About the service:

Amberley Court Care Home is a residential care home that is registered to provide care and accommodation for a maximum of 62 people who require nursing care. People using the service are younger adults, some with a physical disability, brain injury or disorder. 46 People were using the service at the time of the inspection.

People’s experience of using this service:

Staff did not always keep people’s confidentiality and privacy and dignity was not always maintained.

People were supported to have choice and control over their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff to remain safe. There were enough staff available to people and people’s needs were attended to in a timely manner. Risk assessments were in place to minimise any potential risk to people’s wellbeing. Staff were recruited in a safe way. People received their medicines as expected.

People felt that staff assisting them knew their needs. Staff received training and had been provided with an induction, and felt able to approach the registered manager with any concerns. Meals were nutritious and people were kept hydrated. People were supported to maintain their health.

People's care plans reflected their needs and preferences and staff could explain specific care that people required. Complaints were dealt with appropriately in line with the complaints procedure. People participated in activities that were tailored to their needs. End of life plans were in place and acknowledged by staff.

Quality monitoring systems included audits, checks on staff practice and checks on people’s satisfaction with the service they received, using questionnaires. The provider had systems in place to ensure they kept up to date with developments in the sector and changes in the law. People knew the registered manager and felt they were visible around the home and were approachable.

Rating at last inspection: The rating for the service at our last inspection was ‘Requires Improvement’ with our last report published on 23 August 2017.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets. At the last inspection the key questions around Safe, Caring and Well led were rated ‘requires improvement’. This was due to concerns around staffing and staff knowledge around safeguarding procedures, lack of confidentiality and respecting people's wishes and lack of consistency in management and staff's response to this. At this inspection we found that some issues around confidentiality and staff members responses to people remained, but other concerns had been resolved.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 21 and 22 June 2017 and was unannounced. At our last inspection in November 2016 we found that the provider ‘required improvement’ in four questions, namely safe, effective, caring and well led.

Amberley Court Nursing Home provides accommodation, nursing and personal care for up to 62 people with physical disabilities. There were 49 people living at the service at the time of our inspection.

There was 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.

People were supported by staff who had received training in how to recognise signs of abuse but not all staff were aware of their responsibilities to report concerns in a timely manner. Staffing levels across the home were based on people’s dependency levels but staff sickness was having an impact on people’s care needs being met in a timely manner.

New staff rotas and allocation systems were in place to address concerns raised to ensure people’s care needs were safely and effectively met.

Where accidents or incidents had taken place, action was taken and lessons were learnt. People were supported to take their medicines as prescribed by their GP.

People were supported by staff who received a comprehensive induction which provided them with the skills they needed to meet the needs of the people they supported. Staff were given the opportunity to discuss any concerns they may have at supervision and staff meetings.

Staff had access to training and additional training was sought to improve staffs learning in a variety of areas.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to have sufficient amounts to eat and drink and access healthcare professionals to ensure their health and well being.

There was a lack of confidentiality across the home which was a concern to both people living at the home and staff alike. People were supported by staff who they described as kind and caring but not all felt they were treated with respect.

People were involved in the planning of their care. Staff were aware of people’s interests and hobbies and what was important to them. Plans were in place to recruit additional staff to support people to pursue activities that were of interest to them.

People’s opinion of the service was regularly sought and people told us they felt listened to. Where complaints had been received, they were investigated and acted upon.

Changes introduced by the registered manager to improve the quality of service were welcomed by the people living in the home and staff were aware of her vision for the service.

There were a number of quality audits in place to assist the registered manager in identifying any areas of improvement within the home. Where concerns had been raised, lessons were learnt and actions put in place to rectify issues.

This inspection took place on 23 and 24 November 2016 and was unannounced. At our last inspection in November 2015 we found that the provider ‘required improvement’ in two questions, namely safe and well- led and was found to be ‘good’ the remaining three question effective, caring and responsive.

Amberley Court Nursing Home provides accommodation, nursing and personal care for up to 62 people with physical disabilities. The service had 15 Enhanced Assessment Beds (EAB). These beds are allocated to people who have been discharged from hospital but need extra support before they return home. There were 57 people living at the service at the time of our inspection.

There was a new manager in post who had not yet registered with the 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.

People were supported by staff who had been trained in how to recognise signs of abuse and were aware of what actions they should take should they suspect someone was at risk of harm. Staff were aware of the risks to people on a daily basis and how to manage those risks. Where accidents or incidents had taken place, action was taken and lessons were learnt.

People were supported by sufficient numbers of skilled staff who had been recruited safely. People did not always receive their medicines as prescribed.

Staff benefitted from an induction that prepared them for their role and received training that provided them with the skills they needed to meet the needs of the people they supported. Staff had not regularly received supervision and were not given the opportunity to formally discuss their learning and any concerns they may have.

People were supported by staff who obtained their consent prior to supporting them.

People were supported to have sufficient amounts to eat and drink. People’s dietary needs and preferences were adhered to.

People’s healthcare needs were met and they were supported to access a variety of healthcare professionals to ensure their health and wellbeing.

People were supported by staff who were kind and caring but people’s dignity was not always respected. People were supported to make their own decisions and to maintain their independence.

Staff were aware of people’s interests, how they wished to be supported and what was important to them. Plans were in place to provide more support to people to pursue activities that were of interest to them. People were aware of how to make complaints and where complaints had been raised, they were investigated and actions taken.

