We carried out the inspection of Amber Lodge - Leeds on 14 February 2018. This was an unannounced inspection.

Amber Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Amber Lodge provides accommodation and personal care for up to 40 people. The building is a two-storey purpose built home, situated in a residential area of Wortley, close to the city of Leeds. All of the bedrooms are single occupancy and have en-suite toilet facilities. Communal lounges, dining rooms and bathing facilities are provided on the two levels. It has a garden to the rear of the building and a car parking area located at the front of the building.

The home had a registered manager. 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.

At the last inspection in November 2016 we found the service required improvement. At this inspection we found the service had improved.

The provider and registered manager continually assessed, monitored and evaluated the quality of the service. We found audits had identified issues and actions were progressed in a timely manner.

Staff understood their responsibilities to safeguard people from harm and followed the provider's policies. People were supported to take their prescribed medicines safely. There were enough suitably skilled staff on duty to meet people's needs. Staff had been recruited using safe recruitment practices.

Staff sought people's consent before providing care and people's mental capacity was assessed in line with the Mental Capacity Act 2005. The registered manager understood their responsibilities and referred people appropriately for assessment under the Deprivation of Liberty Safeguards.

People received care from staff that had received training to meet people's specific needs, and had supervision to assist them to carry out their roles. People were supported to access healthcare professionals and staff were prompt in referring people to health services when required. Staff understood people's dietary needs and people received a balanced diet, which they enjoyed.

The environment and equipment was appropriately maintained and serviced when required. Adaptations to the building had been made to support people with their daily life. Staff knew about infection prevention and wore personal protective equipment when supporting people.

Staff treated people with respect and helped to maintain their dignity. People received care from staff they knew, which helped them to develop positive relationships. Staff supported people emotionally and practically to promote their independence and well-being. People knew how to make a complaint, and raised them if they wished.

Care plans were updated regularly and people and their relatives were involved in their care planning where possible. Risks to people's health and well-being were assessed and staff had followed plans that were centred on the person as an individual. People were supported to pursue their hobbies and interests and continued to celebrate special days.

We inspected Amber Lodge on the 28 November and 1 December 2016. Both visits were unannounced. Our last inspection took place on 29 June 2015 where the service was meeting all the regulations.

Amber Lodge provides accommodation and care for up to 40 older people living with dementia. The home is purpose built and there is car parking available. The home is divided over two floors and people living there have en-suite rooms. Both floors have communal lounges, dining rooms and bathing facilities. The home has a garden to the rear of the building which is secure.

At the time of our inspection the service had a registered manager. 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.

There were systems in place to ensure that people received their medication as prescribed.

The provider checked with the disclosure and barring service (DBS) whether applicants had a criminal record or were barred from working with vulnerable people and obtained references. One file only contained one reference but two should have been received; the registered manager said two references were received and one must have been misplaced. The registered manager showed us evidence of this reference which had been misplaced after the first day of inspection.

We looked at staff employment histories and found gaps in two of the files we looked. We spoke to the human resources department who stated these should have been followed up and told us these would be looked into. The registered manager told she would ensure an audit of all staff files would be completed straight away to identify any gaps.

There were enough staff to meet people’s needs. However these were not always located on the staff rota. We spoke to the registered manager who told us this had been an oversight and would complete this straight away. On the second day of inspection this was completed. The service had incorporated an electronic system which was to start in the next week; this would capture all staff signing in and out each day. This would ensure the rota would be more robust. Staff told us they received training to be able to carry out their role.

Staff were aware of the supervision and appraisal process and felt supported by the registered manager. Staff had completed supervisions and an annual appraisal, however the supervisions were not in line with the policy. This stated ‘each care staff member will receive formal staff supervision at least twice a year’ and supervision will cover ‘all aspects of practice associated with the provision of care to residents’ and ‘the colleagues career development needs’. We spoke to the registered manager who explained a new electronic system had being introduced due to the old process not been as effective for staff which focused more on aspirations and competencies; each member of staff had completed the first stage and had identified what they did well and how they wanted to develop, and the registered manager was completing the second stage where they provided feedback about each member of staff’s performance.

