At the last inspection in May 2018 we found that there were breaches in providing person centred care, dignity, adequate infection control, medicines, safeguarding people from abuse and governance in that effective systems were not in place to assess and monitor the quality of care.

This inspection took place on 1 and 4 November 2018, the both days were unannounced.

Amber Lodge Nursing Home 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 Nursing Home provides accommodation for up to 40 people in one adapted building. The service specialises in caring for people with physical disabilities and older people including those living with dementia. At the time of our inspection 34 people were in residence.

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. We will continue to monitor this.

We found there had been improvements with the infection control where cleaning schedules and practices had been improved and upgrades to the fabric of the building were ongoing. The provider had improved the depth and frequency of audits and quality monitoring checks. These are supported by the consultant managers and home’s staff and are now recorded and overseen to ensure shortfalls are picked up and improvements made. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives by questionnaires.

Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005.

People were provided with a choice of meals that met their dietary needs. Staff were aware of people’s dietary requirements and any restrictions on what food people could be offered. People’s opinions were sought about the menu choices in order to meet their individual dietary needs and preferences. Most people were offered fluids that supported their wellbeing. However, some people did not have free access to drinks and some of the recording in the daily records was not accurate.

Activities were now planned well in advance and there were personalised to people’s individual needs and capabilities. Staff had access to care plan information and a good understanding of people’s care needs. However, inconsistencies in some care plans and recording of information by staff detracted from the overall improvement in care provision. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

People who used the service and their relatives gave us positive comments about the changes since our last inspection and the care offered to them. Some people were involved in the review of their care plan, and when appropriate their relatives were included. Staff had access to people’s care plans and most received regular updates about people’s care needs. Care plans included changes to peoples care and treatment and people were offered and attended routine health checks.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. They received induction and on-going training for their specific job role and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

The inspection took place on 3 and 10 May 2018. The first day was unannounced; the second day was announced to ensure the registered manager was available in the home.

Amber Lodge Nursing Home provides residential and nursing care to older people including people who are living with dementia. Amber Lodge Nursing Home is registered to provide care for up to 40 people. At the time of our inspection there were 38 people living at the home.

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.

On this visit we found that there were breaches in providing person centred care, dignity, adequate infection control, medicines, safeguarding people from abuse and governance in that effective systems were not in place to assess and monitor the quality of care.

We found a number of infection control issues throughout the home. Documents relating to people’s health and safety were not managed or reviewed. Notifications which the provider is duty bound to send us had been forwarded.

Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. However, the provider had failed to report some safeguarding issues. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005.

People were provided with a choice of meals that met their dietary needs, though some people’s diet was restricted. The catering staff were aware of people’s dietary requirements, and people’s opinions were sought about the menu choices in order to meet their individual dietary needs and preferences. The communication about dietary changes did not always fed through to all staff.

There was little in the way of stimulation and activities were not planned well in advance and were no tailored to people’s individual needs and capabilities. Some staff had had access to information and a good understanding of people’s care needs. However, communication about care plan changes and inconsistency of staff reading updated care plans placed people at risk from inconsistent care. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

People who used the service and their relatives gave us mixed comments about the nurses and staff, and the care offered to their relations. Some people were involved in the review of their care plan, and when appropriate their relatives were included. Staff had access to people’s care plans and most received regular updates about people’s care needs. Care plans included changes to peoples care and treatment and people were offered and attended routine health checks.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

Staff were aware of the reporting procedure for faults and repairs and had access to the contact details of maintenance contractors to manage any emergency repairs. The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an equipment repair was necessary. However, the registered manager had failed to ensure electrical repairs were followed up.

The provider carried out some quality monitoring checks supported by the consultant and home’s staff, though the checks performed by the registered manager were not regularly recorded. The provider had developed opport

This inspection took place on 16 and 17 May 2017. The first day was unannounced. At our previous inspection during March 2016 the provider was meeting all the regulations we checked. However the provider was required to make improvements under safe, effective, caring, responsive and well-led. At this inspection we found that some improvements had been made, but further improvements were needed under safe, caring and well-led.

Amber Lodge Nursing Home is registered to provide nursing care, for up to 40 people older people living with dementia and or a physical disability. At the time of our inspection there were 31people using the service. The service is located within a residential area of Derby. There are bedrooms on the ground and first floors. Access to the first floor is via a stairwell and a passenger lift. Communal areas were located on both floors.

