were not in place to protect people who lived at the home from risks associated with the unsafe use and management of medicine.

We spoke with people who lived at the home and asked them to share with us their views and experience of the care support they received.

One person told us 'I like living here; they (the staff) look after me'. Another person told us 'They (the staff) are always asking what you want for your meals. The food is lovely and we get a choice so we can't complain.'

We spoke with four people who lived at the home and they told us that staff were considerate towards them showing dignity and respect at all times.

We reviewed care files and found there to be an inconsistency with the recording of people's care needs. Appropriate medication management practices were not in place to protect people who lived at the home from risks associated with the unsafe use and management of medicine.

We spoke with staff who told us that they felt well supported by the management and peers. They (the staff) said they worked well as a team.

We spoke with three people who lived at Ranelagh Grange who told us that they were happy and liked living there. Comments included; 'I like living here. I'm quite satisfied' and 'I like the food here. There is plenty of choice' and 'There is no where like home but I'm also quite happy here'.

At the last inspection we had concerns with regards to creams not always being applied to people who needed them. There were also issues around the recording of creams, eye drops, medicines in general and guidance for 'when required' medicines. During this inspection we still had some concerns over the recording of people's creams. This issue mainly related to the night staff. The people we spoke with all required creams to be applied by the care staff. Three of the people told us that they felt they got their creams when they should do. However one person said to us; 'I need cream putting on my back because of the pain. If staff are busy then sometimes it gets missed'.

We found that there were appropriate audit tools in place to monitor the quality of service provision at the home during our inspection.