About the service: Amber House is a residential care home registered to provide accommodation and personal care for up to 44 older people, including those who are living with dementia. At the time of the inspection there were 22 people using the service.

People’s experience of using this service: People were not kept safe from harm. Risk assessments were not up to date, specific or followed by staff to ensure individuals were safe.

Processes and records were not maintained to ensure people always received their medicines safely as prescribed.

Some people told us they had to wait for staff support. We observed staff not meeting people’s needs in a timely way. This had impacted on people’s dignity and showed not all staff had respect for people.

Care was not always person-centred. Some staff had good knowledge about people’s needs but this was not always captured and reflected in care planning. People’s diverse needs were not always considered.

Staff did not receive appropriate training or assessment of their competency to ensure they had the appropriate skills to meet peoples’ individual needs. Lessons had not been learnt from accidents and incidents to reduce the likelihood of reoccurrence.

People, their relatives and health care professionals had mixed views about the care provided. Person-centred care was not reflected within people’s care plans and associated records.

The provider failed to ensure that improvements were made. This is the fifth time the service has been rated overall as below ‘good’ and the provider had failed to deliver on the action plan following the last inspection. There was no registered manager in post at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Rating at last inspection: Requires improvement (report published June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. The provider will continue providing regular updates to their action plan. If any concerning information is received, we may inspect sooner.

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

The inspection took place on 15 and 29 March 2018 and was unannounced. At the last inspection in February 2017 there had been a breach of Regulation 17 of the Health and Social Care Act (HSCA)2008 (Regulated Activities)2014.because the provider had not maintained accurate records.

'Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) well led to at least good.' At this inspection we found that the service was not consistently safe and we have recommended that the provider look at risk assessments. There was also a continued breach of Regulation 17 (HSCA) 2008 (RA) 2014 because the provider had not kept complete records for each person and quality monitoring had not identified where improvements were needed.

Amber House 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. The service accommodates up to 41 older people who may have a dementia type condition in one adapted building.

There was a manager employed at the service who was in the process of registering with the Care Quality Commission. 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.

Risk assessments were not always completed to reflect people's health needs. Risks in the environment had not always been identified and this did not support people in remaining safe.

Staff worked within the principles of the Mental Capacity Act 2005 but did not clearly record how best interest decisions were made.

The manager told us they were dedicated to providing a high standard of care. They had an inclusive style which staff commented upon in a positive way. They worked as a member of the care team supporting staff where necessary. Where things had gone wrong lessons were learned and action taken to prevent reoccurrences.

Our observations showed that people at the service were safe. There had been one recent safeguarding alert which was currently been investigated by East Riding of Yorkshire council safeguarding team. We saw that staff had completed training in safeguarding people and they were able to say what they would do if they had concerns about someone's safety.

There were sufficient numbers of staff on duty on the days of inspection to ensure people's needs were met. People were offered choices around their day to day activities.

Overall, people received their medicines safely. However there had been a recent incident where stocks of medicines had not been ordered in a timely fashion.

The service was clean and tidy with no odours.

Complaints were acted upon in accordance with the services policy.

Staff were trained in subjects considered mandatory by the provider but some training required updating. Staff received supervision to support their practice.

We observed many positive interactions between people and the staff during the two days of inspection. Staff knew people well and were respectful in their approach. Where necessary people had an advocate who supported them.

When people were distressed we observed staff responding appropriately. They were able to access healthcare when needed.

People had care plans in place which were evaluated and reviewed.

Activities were provided at the service.

This inspection took place on 7 February 2017 and was unannounced. At the last comprehensive inspection of the service in June 2015 we rated the home as Inadequate due to breaches in Regulation 12: Safe care and treatment, Regulation 15: Safety and suitability of the premises, Regulation 17: Good governance, Regulation 18: Staffing, Regulation 19: Fit and proper persons employed, Regulation 9: Person-centred care and Regulation 11: Need for consent. At the follow up inspection in December 2015 we found that improvements had been made. We rated the areas of safe and responsive as requires improvement, and the areas of effective, caring and well-led as good. There were no breaches of regulation and we judged that the overall rating was requires improvement. At the inspection in December 2015 we did not impose any requirements, but were concerned that staffing levels sometimes fell below those that were required and that people were not taking part in meaningful activities.