Staff were aware of the processes in place to report incidents of abuse; and had been provided with training on how to keep people safe from abuse and harm. Processes were in place to manage identifiable risks and to promote people’s independence.

People were supported to eat and drink well and to maintain a varied and balanced diet of their choice. People had access to healthcare facilities and support that met their needs.

People had developed good relationships with the staff team who treated them with kindness and compassion. Systems were in place to ensure that their views were listened to; and their privacy and dignity was upheld and respect

We inspected the service on 29 June 2015. The visit was unannounced.

Our last inspection took place on 30 January and 5 February 2015 and, at that time; we found the service was not meeting the regulations relating to care and welfare of people who used the service, training and staffing. People’s needs were not being met regarding nutrition and cleanliness of the home. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had been made in all of the required areas.

Amber Lodge provides accommodation and care for up to 40 older people living with dementia. The home is purpose built and there is car parking available. The home is divided over two floors and people living there have en-suite rooms. Both floors have communal lounges, dining rooms and bathing facilities. The home has a garden to the rear of the building which is secure.

At the time of our inspection there was no registered manager in the home. ‘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 our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

The service was meeting the requirements of the Mental Capacity Act 2005. We felt staff understood how to help people make day-to-day decisions and were aware of their responsibilities under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering, storage and disposal of medicines.

We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found that this was consistent with the guidance within the safeguarding policy and procedure in place at the home.

People told us the food at the home was good and that they had enough to eat and drink. We observed lunch being served to people and saw that people were given sufficient amounts of food to meet their nutritional needs.

We saw the home had a range of activities in place for people to participate in. Staff were very enthusiastic and people’s relatives told us the activities had a positive impact on the lives of their family member. This meant people’s social needs were being met.

We looked at four staff personnel files and saw the recruitment process in place ensured that staff were suitable and safe to work in the home. Staff we spoke with told us they received supervision every three months and had annual appraisals carried out by the manager. We saw minutes from staff meetings which showed they had taken place on a regular basis and were well attended by staff.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service. This showed through monthly and weekly audits that this was an effective system.

We found that staff had training throughout their induction and also received annual refresher training in areas such as dementia care, Mental Capacity Act 2005, DoLS, safeguarding, health and safety, fire safety, challenging behaviour, first aid and infection control. This meant people living at the home could be assured that staff caring for them had up to date skills they required for their role.

We spoke with five staff, the registered manager, one community nurse, nine people who used the service and four visitors / relatives, to gain their views of the service. People told us the home was lovely and clean, also that the staff were very kind and friendly.

We reviewed five care records. We found care records were person centred, detailed and individualised. Risk assessments identified where people were at risk of harm and were used to develop guidelines for staff to follow. People’s weight was recorded monthly.

We observed that the home was clean and did not have any unpleasant odours. We reviewed the cleaning schedule which was in place. One visitor said: "The rooms are always clean". Another relative said: “The home is always clean when I visit”.

We reviewed the duty rota for four weeks, including the week of our visit. They reflected that there were six staff on duty, except on two occasions where four staff were on duty during the afternoon shift and twice where two staff were on duty for the night shift.

Staff told us they worked well together and were a 'good team'. Staff said they had access to training and felt supported by the manager. They had opportunities to talk to their manager about their work and had regular supervision.

The provider had systems in place to identify, analyse and review risks or incidents. Information about quality and safety was gathered and monitored to identify risks and areas for improvement.

We spoke with two people who live in Amber Lodge, and six visiting relatives and friends to the home during our visit to gain their views of the service. All the people spoken with told us they were happy with the service.

Because we were unable to communicate with many of the people who lived at Amber Lodge, we also used observational tools to observe how people were cared for and supported. This is called the Short Observational Framework for Inspection (SOFI). The SOFI involved observing and recording peoples’ mood and how they interacted with staff and others around them at regular intervals over a set length of time. This was carried out in the downstairs dining room over the lunchtime period.

Throughout the observation staff treated people with dignity and respect. We observed examples of good communication skills such as staff displaying positive, friendly and warm approaches towards the people in their care. We saw the use of eye contact and touch to engage people who used the service.

