We carried out a comprehensive inspection of Amberley Hall Care Home on 20 and 25 January 2016. Following this inspection, we served a Warning Notice for a breach of one regulation of the Health and Social Care Act 2008 relating to good governance. In addition to this, we also found an additional six breaches of five other regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during that inspection. These breaches were in relation to person centred care, the need to obtain people’s consent, the safe care and treatment of people, enough staff deployed to support people and treating people with dignity and respect.

Following the inspection the provider wrote to us to say what they would do to meet the legal requirements. We undertook an unannounced focused inspection on 7 July 2016 to check that our warning notice had been complied with. At that inspection, we found that the provider had taken sufficient action to achieve compliance with the Warning Notice.

We undertook this unannounced comprehensive inspection in January 2017 to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. At this inspection, we found improvements had been made in the required areas and the provider was no longer in breach of the regulations.

You can read the report for previous inspections, by selecting the 'All reports' link for 'Amberley Hall Care Home' on our website at www.cqc.org.uk

Amberley Hall Care Home is registered to provide accommodation for up to 106 people who require nursing and personal care. We spent time in four of the six units within the home. This included the units providing nursing care or specialising in care for people living with dementia. During our inspection, we spent time on the Windsor, Kensington, Regency and Buckingham units. There were 102 people living within the home.

This unannounced inspection took place on 11 and 12 January 2017.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us that they felt safe living at the service. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff knew who to report any concerns to. People received their medication as prescribed.

There were sufficient numbers of suitably qualified staff employed at the service. The provider’s recruitment process ensured that only staff that had been deemed suitable to work with people at the service were employed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager was knowledgeable about when a request for a DoLS application would be required. Applications had been submitted appropriately to the relevant local authority.

Staff respected and maintained people’s privacy. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. People’s dignity was respected and that their care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Most care records were detailed and up to date so that staff were provided with guidelines to care for people in the right way. Where records were not up to date, there was a plan in progress to address this.

People were supported to access a range of health care professionals. Risk assessments were in place

We carried out an unannounced comprehensive inspection of this service on 20 and 25 January 2016. A breach of the legal requirements was found and a warning notice was issued in respect of this breach. After the comprehensive inspection, we gave the provider until 15 March 2016 to meet the legal requirements in relation to this warning notice. We undertook this focused inspection to check that they had undertaken changes to meet these requirements. This report only covers the findings in relation to that notice.

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. The service remains requires improvement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Amberley Hall Care Home on our website at www.cqc.org.uk

Amberley Hall Care Home provides accommodation and support to a maximum of 106 older people, some of whom are living with dementia. The home provides a mixture of nursing and residential care. We focused this inspection on two of the five units that are at the home, these were the Regency unit and the Windsor unit. The Regency unit provides care for people living with dementia who require residential care and the Windsor provides care for people living with dementia and who require nursing care.

At the time of this inspection, 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 and associated Regulations about how the service is run.

At the previous comprehensive inspection effective monitoring systems were not in place to ensure quality and safe care. This had resulted in people receiving poor care and being at risk of harm.

At this inspection we saw that there were effective systems in place that had been developed since our last visit. These were to monitor the quality and safety of people living at the home, and to reduce the risk of harm and poor care. The registered manager had identified where improvements had been needed and actions had been undertaken to achieve this, which was proactive and positive. The registered manager had, as a result of this also identified where they would like to make future improvements and a plan was in place for this.

The Warning Notice we issued was complied with.

This inspection was unannounced and took place on 20 and 25 January 2016.

Amberley Hall Care Home is a care home that provides accommodation, personal care and nursing care for up to 106 people. The home is split into six separate units. These are the Kensington unit that provides care for people with nursing needs, the Windsor unit that provides care for people living with dementia who have nursing needs, the Regency unit that provides care for people living with dementia with residential needs, the Balmoral and Buckingham units that provide care for people with residential needs and the Sandringham unit that provides care for people who are reaching the end of their lives. On the day of our inspection, we spent time on the Windsor, Kensington, Regency and Buckingham units. There were total a of 94 people living within the home.

