The inspection took place on 10 and 12 January 2017 and was unannounced.

Amberley Lodge Care Home is registered to provide accommodation and nursing care for up to 17 people with a variety of health care needs, including dementia. At the time of our inspection, there were 17 people living at the home. Amberley Lodge Care Home is a detached property close to the centre of Worthing with easy access to shops and the seafront. Communal areas included a lounge leading to a conservatory with access to a rear garden. The garden has a sheltered courtyard complete with a seating area. There is an additional small dining/sitting room near the kitchen. All rooms were single occupancy. The ambience was warm and inviting.

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 on 3 and 4 November 2015 we identified four breaches of Regulations associated with the premises, staff supervision and training, food preferences and personalised care. Recommendations were also made in relation to improving how staff were deployed and staff training in medicine administration, Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We also recommended the provider improved how they assessed the competencies of staff who administered medicines to people and to review how they monitored the quality of the service provided to people. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider has now met all the legal requirements.

At the last inspection, we observed the premises were not always clean or properly maintained. This was in breach of Regulation 15 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found noticeable improvements had been made to the home environment which had been service user led. This included the widening of corridors and personalised pictures hung in the lounge and throughout the communal areas. The home was clean and tidy throughout, routinely maintained and monitored by the registered manager, therefore this regulation was now met.

At the last inspection, we noted gaps in staff supervision, appraisals and training. This was in breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found staff received regular supervisions, appraisals and training in all relevant subjects to enable them to carry out their role and responsibilities. Therefore, this regulation was now met.

At the last inspection, we found people’s preferences about food choices had not always been considered. We also found some people had not been assessed as needing a specific diet therefore their needs not being met in this area. This was in breach of Regulation 14 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found improvements and actions had been taken by the provider to ensure people were appropriately assessed regarding specific diets and their food preferences considered. Therefore, this regulation was now met.

At the last inspection, we found people did not always receive personalised care that was responsive to their needs. We found some people were at risk of social isolation due to a lack of social activities and stimulation offered to them. We also found care plans failed to reflect how people and their relatives were involved in decisions made about their care and treatment. This was in breach of Regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked round the home with the manager and met all the people living there. We spoke with three people using the service. One told us “I’m OK.” Another said “The food’s good, I’ve got no complaints.”

We spoke with the manager and the provider, two nurses, two care staff, the chef, the housekeeper and the cleaner. One member of staff told us that the strength of the Amberley Lodge was that “it is like a family home.”

We reviewed care records for three people using the service. We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans updated to reflect a person’s current needs.

People had a varied diet and were given the support and encouragement they needed to eat and drink.

People were protected from the risk of the unsafe management of medication because staff were trained, procedures were in place and audits undertaken.

There were effective systems in place to ensure people were safe because staff were subject to rigorous recruitment procedures and a thorough induction.

We were informed that there were sixteen people living at Amberley Lodge Care Home. We looked around the building which was clean and free of unpleasant odours. The proprietor informed us that the home had a plan of refurbishment in place and had replacing flooring and redecorated some of the bedrooms. The majority of rooms were single occupancy with their own hand basin. The rooms were personalised with photographs, TV’s and pictures. There was a lift so people could access the first floor.

During our visit we spoke with two people who used the service however due to the nature of their disability conversation was limited; and three members of staff and the proprietor. We also spoke with a General Practitioner. We spent time observing how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

All the people we saw looked happy living at Amberley Lodge Care Home. People told us that it was a nice place, and that the staff were good. One person said the food was good and another said they always get a lot of vegetables and that they were ‘very lucky’. A General Practitioner who was visiting the home told us they did not visit the home often but thought the home was not bad and that the staff team was a good.

We saw that care plans were person centre and people’s care assessments looked at people's goals and the support they required. Care plans had details of people’s likes and dislikes.

We spoke with four people who live at Amberley Lodge. Conversation with people was limited due to their disability. However, we spent time with them during the morning as they took part in activities. We also observed the care they received from staff in order to understand what it was like to live at this care home.

We spoke with three members of staff who were on duty. They demonstrated they knew about the level of care that each person required. They also told us they were well supported by the manager.

We spoke with the provider who explained how the quality of service provision has been assessed and monitored.

The inspection took place on 3 and 4 November 2015 and was unannounced.

Amberley Lodge Care Home is registered to provide accommodation and nursing care for up to 17 people with a variety of health care needs, including dementia. At the time of our inspection, there were 16 people living at the home. Amberley Lodge Care Home is an older style detached property close to the centre of Worthing with easy access to shops and the seafront. Communal areas include a lounge leading to a sun-lounge, a further small sitting/dining room and a rear garden with a sheltered courtyard area and seating. All rooms were single occupancy.

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.

Premises were not always managed to keep people safe. Some trunking had come loose exposing loose wires in one part of the home and there was extremely poor lighting in the ground floor bathroom. There was only one bathroom available for people to have a shower. An upstairs bathroom had been decommissioned as the bath was unsuitable for people who had limited mobility. Generally, the home was clean and tidy. There were sufficient staff on duty, but they were not always deployed in a way that meant people’s needs were responded to promptly. People felt safe and any risks to them were assessed and managed appropriately. Safe recruitment practices were followed. Medicines were managed safely, although competency checks for staff had not been undertaken.

Staff had received training considered essential to their work, but records were not available to confirm this. Additional training opportunities for staff were available from an external organisation, but not all staff had accessed this. Staff had received at least one supervision in the year, although the provider’s policy stated that supervision meetings should occur every two months. No staff had received an annual appraisal and formal staff meetings had not been planned. However, staff communicated with each other at handover meetings. Care staff had achieved appropriate vocational or professional qualifications and new staff followed the Care Certificate, a universally recognised qualification.

Consent to care and treatment was sought in line with legislation and guidance and staff had received training in this area. However, not all staff had a thorough understanding of the legislation in relation to consent to care and treatment.

People were supported to have sufficient to eat and drink and to maintain a balanced diet. Some people’s preferences with regard to food choices were not always taken account of. Special diets were catered for. People had access to a range of healthcare professionals. Some areas of the home were warm and inviting, however, other areas were starker with narrow corridors and a lack of helpful signage for people living with dementia.

Staff knew people well and kind, caring relationships had been developed. People were encouraged to express their views and staff supported people in a caring and reassuring way. People were treated with dignity and respect. Staff knocked on people’s doors before entering to promote privacy.

People did not always receive care that was personalised to meet their needs. Activities were organised for people and staff tried to involve people in these. However, some people had little mental stimulation during the day or access to meaningful activities. Care plans provided detailed information about people and were reviewed and updated every month. There was a complaints policy in place, however, this was in need of updating. No complaints had been received within the year.

People’s views were obtained through informal means and the registered manager met with people every day to check on their wellbeing. People and their relatives were asked for their views in a questionnaire. However, this referenced the CQC fundamental standards and would not have been easily understood by the majority of people. Generally, people and their relatives felt the home was well-run and staff felt supported by management. There was a range of audits in place to measure the quality of care delivered, including environmental checks. However, the environmental checks were not always effective in identifying areas of concern such as cleaning and maintenance issues.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.