Amber House provides accommodation with personal care for up to 15 older people. There were 14 people living at the home at the time of the inspection. At the last inspection on 25 January 2016, the service was rated Good. At this inspection the service remained Good.

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.

People’s safety was supported by care staff that knew and understood how to protect and reduce the risk of harm. People were happy that their home was safe and the care staff helped to keep them safe. We saw people had their needs met during our inspection from care staff who were available to offer guidance or care. People told us they received their medicines at the same time daily. If needed extra pain relief or other medicines were provided on request or as assessed by care staff.

Care staff were supported to look after people with training and were supported by the management team. 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 told us they enjoyed the meals and always had a choice of meals and drinks they enjoyed and kept them healthy. We saw that where people needed additional support from healthcare professionals the treatment was supported by the care staff who followed any advice and guidance.

People told us and we saw that their privacy and dignity was promoted and care staff were respectful and kind with people. People's choices and decisions were listened to and respected by care staff when providing care and support in the communal areas.

People’s care needs were assessed, including their views on how their care was planned and delivered to meet those needs. Where needed to aid planning, people’s relatives felt they were involved in the care and were asked for their opinions and input. People told us staff offered a variety of things to do and had entertainers visit which included music and exercise.

People were confident to approach the manager if they were not happy with the care. The provider had reviewed and responded to all concerns raised.

People’s views and opinions of the care they had received had been sought and reviewed to look at how improvements could be made. The management team ensured people and their relatives were kept informed of any changes or improvements planned. People and care staff told us the management team were easy to talk with and always available within the home which people and relatives liked.

Further information is in the detailed findings below2

We carried out an unannounced comprehensive inspection of this service on 15 January 2015. Since that inspection we received a concern in relation to how the risks associated with people’s care were managed. As a result we undertook a focused inspection on 25 January 2016, to check whether people were safe.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Emerald Care Ltd on our website at www.cqc.org.uk.

Amber House is a small residential care home which provides care and support to a total of 15 people who live with dementia. At the time of our visit, 13 people were living at the home.

The service has 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.

A relative and staff told us people were safe living at the service.

Staff were trained in safeguarding adults and understood how to protect people from abuse.

Risks associated with the care provided to people who lived at Amber House at the time of our visit, had been assessed and action taken to minimise the risk.

Incidents and accidents had been documented in detail, and the provider had taken action to reduce the risks of identified incidents re-occurring in the future.

There were sufficient numbers of staff on duty both day and night to meet people’s needs.

We carried out this inspection on 15 January 2015. The inspection was unannounced.

The home is registered to provide accommodation and personal care for up to fifteen older people with a diagnosis of dementia. At the time of our inspection, ten people lived at the home and two of those people were in hospital.

The service has a registered manager who was present on the day of 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.

Amber House is a two storey older style detached property. The home has two owners, one who is the registered manager and who was working on the day of our inspection.

Staff we spoke with knew about safeguarding people and what to do if they suspected abuse. We saw there were suitable numbers of staff at the home and people’s care needs were being met. Medicines were stored securely and systems were in place to ensure people received their medication as prescribed.

Risk assessments were completed and plans put in place to minimise any identified risks so care was provided safely. These were reviewed regularly to ensure any changes were identified.

Checks were carried out prior to staff starting work at the home to ensure their suitability for employment. We saw staff had training to do their jobs effectively and were encouraged to continue to develop their skills.

Mental capacity assessments were recorded on care records and if a person was assessed as ‘lacking capacity’ we saw decisions were made in their best interests.

People were offered a choice of food, and drinks were encouraged throughout the day. We saw the service was flexible, people could eat at different times to suit preferences. Staff were caring and knew the people living at the home well. They knew their likes and dislikes and how to support people living with dementia effectively, ensuring dignity and respect were upheld.

Activities at the service were varied and incorporated days out and one to one activities. People could choose to join in social events or not if they preferred. Staff spent time talking to people at the home.

The registered manager knew the staff and people at the home well. She was experienced in providing care for people with dementia and did this in a personalised way. Staff told us they felt valued and there were incentives in place to support and encourage staff. The manager had good systems in place to make sure the service was effective, monitored and audited.

The provider was meeting the requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection, six people had DoLS applications submitted and these were waiting to be assessed. The manager was aware of recent changes in legislation.

When we visited Amber House there were eleven people living at the home. People living there had a diagnosis of dementia so we were unable to gain their views about the care provided. We therefore spent time observing the care and support provided by staff. We spoke with three care staff on duty and the registered manager.

People's care and support needs were being effectively managed. We observed staff supporting people with respect and patience.

Staff understood their obligations to report any observed or suspected abusive behaviour.

We were satisfied people were receiving their medicines when they needed them and in a safe way.

Staff spoke positively about the training they received. One staff member told us, “They will always ask us if we think there is something we need to do.” Staff found the specialist dementia training they were undertaking supportive of their practice in the home.

Records we looked at showed the service had systems in place to monitor the care provided to people. We saw there was a process in place to audit records to make sure people were receiving the care as outlined in their care plans.

Our visit was unannounced. We spoke with the three care staff on duty, with people living at the home and observed care and support given by staff. At the time of our visit, all those who lived at the home were women. We were unable to obtain clear opinions from people who lived at the home on how they viewed the care and support they got. However, people showed by their demeanour and reactions they were comfortable and at ease with staff and their environment.

We also spoke with two visitors, and spoke with two relatives by phone. We spoke with the manager and the co-owner of the home and looked at a sample of three care plans. We also spoke with a contracts monitoring officer from the local authority.

We saw staff engaging with people at the home in a positive, respectful and supportive manner throughout. We spoke with two relatives by phone who were very positive about the home. One person told us they were “Very, very happy with the home.” Another told us “They are very good – very approachable.” One relative who was visiting the home and took an active part in the care of their relative told us were not happy about the care and had complained about this.

We found a very relaxed and quiet atmosphere at the home. Staff told us that this was exceptional, and that more frequently there were some residents presenting behaviours that challenged. The home specialises in providing care and accommodation for people with mental frailties associated with dementia. Some people remained in their rooms; two were being cared for in bed, but most people had got up and spent their time in one lounge. We spent much of the time in the lounge observing people’s interactions with the staff, and talking with them. People expressed, in varying ways, satisfaction with the care and support, and responded positively to staff, who showed a good awareness of individual needs and wishes. Staff were able to spend time reassuring people, answering queries and encouraging them to eat and drink, especially where people required a lot of encouragement and support.

Although no specific activities took place during our visit, records, photographs and discussions with staff, relatives and residents showed that these took place regularly. Staff had accompanied several residents to the pantomime the previous day. We spoke with one lady who had been. Although she told us she could not recall going, later on she made several references to pantomimes that indicated she had some recollection of the event.

We spoke with two relatives of people living at the home by phone following our visit, and they had nothing but praise for the care provided at Amber House. Comments from relatives included, “very individual care”, “empower people to make choices about what is important to them”, “very satisfied” “treat people like members of their own family.” Relatives were equally confident of the home’s management of people in the earlier stages of dementia, and in the later stages.