About the service

Amberley House is registered to provide accommodation for up to 42 older people who require personal care. The majority of people living at the home were living with dementia. Some people required nursing support and this is provided by the local community nursing team. At the time of the inspection, 40 people were living at the home, one person was in hospital.

People’s experience of using the service

People using the service benefitted from caring staff. People and their relatives told us they were treated with kindness, compassion and respect.

People were placed at the heart of the service and where possible, involved in decisions. People and staff told us they were listened to and care was individualised.

People’s care was provided safely. The staff team were consistent, staff knew people well and staff supported people to move safely around the service. People’s risks were known and managed well, promoting independence as far as possible. People were protected from discrimination because staff knew how to safeguard people.

People lived in a service which had a positive culture and was led by a dedicated senior team of staff including the registered manager, a manager and the deputy manager. Amberley House had good relationships with local healthcare professionals supporting people’s care.

Rating at last inspection:

At the last inspection, the service was rated as Good (The last report was published 31 March 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained Good.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns, we may bring our inspection forward.

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

Amberley House provides care and accommodation for up to 42 older people some

who are living with dementia. At the time of the inspection there were 40 people living in the service.

Some of the people who lived in the home had limited communication therefore we spent time observing people.

At the last inspection, the service was rated Good overall. However it was Requires Improvement in Safe because medicines were not being managed safely. .

At this inspection we found the service Good in all areas.

Why the service is rated good:

People remained safe at the service but they now received their medicines safely. People and staff told us there were sufficient staff to meet people’s needs. Risk assessments were completed to enable people to retain their independence and receive care with minimum risk to themselves or others.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff were well trained and competent. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were monitored by the staff and people had access to healthcare professionals according to their individual needs.

People said the staff were very caring. We observed staff being patient and kind. There was a calm atmosphere in the service. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received. One person said; “You couldn’t ask for better care.” And a relative said; “Excellent staff and excellent care.”

The service remained responsive to people's individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Complaints were fully investigated and responded to. A relative said; “If I have any issues they are always dealt with straight away.”

People were assisted to take part in a wide range of activities according to their individual interests. Trips out were also planned for people.

The service continued to be well led. Staff told us the registered manager and management team were very approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Further information is in the detailed findings below.

We met and spoke with most of the 37 people who used services, five relatives, staff on duty and checked the provider's records. One person using the service said they “Couldn’t wish for anything better”.

People living in Amberley House received care or treatment when consent had been obtained and the staff acted in accordance with their wishes. Throughout our visit we saw staff involving people in their care.

We saw people’s privacy and dignity being respected. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. One person living in the home said, “They always knock on my door and ask me if I need help, they are wonderful”.

Staff we spoke with were clear about the actions they would take should they have any concerns about people's care and welfare.

We looked at care being provided for four people living in Amberley House. We spoke with staff about the care given, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their needs and how those needs were met. People's mental capacity was assessed to determine whether they were able to make particular decisions about their lives.

We spoke with most of the staff working during our visit. Some of the staff had worked at the home for a number of years with one saying “We all rally around together to help”.

We saw that Amberely House had a complaints procedure available and documentation of complaints dealt with.

We carried out an unannounced inspection on 14 June 2012. On the day of our visit there were 39 people living at Amberley House. We spoke with 11 people living at the home, five staff member and looked at five people’s care files.

People told us what it was like to live at the home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience”; people who have experience of using services and who can provide that perspective.

Most of the people who used the service at Amberley House had a dementia and therefore some were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

On our visit to the home we spoke with five of the people living there five staff, one relative and the owners of the home.

People living at the home who told us that they never had any concerns about the care and treatment they receive from the home and that a doctor was always called if there were any concerns about their health.

People living at the home told us that they enjoyed living there, that staff were 'very good' and there was always enough staff about. One person told us 'Doesn’t matter who you talk to - they are all good'. Another person told us 'If you want anything done it is usually done very efficiently and quickly'.

The inspection took place on 26 August and 2 September 2015 and was unannounced. Amberley House provides care and accommodation for up to 42 older people some whom are living with dementia. On the day of the inspection 42 people resided at the service with two people currently in hospital. Amberley House is owned by A & L Care Homes Limited. A & L Care Homes Limited has another service within the county of Devon.

The service had a registered manager in post. 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.

People’s medicines were not always managed safely. People had not always been given their medicines as prescribed. Medicine records were incorrectly recorded and the documented number of medicines held was incorrect.

People looked relaxed with the staff and there was a friendly and calm atmosphere. People were chatting and enjoying the staffs company. Comments included; “Best place I’ve been.” People, who were able to, told us they were happy living there.

People’s privacy and dignity were maintained. We observed staff supporting people and being kind and compassionate. People told us staff were kind and caring. People’s privacy and dignity were respected by staff who provided individual and personalised care.

People, their relatives and professionals were happy with the care provided by the staff and said staff were knowledgeable and were able to meet people’s needs. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives.

People were protected by safe recruitment procedures. There were sufficient staff employed to meet people’s needs and new staff completed an induction programme. Staff received a comprehensive induction programme. Staff had undertaken training and had the right skills to meet people’s needs.

People visited healthcare professionals, for example GPs and district nurses, to ensure they received appropriate care and treatment to meet their health care needs. Staff responded to information given to them by professionals to ensure people received the care they needed to remain well.

People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected and worked with others in their best interest. People’s safety and liberty were promoted.

People were better protected from harm as staff had safeguarding of vulnerable adults training and had the knowledge on how to report any concerns and what action they would take to protect people. Staff were confident any incidents or allegations would be fully investigated.

People were supported to maintain a healthy balanced diet. People told us they enjoyed their meals, there was plenty of it and they did not feel rushed. People had opportunities to take part in a variety of activities.

People’s care records contained detailed information about how people wished to be supported. Records were updated to reflect people’s changing needs. People and their families said they were involved in the planning of their care.

Staff told us they were happy working at the service and told us the registered manager was supportive, kept them informed, listened to them and acted on any concerns raised.

There were quality assurance systems in place. Feedback to assess the quality of the service provided was sought from people and their relatives. Audits were carried out to help ensure people were safe, for example environmental audits were completed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.