We also spoke with six visiting relatives to gain their views of the service. They told us families had been involved in decisions regarding the care and treatment of their relatives and had been given appropriate information. One relative commented “This home was our number one choice when we looked around.” Another person said “My relative’s room and the communal areas are always clean and tidy and there are never any odours other than meals.”

All people spoken with were complimentary about the care they received at Amber Lodge. One visiting relative commented “The care is excellent.”

Both of the people living in the home spoken with told us they felt safe living in the home and visiting relatives also said they felt their loved ones were safe. One person commented “I know my mum is safe and well looked after.”

People spoke positively about the staff. One person said “Staff are very friendly and can’t do enough for you.” A visiting relative told us “Staff are always welcoming to visitors.” All people spoken with said there were sufficient staff to meet the needs of the people who live in the home. People living in the home and visiting relatives were particularly complimentary about the positive and caring attitude of recently appointed younger staff.

People spoken with told us they felt able to make comments or complaints and believed they would be listened to and their concerns acted on, without the fear that they would be discriminated against for making a complaint. One person told us “If I have any issues I would ask staff.”

People who use the service said they were generally satisfied with the care they receive. One person told us the home was “great”. When asked if she felt that staff knew how to look after her properly she said “some know better than others” but she felt that she and her family had “picked the right place”.

The inspection took place on 30 January 2015 and 5 February 2015, both days were unannounced.

Amber Lodge provides accommodation and care for up to 40 older people living with dementia. The home is purpose built home and there is car parking available. The home is divided over two floors and people living there have single en-suite rooms. Both floors have communal lounges, dining rooms and bathing facilities. The home has a garden to the rear of the building which is secure.

At the time of our inspection 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.

There were not enough staff to sufficiently meet people’s needs, this was of particular concern in the early morning when people were getting up for the day. We saw a number of people trying to get help from staff but they were unable to attract anyone's attention and people were not given a hot drink until 8.30am.

During the day we saw a number of people were pacing up and down the corridors and staff were not available to try and interact with people and distract them from their distress.

Not all areas of the home were clean, this was a particular issue in the communal bathrooms. Some people’s ensuite bathrooms had damage to the walls and we saw two ensuite bathrooms did not have towels or any other means for people to dry themselves. A visiting nurse told us they had difficulties getting appropriate equipment such as wipes, flannels and bowls to meet people’s needs hygienically. The general décor of the home needed improvement, pieces of wall paper were peeling off and there were marks on the handrails and skirting boards.

The environment was not dementia friendly, there were limited opportunities for people to engage in stimulation around the home. There was some memorabilia around but this was limited. We saw some people upstairs in the home spent most of the day pacing up and down one long corridor.

We looked at the administration of medication and found people were being given their medication as prescribed. We found the recording of the medication administered was good. Staff told us they had received the training required to administer medication safely.

Staff were aware of how to protect people from harm and knew how to recognise and report abuse. The service had a safeguarding and whistleblowing policy in place.

People’s nutritional needs were not being met. The food we saw was not appetising and people had limited choice. On the day we observed lunch the portions were small. We found people had lost weight and had not been referred to appropriate health professionals. In addition to this people who were supposed to be on a fortified diet were not routinely having this and the records of people’s food and fluid intake were filled in later in the day, which could have an impact on the accuracy of the information recorded.

Staff had received training but this was not followed up with any assessment of competency and meant not all staff were equipped with the skills required to support people to live well with dementia.

Mental Capacity Assessments were recorded in people’s care plans, however, some staff had limited understanding of what this meant for people they looked after. Deprivation of Liberty Safeguards had been appropriately applied for.

We saw care was not always delivered in a kind and compassionate way, people did not consistently have their dignity maintained. We did see some compassionate care and we saw work experience students had time to spend with people, which meant they were able to have conversations and quality time.

People had access to some activities but these were often interrupted as staff had to assist people with their personal care needs. The provider was looking to increase the hours of the activities co-ordinator.

People knew how to make complaints, and the service had staff and residents/relatives meetings which meant people could be involved in the service.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which has since been replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.