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.

The provider's arrangements for staff recruitment were not always thorough, which did not ensure suitable people were employed. We found that all the required pre-employment checks were not always in place. Medicines were generally safely managed. However we found that medicines recording was not robust to ensure there was a clear audit trail in place.

Personal emergency evacuation plans, did not provide information on the level of support a person required in the event of fire or any other incident that required the home to be evacuated. This did not provide assurance that people would receive the appropriate level of support in an emergency to keep them safe.

The provider was not clear about their responsibility in notifying the CQC of all incidents and events that the provider was required by law to tell us about. They had not notified us when people’s Deprivation of Liberty Safeguards (DoLS) authorisations had been approved by the supervisory body. After our discussion with the registered manager these were submitted following the inspection visit.

The provider did not have robust systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

Staff did not always feel supported by the management of the service.

Risk assessments and care contained clear information on people’s care needs. Staff told us that they had relevant information on how to minimise identified risks to ensure people were supported in a safe way. There were sufficient staff available to support people.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions

People who used the service were positive about the support they received. People told us they felt safe at the service. We saw staff interacting with people in a relaxed and friendly manner. People were supported to socialise and take part in activities to promote their wellbeing. However we found that staff were not always caring in their approach. For example some staff did not always use suitable term when talking about people who required assistance at meal times.

People were supported to maintain a diet that met their dietary needs. People were supported to use healthcare services. People were supported to maintain relationships which were important to them.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People told us they felt if they raised any concerns these would be taken seriously and would be addressed by management.

People and relatives we spoke with f

This inspection took place on 8 & 10 March 2016 and was unannounced.

The service was last inspected on 17 March 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Amber Lodge Nursing Home is registered to provide nursing care for up to 40 older people living with dementia and or a physical disability. At the time of this inspection there were 35 people using the service. The service is located in the Osmaston area of Derby. Accommodation is provided over two floors with access via a stairwell and a passage lift. Communal living areas were located on both floors.

There was a registered manager at 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.

The provider was not clear on how to report safeguarding incidents to the relevant agencies. The registered manager had on occasion investigated allegations without making a referral to the safeguarding team at the local authority. This did not provide assurance that people living at the service were protected from harm. People using the service and relatives told us that they felt safe at the service. Staff we spoke with understood their responsibility in protecting people from the risk of harm. Staffing levels were adequate to meet people’s needs, however people told us they were not always supported to pursue and develop their individual hobbies and interests. People told us that they were not supported to maintain and develop their social interests.

Recruitment procedures were not robust, as all the required pre-employment checks were not in place. This did not provide assurance that suitable staff were employed to work with the people who used the service.

Where risks had been identified, potential risks were not supported by a care plan which detailed how risks were to be managed by staff to promote people’s welfare and safety.

Systems in place did not always ensure people were given their medicine as prescribed. We saw gaps on some people’s medication administration records, so that It was not clear whether the medicines had been given or not. People were referred to healthcare professionals to maintain their health and wellbeing.

Staff told us they would benefit from regular supervisions with the registered manager, to discuss their training and development. Staff told us that they received training to support them to meet the needs of people.

The registered manager did not clearly understand their responsibility to comply with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Applications had not been made for DoLS in line with legislation. However staff supported people to make their own decisions.

Staff were not always caring in their approach when supporting people. People told us they liked the staff but felt some staff were more caring than others.

People felt confident that they could raise any concerns with the registered manager. However one person felt that they did not want to get people into trouble and only complained if they really had to.

The leadership and management of the service and its governance systems were not robust, which impacted on the quality and consistency of care being provided. This further restricted the development of the service. Staff felt that management of the service was ineffective.

People enjoyed the meals provided and we found meals to be of a good quality, with people being offered choice.

This was a short, focused visit, to check that the compliance actions left at our visit in September 2013 had been met and following information received, to establish that sufficient staff were on duty to meet people’s needs.

Since our last visit the provider has taken steps to ensure people’s support records, assessments and monitoring records were reviewed on an ongoing basis to demonstrate that their needs continued to be met effectively.

Improvements have also been made to the quality monitoring systems. Information regarding prescribed medication in care records matched the information in people's medicines administration records. This demonstrated that the information in care records, regarding people’s prescribed medication was up to date.