At this inspection we found that staffing levels were sufficient to meet the needs of people who lived at the home, and that efforts had been made to improve the type and availability of activities, although we considered there was room for further improvement.

The home is registered to provide accommodation and care for up to 41older people, including people who are living with dementia. On the day of the inspection there were 17 people living at the home. The home is situated in Bridlington, a seaside town in the East Riding of Yorkshire. The premises has three floors and a passenger lift operates between all levels. There are a small number of steps between split floor levels so only people able to manage the stairs can be accommodated in the areas that are accessed by steps.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

Care plans included information to guide staff on how to meet people’s assessed care and support needs. However, we noted some anomalies or gaps in recording in care plans, positional change charts and medication records that could have resulted in people not receiving the care they required.

This was a breach of Regulation 17 (1)(2)(c) of the Health and Social Care Act (Regulated Activities) Regulations 2014: Good governance.

We detected some malodours around the premises and we have made a recommendation about this in the report.

People were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No-one living at the home had a DoLS authorisation in place but the registered manager had submitted applications that were being considered by the local authority.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with people who may be vulnerable had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs.

Staff told us they received the training they needed to carry out their roles effectively and confirmed that they received induction training when they were new in post. Staff told us that they were well supported by th

This inspection took place on 18 December 2015 and was unannounced. We previously visited the service on 4 June and 8 July 2015 and we identified that there were insufficient numbers of staff employed to meet the needs of people who lived at the home, that the premises were unsafe, that some care workers did not have the skills to communicate effectively with people who lived at the home, there was a lack of evidence staff had completed induction and on-going training that equipped them to carry out their role, that some people received inadequate support when they displayed behaviour that might challenge others, there was a lack of opportunity for people to comment on the care and support they received and that action had not been taken when the need for improvement had been identified. The concerns we had meant that we placed the service in ‘Special Measures.’ Services in Special Measures are kept under review and , if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

At the inspection on 18 December 2015 we checked that the registered provider had made the required improvements to ensure that people received a safe and effective service. We found that significant improvements had been made which meant that the service was no longer placed in ‘Special Measures.’

The home is registered to provide accommodation for up to 41 older people who require assistance with personal care, some of whom may be living with dementia. On the day of the inspection there were 20 people living at the home. The home is situated in Bridlington, a seaside town in the East Riding of Yorkshire. It is close to town centre facilities and the sea front.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was not registered with the Care Quality Commission (CQC). However, they had submitted an application for registration. 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 the day of the inspection we saw that there were sufficient numbers of staff employed to meet people’s individual needs during the day but that staffing levels during the night were sometimes reduced. Night time staffing levels were increased from the day following our inspection. We made a recommendation in respect of this shortfall as we needed to see that the improved staffing levels would be maintained in the long term.

People told us that they felt safe whilst they were living at Amber House. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff had completed training in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. The training records evidenced that staff had completed training that equipped them to carry out their roles effectively. Staff who administered medication had received appropriate training although it was acknowledged that more staff who worked during the night required this training; this was addressed on the day following our inspection.

New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people had been employed.

People told us that they received the support they required from staff and that their care plans were reviewed and updated as required. People told us that staff were caring and that their privacy and dignity was respected.

People’s nutritional needs had been assessed and people told us they were happy with the meals and refreshments provided. We saw that people were encouraged to drink throughout the day to promote hydration.

There was a complaints policy and procedure in place and people told us they were confident that any complaints or concerns they raised would be listened to.

There were systems in place to seek feedback from people who received a service, and this feedback was used to identify improvements that needed to be made. Activities at the home had increased as a result of feedback received in surveys, although people told us they would appreciate more activities. We made a recommendation in respect of this shortfall in the inspection report.

The quality audits undertaken by the manager were designed to identify any areas that needed to improve in respect of people’s care and welfare.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at this time.

We spoke with three people who lived at the home, two members of staff and the manager during this inspection.

