Amber House Residential Home Limited 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 care home accommodates up to 18 people in one adapted building, arranged over two floors. At the time of our inspection, there were 15 people living there, some of whom were living with dementia. There is a communal lounge and a separate dining room on the ground floor. There is also a garden area that people can access.

There is a registered manager in post. The registered manager is also the provider. 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.

Following the last inspection on 7 August 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well led to at least good. We asked the provider to take action to make improvements in relation to staffing, capacity and consent and governance of the home we found these actions had not always been completed.

We found people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

The systems the provider had in place were not always effective in identifying concerns in the home. The medicines audit had not identified concerns around unaccounted for tablets and medicines not being on the MAR chart when needed. The audit had also not identified one person was not receiving their medicines as prescribed. Medicines were not always managed in a safe way and staff competency was not always checked in this area. The infection control audit had also not identified concerns with mould. When concerns had been identified we found the action taken had not ensured the home had improved as we found the same concerns had occurred for several months.

The provider sough feedback from people and relatives however this information was not always used to make changes to the home. There was no system in place to ensure staff suitability to work with people. The provider told us when things went wrong in the home they used the information so lessons could be learnt however they were unable to demonstrate this to us during and after our inspection.

When people had behaviours that may challenge there was no clear guidance in place for staff to follow and they offered an inconsistent approach. Other risks to people were considered and reviewed.

Staff had received training in safeguarding and demonstrated an understanding of when people may be at risk of potential harm. There were procedures in place for this. People enjoyed the food and were given the opportunity to participate in activities they enjoyed. When needed people had access to health professional. They were supported by staff they liked and who knew them well. We found people were encouraged to remain independent and make choices how to spend their day. Their privacy and dignity was maintained. Both people and relatives felt involved with their care and this was reviewed when needed.

There were complaints procedures in place and people knew how to complain. The provider notified us of significant events that had occurred within the home and the rating was displayed in the home in line with our requirements. There were sufficient staff to support people.

This is the second consecutive time the service has been rated Requires Improvement.

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

This inspection was completed over two days. The first day was unannounced and second day was announced due to the registered manager being out the country on the first day. The service was registered to provide accommodation for up to 18 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 16 people were using the service. At our last inspection in September 2015, the provider was rated good. At this inspection we found some areas which required improvement.

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. The registered manager was also the provider of the service.

The provider did not always notify us of events which reflected when people were at risk of harm. Not all the staff were able to provide us with the assurance they understood how to protect people from harm and the reporting process. Audits had been completed in some areas, however they had not always identified areas of concerns and therefore the improvements had not been made.

Medicines had been managed safety; however some documentation was not available to provide information to support people who had ‘as required’ medicine. There was not always enough staff to support people’s needs and respond when they required support. The provider had not considered the risks to people at certain times of the day, when other people were having their care needs met.

People’s capacity had been considered, however there was no formalised assessment to reflect how the decision had been made. The information had not considered how the person could contribute to their decision making. Best interests decisions had not been made with the relevant people to ensure the decision was the least restrictive. Some people were deprived of their liberty and the authorisations had been sought from the local authority.

People were able to make their preferences known, which had been documented in the care records. People were encouraged to make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns.

People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained.

Risk assessments had been completed and guidance provided. The provider ensured appropriate checks before people worked at the service. The fire procedures and maintenance had been completed and each person had their own evacuation plan.

We saw people had a choice of food and when required support and advice around health and nutrition had been considered. Support from health professionals was requested and available when needed. We saw that the previous rating was displayed in the reception of the home and following our visit also placed on the website as required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

We inspected this service on 18 September 2015. The inspection was unannounced. At our previous inspection in July 2013, the service was meeting the regulations that we checked.

Amber House provides accommodation and personal care to 18 older people. They are not registered to provide nursing care. There were 18 people who used the service at the time of our visit.

The service 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.

Staff understood how to protect people from abuse and were responsive to their needs. People were protected against the risk of abuse, as checks were made to confirm staff were of good character to work with people. Sufficient staff were available to meet people's needs.

Risk assessments and care plans had been developed with the involvement of people. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way. People had equipment in place when needed, so that staff could assist them safely. Processes were in place to ensure people received their medicines in a safe way.

Staff understood people’s needs and abilities and were provided with training to support them to meet the needs of people they cared for. Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions. People’s dietary needs and preferences were met.

Staff treated people in a caring way and respected their privacy. Staff supported people to maintain their dignity. People’s needs were assessed and care plans were in place to support staff to meet people’s needs appropriately. People were supported to maintain good health; we saw that staff worked with health care professionals to maintain people’s health.

The management of the service was open and transparent. People knew how to make a complaint and were confident that their complaint would be investigated and action taken if necessary. Arrangements were in place to assess and monitor the quality of the service, so that measures could be put in place to drive improvement. There were systems in place to supervise and manage all staff, to ensure staff’s practice was monitored and to identify when additional support or training was required. Positive communication was encouraged and people’s feedback about the support provided was sought by the registered manager to further develop the service and drive improvement.

This inspection was unannounced which meant the provider and the staff did not know we were coming. Seventeen people were in residence when we undertook our inspection. We spoke with five people living in the home, four visitors, three staff and the registered provider. Everyone spoke well of the home, one person using the service said, “It's beautiful here, the staff are great. They look after you, I really mean that, I am very happy.”

We found people using the service were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs or concerns.

We saw the home could demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

People told us that care and support was provided by skilled staff who knew their needs well. We found the service was well led because we saw the provider managed risk to the service effectively.

We carried out this inspection to check on the care and welfare of people using this service. We visited Amber House in order to up date the information we hold and to establish that the needs of people using the service were being met. The visit was unannounced which meant the provider and the staff did not know we were coming. We spoke with five people using the service, three staff on duty and four visitors.

The atmosphere in the home was calm and relaxed. We saw people being cared for in a way that ensured their human rights were respected and people who spoke with us told us they felt safe. One visitor said, “It has been such a relief, all the staff have been lovely, I know my relative is well cared for which gives me peace of mind.” People told us they received care in a flexible, individual and inclusive way which took into account their diverse needs.

The home was warm, well maintained and there was no malodour. We saw people's rooms were clean and suitably furnished. People had been able to personalise their rooms and bring in their own furniture if they wished.

We spoke with people who used the service during our visit and they told us that staff were very caring towards them. People described the staff as 'kind and thoughtful'. One person who had lived in the home for some time told us they were very happy living at Amber House and would not wish to be anywhere else. Another person told us they were settling in well and had been made to feel 'at home.'

During our visit we saw numerous examples of staff interacting well with people living in the home, they spoke respectfully and it was clear from our observations that people reacted positively when the staff engaged with them.

They commented that they received support from regular staff, which promoted consistency of care. From records seen and discussions held it was clear the majority of staff had been working at the home for a number of years and the staff turnover was minimal.

Relatives told us they were encouraged by staff to continue to play an active role in their loved ones life. Family and friends could attend social events and were involved in supporting people using the service where appropriate. One visitor told us, “I have never met such lovely people, all the staff are polite and kind and involve me, I would come and live here myself.”

We viewed staff files during our visit and found that the organisation had a process for recruitment and training. The provider told us all staff employed by Amber House were subjected to appropriate checks prior to commencing their role.