Prior to this visit we received information regarding the staffing levels in place at Amber Lodge. We therefore looked at the staffing levels in place and found that sufficient staff were rostered on duty to meet people’s needs.

We found that there was no registered manager in place at the home. The acting manager told us that he was in the process of submitting his application for registered manager.

We found that the provider had put systems in place to ensure that people who used the service were protected against the risks associated with the unsafe management of medicines.

We found that the provider had put in place a system of supervision and appraisal for staff with clear goals and follow up actions where necessary. Training schedules were also in place for staff at the home. Staff we spoke with told us "We get supervision and training now".

We found that the provider failed to implement the quality monitoring systems in line with their action plan submitted to the CQC on 10 September 2013.

People living at the home who were able to express there views told us that they liked living at the home. One person told us "the care is lovely here" and another said " If I want anything I just ask, they really are very good". Relatives also spoke highly of the service with one telling us "I can't fault it, the care is second to none".

We found that people ere offered choices in their care and treatment and their choices were respected. Staff had knowledge of their responsibilities under the Mental Capacity Act, which ensured people needs were met in accordance with their best interests.

The provider had systems in place to ensure that people who used the service had access to a range of allied health professionals.

We found that the provider did not have appropriate systems in place to ensure all medicines were managed and stored safely. We found that the provider did not have a system in place to manage stocks of medical items.

Staff told us they enjoyed working at the home and people using the service and their relatives told us they found staff to be polite and helpful. We found that the provider did not carry out all relevant checks when they employed staff. Staff were not properly supported, or trained to provide care and treatment to people who used the service.

We found that the systems in place to identify and mange risks to staff and people using the service were not always effective.

We found that the provider had reviewed the lunchtime meal service and had put in place systems to ensure people were served their lunch in a timely manner. We saw that the provider had made changes to how information relating to peoples food preferences were stored meaning that their privacy and dignity was respected.

We saw that the provider had replaced corroded toilet aids and commodes and had put in place audit systems to monitor the risk of infection control at the home.

We also found that the provider had put in place systems to ensure staff received appropriate supervision.

People we spoke with told us that they liked living at the home and that they felt safe and cared for. One person we spoke with told us "they are lovely to me here, they look after me”. One of the relatives we spoke with told us “it’s like a five star hotel”.

We observed that staff were aware of people's individual needs and knew how to best to communicate with and support people make choices for themselves regarding their daily routines.

We spoke with five people using the service and they told us they were happy in the home and they felt well cared for. One person told us, “I love it here, I have made friends.” Another said, “My family visit every week and they are always pleased with the home.”

When we last visited the home, two people who use the service told us that there was not often much food available that met their cultural preferences. We asked them during this visit if things had improved. They told us they now had a special take away once a week and two other dishes that met their cultural preferences were regularly served and they enjoyed this.

We spoke with five people using the service and they all said that they felt the home was kept clean and hygienic. One person said, “they (staff) come and clean my room every day and they change my bed most days.” Another person confirmed their room was cleaned every day. A visitor that we spoke with told us “The home is kept as clean as it is possible to do, I find it is cleaned at an adequate standard.”

We spoke with three people using the service about the care they received and they told us that they were very happy with the care they were getting. One person using the service told us, “staff are lovely, I am well cared for here.”

We were told by one person that they would prefer their drinks to be served in a glass. This would indicate that people’s choices are not always taken into consideration.

One person said, “the food is excellent, I always enjoy my meal”.

We spoke to three people who use the service. Everybody said that they liked living at Amber Lodge Nursing Home. One person said “I like it here. Staff are kind and I feel safe”. Another person said “I am happy, the staff come when I call and they do what I ask for”. We spoke to two relatives of people using the service who both confirmed that they were happy with the service provided.

We spoke to one person who was in their bedroom who said “They don’t cook the food I like, its potato most days. The cook left who could cook the food I like. I have a takeaway sometimes and my daughter brings me some food”. This person told us that, due to their cultural needs, they preferred a certain diet. We were told that currently this person’s dietary preference was not being met. We mentioned this to the acting manager during our visit who said that they would look into how they could better meet this person’s needs.

People using the service told us that the registered provider of the home visited every day and always asked how they were. One person told us, “He (the provider) never walks past my bedroom door without stopping and asking me how I am today.”