Amber House is registered with the Care Quality Commission (CQC) to provide accommodation and personal care for a maximum of 13 people. It is situated in the village of Broughton, close to local amenities. Accommodation is provided over two floors, in single bedrooms with en suite facilities. There is a large sitting room set out into two separate areas, a small sitting area and a dining/activities area. Two further lounges are situated on the ground floor. Enclosed gardens to the side and rear of the building are easily accessible.
We undertook this inspection on 29 and 30 March and 3 April 2017. The last inspection was carried out on 1 February 2016 where the service was found to be compliant with the regulations looked at with the exception of well-led. This was because the manager in post had not yet registered with the CQC.
The service now had a registered manager in post as required by a condition of their registration. 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.
Due to concerns found during the inspection, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
Following the inspection, we met with the registered provider and have requested an interim action plan. We also requested, and have received, weekly updates to assure us actions have been taken to address the concerns. We found multiple concerns and are considering our regulatory response. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the provider to take at the back of the full version of the report.
We found concerns with how the service was governed. The CQC had not always received notifications of incidents which affected the welfare of people who used the service.
There was no effective quality monitoring system in place and audits completed had not been effective in identifying shortfalls within the service.
We found accidents had been logged, which highlighted specific issues but lacked analysis to ensure lessons were learned to prevent reoccurrence.
We found there was no staffing matrix tool used to determine staffing levels required for the residential, respite and day care services. This led to inadequate staffing levels within the service, people’s care needs being overlooked and had led to people put at risk while out in the community.
Some people were at risk of not receiving their medicines as prescribed due to errors in recording.
There was a lack of robust risk assessment and management; staff had not always followed policies and procedures, guidance from health professionals and outcomes from risk assessments.
Some areas of the environment were potentially unsafe yet were constantly accessible to people, for example the laundry, where cleaning products were openly stored. These issues had placed people who used the service at risk of harm and injury.
Not all staff had received safeguarding training. Training provided to staff on restrictive physical interventions included the use of pain-inflicted techniques, which was not appropriate in this setting.
We found there was an inconsistent application of mental capacity legislation. Some people had assessments to determine their capacity to consent to specific restrictions such as behaviour management interventions but others did not. Best interest decision making was not always completed.
There were concerns with the management of infection prevention and control as some areas of the service required deep cleaning. Poor infection control procedures were observed which included soiled washing stored in baskets on the floor alongside clean laundry stored in open baskets; this created the potential for cross-contamination.
We saw from records that not all staff had received training to enable them to support people who used the service safely and to an appropriate standard.
Staff had not been receiving regular supervision in line with the registered provider’s supervision policy.
People told us that the approach of some members of staff was kind and caring and they felt able to raise issues with them. However, others told us they had raised concerns with the registered manager about care and support, but their issues had not been addressed.
Not all interactions between staff and people who used the service were seen to be positive. For example, we overheard one member of staff ask someone if they wanted to use the toilet before going out; this was overheard by all of their peers and other people in the vicinity and did not promote the person’s dignity. Another person, whose behaviours compromised their dignity, was not supported to engage in these behaviours in private, so was seen by their peers and others in a state of undress.
We found people’s nutritional needs were met. There was a varied menu which provided people with choices and alternatives.
There was a range of activities offered by the day care facility, based within the service, for people to participate in. However, people told us that the way these were structured meant there was little flexibility available and they did not always wish to participate in group activities.
Staff were not always recruited safely, when positive disclosures were identified there were no assessments in place to mitigate any potential risks to people who used the service.
Complaints raised by relatives were not recorded and addressed in line with the registered provider’s policy and procedure.
We identified a number of fire safety issues whilst undertaking an inspection of the premises. For example, four, floor-mounted hold back devices on fire doors were not working. These issues meant that people who used the service were placed at risk and would not be protected in the event of a fire.
We saw people’s saw people's health needs were met. Staff kept a log of when people had contact with health professionals in the community. Staff followed advice about treatment plans the health professionals prescribed.