This inspection took place on 17 and 18 October 2018 and was unannounced. We last inspected the service on 23 November 2015 and we rated the service as good. Following this inspection, we have rated the service as 'Requires Improvement'.

Amberley 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. Amberley accommodates up to 25 older people that may live with dementia in one adapted building. At the time of this inspection 23 people were using the service.

There was a registered manager and she was present during our inspection. 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.

Risks to people’s safety were not consistently managed and action was not taken to mitigate those risks to ensure people received safe care. Accidents were not analysed to assess for any patterns and trends and to introduce measures to reduce further risks. Audits of the environment had not been undertaken to ensure all areas of the home were safe for people to use.

Assessments and care plans were not detailed to ensure staff had access to personalised information about people’s abilities, wishes, and support needs and how these should be met. Some records had not been updated to ensure they reflected people’s current needs.

The systems to monitor the quality of the service were not effective and did not ensure shortfalls were identified to ensure improvements could be made.

You can see what action we told the provider to take at the back of the full version of the report.

People received their medicines as required, but we identified shortfalls where medicines were not always managed safely. Staff knew how to escalate safeguarding concerns they had about people. People told us they felt safe and there was enough staff to meet their needs.

Staff received an induction to their role but we found gaps in staff training and some staff needed to complete refresher training to maintain their skills and knowledge. Staff had a basic awareness of the Mental capacity act (MCA), and were not aware which people had a Deprivation of liberty authorisation in place. Staff did seek people’s consent before providing support.

Not all aspects of people’s healthcare needs were being met as people did not have access to dentistry services. The registered manager took action following our visit to access this provision and complete the required referrals. Improvements with the environment were required to enable people that lived with dementia to be able orientate themselves within the home.

People described the staff and the manager as caring, kind and told us their dignity and privacy was respected. However, we observed some occasions where staff did not maintain people’s dignity. People told us there were not enough daily opportunities in the home to engage in meaningful activities. Themed events where facilitated such as vintage tea parties and a Halloween party was planned.

People and their relatives knew how to complain and procedures were displayed in the home. However, we found not all complaints had been recorded to enable us to review these and the responses provided.

Systems were in place to gain feedback from people and their relatives. Staff felt supported in their role and thought the manager and provider were approachable.

We spoke with seven of the 25 people living there, the manager, a senior staff member, two care staff and the cook. We also spoke with three visiting relatives. A relative said, “It’s a nice home, the staff are very caring and talk to us a lot about our relative, I feel well informed and my relative gets good care”.

Staff understood the importance of getting consent from people before they delivered care and we saw arrangements were in place to protect people who were unable to give their consent.

People had a care plan that reflected their needs and their personal routines and preferences. We saw people’s needs had been assessed and planned for.

People were happy with their meals, one person said, “You always have a choice and seconds and if you don’t like it they ask you what else you might eat”. Appropriate arrangements were in place to support people who did not eat or drink enough. This meant the risks of dehydration or poor nutrition were reduced.

Staff members said they received support to do their job. People who lived there and visiting relatives were complimentary about staff. One person living there told us, "You won’t get nicer staff they are very good”

People had opportunities to voice any complaints and were confident these would be resolved.

This inspection took place on 23 and 25 November 2015 and was unannounced. The home is registered to provide accommodation and personal care to 25 people.

On the day of our inspection 25 people lived at the home. People had a range of age related needs which included dementia. At our previous inspection in June 2013 the provider was compliant with the standards we assessed.

There was a registered manager in post and she was present during our inspection. 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 and associated Regulations about how the service is run.

People felt safe using the service and risks to their safety had been identified. Staff knew how to support people safely and had training in how to recognise and report abuse.

Staff were recruited in a safe way. We found there were enough staff to support people and meet their needs in a personalised manner.

We found that medicine management systems needed some improvement so that people would receive their medicine safely and as it had been prescribed by their doctor. The registered manager addressed this on day two of the inspection.

Most staff worked in a manner that showed they sought people’s consent, some staff were less consistent. People’s liberty was not restricted and the registered manager had followed the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) where people’s safety needed this.

People were supported to eat and drink enough. The two week menu was repeative and people reported it did not provide enough variety.

People had access to routine health checks. Links with health proffessionals where people had continued health conditions such as diabetes needed to improve in order for people to experience positive outcomes regarding their health.

A complaints procedure was available for people to use. However, complaint documentation did not give full assurance that complaints had been followed through to an outcome.

People described the management of the home as friendly and approachable.  Staff felt supported and the provider had carried out audits on the quality of the service and had made improvements to ensure the safety of people.