Changes in management had created a period of unsettlement at the service and not all staff were fully on board or aware of the manager’s vision for the service. The manager was praised by staff for her commitment to the people living at the service.

There were a number of quality audits in place to identify any areas of improvement that were required within the service. Where areas where identified, action plans were put in place to address any issues.

People's needs were assessed to establish the care that they needed and care and treatment was planned and delivered in line with people's individual care plan. Plans were kept up to date. One person told us "I always feel at ease when I come here. I never feel that I am a pain because my needs are increasing."

People were supported to access other health and social care services that they needed and the provider worked in co-operation with others involved in people's care and treatment.

The home was purpose built and the premises were suitable for the needs of the people who used it. Each person had a room of their own with a toilet and wash basin ensuite. Bathrooms were accessible and there were a range of communal rooms and accessible outside space for people to enjoy. Plans are in progress to improve the therapeutic and leisure facilities available at the home.

People were not put at risk of harm from unsafe or unsuitable equipment. Equipment including people's personal equipment was kept in good order and regularly inspected and tested. People told us: “They have got the electric beds now, which is great" and “They have arranged for me to have a new wheelchair because this one keeps breaking, I’m just waiting for it to arrive.”

People had their health and welfare needs met by sufficient numbers of appropriate staff. Nursing staff were supported by care assistants and the home employed a range of ancillary staff and also activities coordinators.

In addition to the routine inspection we followed up on one issue of concern. Birmingham Social Services told us that the home had not met the needs of one person. We visited the service on 13 November 2012. Some people were not able to give us their views because of their complex needs and conditions. We used a variety of ways to understand their experience including spending four hours in communal areas of the home observing how people lived and were looked after. We did speak with five people and two visitors.

We found that people's needs were assessed and people had plans of care that were individual to them and addressed their needs. People told us that they were well looked after. One person said " I'm very happy, everyone knows my routine, I've got no complaints."

The design and layout of the premises were generally suitable for people who used it and people also had access to computers. The equipment that people needed was adequate, sufficient and safe to be used. One relative told us that installation of physical therapy and exercise equipment at the home would benefit their family member.

Nurses led the shifts in each of the four units and were supported by care assistants. Staff told us they felt supported in their job. Training systems had been improved. People spoke highly of staff, one person said "these guys are just great!"

There were systems in place for checking the quality of the service but staff training records were not easy to check.

Some of the people who lived at Amberley Court were not able to communicate verbally due to their health needs. Therefore we spoke with some relatives and staff. We also spent some time observing life in the home and how people who lived there were being supported by staff to meet their needs.

We saw that people who lived in the home appeared to be clean and dressed appropriately for the time of year. A person who lived in the home expressed satisfaction with the support they received. A person shared their views about life in the home and we were told, ‘’It’s getting better all the time’’.

We found that the health care needs for people who lived in the home were promoted so that people remained healthy and well. For example, care records that we looked at showed that people who lived at the home were having regular eye and dental check-ups, and that staff were asking for doctor and district nurse visits when necessary. A person told us about their hospital appointment for treatment to assist them in feeling better.

We looked at how the choices of meals were promoted to meet individual’s preferences. We saw menus displayed and people who lived in the home had two choices of meals. A taster session was displayed so that people could attend this so that they could influence the choice of meals offered. We were told that relatives could join people who lived in the home for meals. We were told by a person who lived in the home that biscuits and fresh cream cakes were offered in the afternoons’ which they enjoyed.

We looked at how some people spent their day and staff that we spoke with said that some people enjoy going out to places that are of interest to them and staff would accompany people if required. We also spoke with a person who lived in the home who told us, ‘’I go out a lot. Go to Kings Heath and town. Do my own shopping and manage my own money.’’

This was an unannounced inspection. At our last inspection on 9 and 10 October 2014 we found there were two areas where the service was not meeting regulations. The provider had not ensured that effective systems were in place to prevent people been unnecessarily deprived of their liberty and people were not always protected against the risk of poor nutrition. The provider sent us an action plan detailing what action they had taken. During this inspection we found the provider had effective systems in place to ensure that the DoLS legislation was properly applied. Improvements had been made to ensure that the risk of poor hydration was managed.

Amberley Court provides accommodation, nursing and personal care for up to 62 people with physical disabilities. Accommodation is arranged over two floors and there is a passenger lift to assist people to move between floors. The service had 15 Enhanced Assessment Beds (EAB). These beds are allocated to people who have been discharged from hospital but need extra support before they return home. There were 57 people living at the home at the time of our inspection.

There was a registered manager in post and he was present for part of the 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.

Systems were in place to monitor the quality of the service. These could be more robust to ensure that records relating to care were well maintained.

The provider had systems and arrangements in place to recruit staff safely and to assess staffing levels. However, some people did not receive care when they needed it.

People felt safe using the service and they were protected from the risk of abuse because the provider had systems in place to minimise the risk of abuse. Staff were trained to identify the possibility of abuse occurring. Staff understood their responsibility to take action to protect people from the risk of abuse and how to escalate any concerns they had.

People were supported to receive their medicines as prescribed.

Staff received the necessary training and support to carry out their role.

Interactions between people and staff were friendly, relaxed and polite.

Staff had a good understanding of how to ensure that consent was obtained and how people’s rights were to be protected if they did not have the ability to make decisions for themselves.

People’s health care needs were met and they were supported to access both social care and healthcare professionals to ensure their needs were met.

People described the management of the home as friendly and approachable. Staff felt supported by the provider. All previous breaches of the regulations were met.