About the service:

Amber House is a care home for up to six people who have been discharged from hospital and who require care, support and accommodation for mental health issues. At the time of our inspection three people were using the service.

People’s experience of using this service:

• People continued to benefit from kind and committed staff. People complimented the support received and told us they formed meaningful, caring relationships with the staff. Staff knew what was important to people and ensured people had care that met their needs and choices. People's dignity, confidentiality and privacy were respected and their independence was promoted.

• People received support that met their needs and was in line with care plans and good practice. People's rights to make own decisions were respected. People were encouraged to maintain good diet and access health services when required.

• The registered manager ensured people received safe care and treatment. People complimented the continuity of care provided by skilled and competent staff. People received their medicines safely and as prescribed. Risks to people's well-being were assessed, recorded and updated when people's circumstances changed. The staff ensured any lessons learnt were reflected to improve the service delivery.

• The service was well run by the registered manager who was supported by a team of committed staff. The provider's quality assurance processes were effective and there was a focus on continuous improvement. Where an area for improvement had been identified there was a prompt action taken to address it.

• People, staff and relatives were involved and felt listened to. The team at Amber House worked well in partnership with other agencies, social and health professionals and external organisations.

More information is in the detailed findings below.

Rating at last inspection:

Good, report published 21 February 2017

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

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

We inspected Amber House on 31 January 2017. The inspection was unannounced.

Amber House is a care home for up to six people who have been discharged from hospital and who require care, support and accommodation for mental health issues. At the time of our inspection four people were using the service.

There was 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 carried out an unannounced comprehensive inspection of this service on 23 August 2016 and found breaches to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014).

After the last inspection on 23 August 2016, we took enforcement action and issued a warning notice. We asked the provider to take action to make improvements in relation to the management of incidents and accidents and in relation to notifying the commission about important events.

This inspection in January 2016 was to check they had met the legal requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to good governance.

We also checked they had met the legal requirements of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014), which relates to notifying the care quality commission of notifiable events.

Since August 2016 the provider had improved their practices in relation to maintaining a complete and accurate record of accidents and incidents within the home. Incident and accident forms were accurate and enabled the service to monitor the ongoing quality and safety of the care being delivered.

Since August 2016 the provider had also improved their practices in relation to notifying the Care Quality Commission of notifiable events that occurred within the service.

Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery. The service had systems to assess the quality of the service provided. Learning from audits took place which promoted people's safety and quality of life. Staff spoke positively about the registered manager.

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

We inspected Amber House on 23 and 25 August 2016.

Amber House is a care home for up to six people who have been discharged from hospital and who require care, support and accommodation for mental health issues. At the time of our inspection four people were using the service.

There was not a registered manager at the service. The home had a manager in place who was in the process of registering with the Care Quality Commission to manage the service. 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 carried out an unannounced comprehensive inspection of this service on 15 July 2015. We found the provider was not meeting the legal requirements of four of the fundamental standards. After the comprehensive inspection, we issued requirement notices to the provider to meet the legal requirements of the four fundamental standards.

This inspection in August 2016 was to check they had met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to people’s safe care and treatment. We also checked they had met the legal requirements of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to staffing. Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to person centred care and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to governance.

Since July 2015 the provider had made significant changes and improved their practices in relation to mitigating the risks associated with people’s care. The service had improved its practices in relation to the deployment of staff and safe recruitment procedures. The service sought feedback from people using the service in order to evaluate and improve their practice. Staff were deployed effectively and people received person centred care. However we identified further concerns in relation to good governance and record keeping.

Accidents and incidents were recorded. However incident forms did not always contain information on what steps had been taken by the service following the incident.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. The manager of the service had not always informed the CQC of reportable events. The manager had not reported concerns to the local safeguarding team.

Services are required to display their most recent ratings on their website and at the provider’s principle place of business. Ratings of the July 2015 inspection were displayed at the location of the service. However we noted that the most recent ratings were not displayed on the service’s website.

