Prior to the inspection we had received a number of whistle-blowing concerns and concerns from other regulatory bodies and linked organisations about the safety and welfare of the people who used the service. We took the decision to bring forward the date of the scheduled inspection. We considered the findings of our inspection to answer questions we always ask:
Is the service caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?
This is a summary of what we found:
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
The practices in the home did not protect the people who used the service, staff or visitors from the risk of harm. Serious concerns were raised regarding the lack of guidance and training for staff to support people safely and to manage their behaviour appropriately when it was challenging.
Some incidents had resulted in verbal and physical abuse between people who used the service. These had not always been reported to the local authority safeguarding team and the Commission had not been informed. It is important that we are informed of these incidents so we can monitor how they are managed.
Not all staff had received training in how to manage safeguarding concerns in order to protect vulnerable people from the risk of abuse or harm.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
We found that people's medicines were not always managed safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.
Is the service effective?
There was little direction and support for staff and the support to people who used the service was inconsistent and unstructured. The service was for people with complex needs around their learning disability and or their mental health and often people presented with behaviours that challenged the service. Yet systems had not been put in place for all persons to safely manage these behaviours, to recognise triggers or to encourage positive behaviour. From observations during the visit and discussions with members of staff we found that some staff were not confident in delivering aspects of the care people required.
There were gaps in the staff training and development programmes as some staff had not received training to meet the specialist needs of the people who used the service. Staff told us they felt isolated and at times had been left to manage situations they did not feel confident about.
Risks were not always appropriately assessed or responded to, and we found that the provider did not take all of the required steps when dealing with allegations of abuse. People told us they were generally happy with the care they received and their needs had been met but this was sometimes impacted by a lack of staff.
We found staff had not completed training in The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This legislation protects people's rights to be involved in making decisions about their lives and where they do not have the capacity to do so, then safeguards must be put in place and followed to ensure decisions are made that are in the person's best interests.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.
Is the service caring?
We found that staff were supportive and attentive to people who used the service. People were given choices. We observed staff speak to people in a friendly and professional way.
We saw a lack of evidence to show that all people's preferences, interests, aspirations and individual needs were recorded or that care and support was provided in accordance with people's wishes and feelings.
Is the service responsive?
People had access to a range of health and social care professionals for support and treatment.
Staff we spoke with told us they did not have access to key information about people's care needs. They told us they were at times supporting people based on verbal information received from head office, other staff or previous knowledge of their needs. This meant people may not always receive effective care.
We saw some staff had completed essential training but other training was overdue. We found staff had not attended training linked to the healthcare needs of people living at Amber House to help them support people's needs appropriately.
Sufficient numbers of care workers were not always provided to respond to people's health and welfare needs.
Safe recruitment practices in line with the provider's policy and procedures had not always been followed to ensure new staff were safe to work with people who used the service.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.
Is the service well-led?
There was no clear leadership in the service. Staff were given conflicting guidance from the management team and this guidance was not always written down which led to confusion and inconsistency with the care provided. There was a lack of policies and procedures for staff to refer to in the service.
The acting manager had been appointed from within the organisation, but following a high turnover of senior staff, they told us their workload had increased considerably and they needed additional support in order to fulfil their role.
There was no system in place to make sure that the acting manager and staff learnt from events such as accidents and incidents, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learnt from mistakes.
We found the service did not have an effective quality assurance system in place.
There was some documentary evidence to show the views and opinions of people who used the service and staff were sought as part of the quality assurance process. But there was little evidence that the provider was taking action to address the shortfalls identified. This lack of documentary evidence made it difficult to establish if the service was being managed in people's best interest.
Turnover of staff was very high and staff absence due to sickness was also significant. Although this was monitored by the provider there was little evidence of any action taken to improve staff sickness rates and staff retention.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.
What people who used the service and those that matter to them said about the care and support they received:
People told us they did not feel safe at the service. One person told us, 'I don't like being alone with Xxx, they hurt me sometimes when staff aren't around.'
One person told us they liked the staff and another person said they did not feel safe with one staff member. We reported this to the acting manager. People told us about the staff changes and what this meant, one person said, 'I haven't had any psychology since they left in January. I miss it.' They also told us, 'I miss the old staff, but the new staff are nice.'
We have raised our concerns about the care of people at the service with the local authority safeguarding team and with commissioners. We are working with all relevant authorities to protect and improve people's care.
You can see our judgements on the front page of this report.