We checked the care records for three people who lived at the home and saw that they had been reviewed and updated consistently so that staff had up to date information about the people they cared for. People who we spoke with were positive about the care they received and described staff as "Pleasant" and "Professional". One person told us, “I like it here. The staff are good and I like the meals”.

Staff had received training on safeguarding adults from abuse and the people told us that they felt safe living at the home.

The home was clean and well maintained and we saw that refurbishment was ongoing.

Staff and people who lived at the home told us that there were sufficient numbers of staff on duty. People told us that staff answered call bells as quickly as they could.

Quality audits had been carried out to monitor that systems in the home were being followed consistently to ensure that people received safe and appropriate care. People told us that they would speak to a member of staff or the manager if they had any concerns and were certain that they would be listened to.

People who lived at the home told us that they were happy with the care they received. One person said “You can have a laugh and a joke with the staff, but when discussing important matters, they are professional and take things seriously” and another said, “The staff are very good – they always listen”.

We saw that people were supported to be as independent as possible and that people's privacy and dignity were respected by staff. People were encouraged to spend time outside of the home when it was considered safe for them to do so.

Staff were recruited safely and we saw that they were skilled in communicating with people who lived at the home.

People who lived at the home and staff told us that the manager had an 'open door' policy and they were able to speak to her at any time. They felt that the manager would listen to them and act professionally if they shared information of concern with her.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

This inspection took place on 4 June 2015 and 8 July 2015 and was unannounced. A specialist advisor visited the home on 11 August 2015 to check the electrical installation systems, as we had not been assured of the home's safety by information provided by the home. Information about the specialist advisor's findings and the subsequent action that needed to be taken by the registered provider is included in this report.

We previously visited the service on 16 January 2014 and we found that the registered provider met the regulations we assessed.

The service is registered to provide personal care and accommodation for up to 41 older people, some of whom may have a dementia related condition. The home is located in Bridlington, a seaside town in the East Riding of Yorkshire. It is close to town centre facilities and the sea front. Most people have a single bedroom and some bedrooms have en-suite facilities. On the day of the inspection there were 29 people living at the home.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). 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 have written to the registered provider to inform them that it is a legal requirement for the service to have a manager who is registered with CQC.

We observed some good interactions between people who lived at the home and staff on the day of the inspection. However, we were concerned that two staff were from another service operated by the registered provider and were not familiar with people’s needs, and another member of staff was not able to communicate effectively with people due to language difficulties.

We saw that there were insufficient numbers of staff on duty to meet the needs of people who lived at the home and to enable them to spend one to one time with people. Staff had been interviewed and appointed even though they did not have the skills needed to carry out their role.

Staff told us that they were happy with the training provided for them. However, records evidenced shortfalls in the training that was considered to be mandatory by the home, and that was needed to evidence that staff had the skills and knowledge to keep people safe and promote their well-being.

There were systems in place to seek feedback from people who lived at the home, relatives, health and social care professionals and staff but these were rarely used. Some areas for improvement that had been identified following surveys or meetings had not been acted on so there was little evidence that quality monitoring was having an impact on the way the service was being operated.

There was a handyman in post and some in-house checks were being carried out to promote the safety of the premises. However, some maintenance that needed to be undertaken by a qualified contractor was overdue. A lack of auditing in respect of the safety of the premises meant that some health and safety hazards had not being identified and remedial action had not been taken. Some quality audits had been undertaken by the manager or senior staff, although the infection control audit that we saw did not include a record of when actions had been completed to evidence that improvements had been made to protect the safety of people who lived, worked at or visited the home.

People told us that they felt safe living at the home. Most staff had completed training on safeguarding adults from abuse and were able to describe to us the action they would take if they had concerns about someone’s safety.

People were supported to make their own decisions and when they were not able to do so, meetings were held to ensure that decisions were made in the person’s best interests.

People’s nutritional needs had been assessed and people told us that they were satisfied with the meals provided by the home. People were supported appropriately by staff to eat and drink safely.

Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust.

There were numerous breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These are reported on in more detail in the main part of this inspection report.