People’s care plans contained risk assessments which included risks associated with their mental health and the environment. Where risks were identified plans were in place to identify how risks would be managed.

Since July 2015 the provider had made significant changes to how they deployed staff. We observed, and staffing rotas confirmed, that there were enough staff to meet people’s needs. Staff rotas confirmed planned staffing levels were consistently maintained. Records relating to the recruitment of staff showed relevant checks had been completed before staff worked unsupervised.

People told us they were safe. People were supported by staff that could explain how they would recognise and report abuse and staff were also aware they could report externally if needed. Measures were in place to mitigate the risk associated with infection control.

Staff we spoke

We met the four people who lived at the home. Two people were happy to talk to us about their care. We also spoke to two members of staff and listened to a ‘phone conversation between the manager and a relative. One person said that “Staff treat you as an equal.”

We reviewed three care plans including risk assessments, care programme approach information and daily notes of care. A person said of key workers “basically they take care of you”. Another person told us that “I have a good network of people looking out for me.”

We saw two staff files and records of supervision. These provided evidence that staff received appropriate training and regular individual supervision. One member of staff said that their supervision was “top” and that the manager spent “as much time as needed” to support them.

People were able to make comments or to express concerns about the service.

People told us that staff were supportive and they were encouraged to make decisions for themselves. One person told us that they were working towards being sufficiently independent to live in the local community. Another person was attending work experience, with a view to eventually being more independent.

We spoke with two members of staff, who confirmed they supported people to understand their rights and to give their consent to treatment and care This may include the involvement of health and social care professionals.

One person told us "very happy here","staff are nice","manager lovely" and "staff took me to see my X by train".

We saw evidence that regular staff meetings took place and staff received regular one to one supervision. One member of staff said they felt well supported and enjoyed working in the service.

We were told that the views of people were sought using a feedback form. Quality assurance audits are completed every three months. We saw a sample of monitoring forms completed.

We undertook an announced inspection of Amber House Didcot on 15 and 22 July. Amber House is a care home for up to six people who have been discharged from hospital and who require care, support and accommodation for mental health issues.

At the time of our inspection three people were using the service. At our last inspection in December 2013 the service was found to be meeting all of the requirements of the regulations at that time.

There was not a registered manager at the service. The home had a manager in place who was in the process of registering with the Care Quality Commission to manage the service. 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 were supported by staff who could explain how they would recognise and report abuse. However people did not benefit from a safe environment and information surrounding risks was not always accessible.

Safe recruitment procedures were not always followed at the home to ensure staff were of good character. Records relating to the recruitment of staff showed relevant checks had not been completed before staff worked unsupervised with vulnerable adults.

Staff felt they had the appropriate training to support people effectively and where encouraged to improve the quality of care they delivered through the supervision and appraisal process. These are formal one to one meetings between staff and the manager to discuss development and support needs. However records of these sessions taking place were not always completed.

No one accessing the service had been assessed as lacking capacity under the Mental Capacity Act (MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time). However the manager and staff did demonstrate a good understanding of the principles of the act and understood their responsibilities.

People benefited from a caring culture that understands the challenges of people with complex needs. One person told us. "They're fantastic, they really are caring" and ‘[the staff] helped me get my confidence and self-respect back".

People had their own personal rooms and staff told us they promoted people’s dignity by “respecting their personal space”. When staff spoke about people to us or amongst themselves they were respectful.

Care plans contained personal histories and preferences. However it was not evident that a person centred approach was continued throughout the care planning process. Care plans did not always contain up to date information.

During the inspection we observed one person who was at risk of social isolation. There was also a concern about the person’s repetitive behaviour. We saw no evidence of any discussion with this person surrounding the choices they were making.

The service had a system in place to monitor the quality and the safety of the service however they were not always effective. There was a monthly quality audit that covered a number of areas in the service, however these audits did not identify the concerns we found at this inspection.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.