The current manager had been employed at the home since September 2015. They had not yet registered with us but told us that they planned to do so shortly. 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 and associated Regulations about how the home is run.

At this inspection we found six 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 this report.

People who could provide us with feedback felt safe living at Amberley Hall Care Home and were happy living there. They were given choice about how they wanted to live their lives, were listened to and respected and had plenty of activities to participate in to enhance their wellbeing. However, not everyone who was living with dementia had the same experience.

There was a lack of stimulation for people who were living with dementia and they were not always treated with dignity and respect. There were not enough staff to meet their needs and provide them with personalised care. The staff did not always follow the principles of the Mental Capacity Act when making decisions on behalf of people. Therefore, people’s rights may not have been protected.

The staff were kind and caring but some lacked the skills to engage with people who were living with dementia effectively. Some staff lacked robust supervision which contributed to some of them displaying poor care practice. Risks to people’s safety were not always managed well and some people did not receive their medicines when they needed them. This left them at risk of harm.

People received enough to eat and were supported to maintain their health. The equipment that people used and the premises they lived in had been well maintained.

The provider had not taken timely action to make sure that people received the care they needed, when they needed it. There was a lack of oversight of the quality of care that was being provided on some units. The current systems in place to monitor the quality of the care provided were not effective. This had been recognised and a number of improvements were being implemented.

This inspection took place on 18 March 2015 and was unannounced.

Amberley Hall Care Home is a nursing home that provides accommodation, nursing care and support for up to 106 people some of whom may live with dementia or a physical disability.

There was a newly appointed manager in post who was in the process of applying to become the 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 and associated Regulations about how the service is run.

Staff treated people with respect and used a gentle approach when providing any care or support. People living at the home felt the staff were approachable and that they could speak with them if they had any concerns or worries. However, call-bells were not always answered promptly and there were times when sudden staff absence was not covered. People did not always receive individualised care at the times that they needed it due to the staffing situation in the home.

Staff knew how to make sure that people were safe and protected from abuse. They had been trained and had the skills and knowledge that was needed to provide support to people. They felt supported by the senior and management teams working in the home but they had not received regular supervision or an appraisal.

Improvements were needed to ensure that everybody living in the home had access to sufficient drinks throughout the course of the day. 

People had access to healthcare professionals when they became unwell or required specialist support for a medical condition. Their independence was encouraged.

Staff felt they worked together as a team and supported each other. Concerns and complaints had been quickly dealt with and resolved to the complainants satisfaction. People felt that they had plenty of opportunities to voice their opinion about the quality of the service that was provided.

Regular checks were made on the premises to make sure the home was suitable for people. Medicines were managed well.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. Staff received relevant training and had a good understanding of how to ensure that people were supported to make their own decisions.

The new management team had identified areas in need of improvement and started to take action to address these. Further action was need to ensure that people received the care they needed in a consistent way.

We looked at care plans that set out the needs of people and how the person had chosen to be supported. We saw people's individual choices and daily routines described throughout the development of their care plan. This showed us that people were fully consulted and that they had agreed with each stage of their care plan.

Care plans contained the information that enabled staff to provide appropriate and safe care and support. People we spoke with who used the service told us that they were provided with the assistance they needed. One person told us “Staff are really excellent here and always ready to help.” Another person said “I have no complaints at all, everything is just wonderful.”

Records showed us that staff received training and supervision on a regular basis and staff told us that they felt fully supported by senior management. This ensured that staff had the relevant training to meet the needs of people and that the manager was aware of any training areas that needed reviewing.

We saw that an assessment of the quality of the service was regularly carried out. People told us that there were regular meetings where they voiced their opinions about the care and support that was provided. The auditing systems that were in place helped to develop any new procedures that supported the safety and wellbeing of people living in the home.

We spoke with people who used the service and their relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind.

Staff members were trained and were supported to provide an appropriate standard of care and support. Improvements were being made to ensure that all staff received regular supervision and a yearly appraisal and took part in planned staff meetings.

People spoken with were aware of the complaints system. Complaints were dealt with appropriately and people were able to access and use the complaints system in a format that met their needs.

Following information received from the home, dated 14 September 2012, we visited the home on 20 September 2012. This was to ensure that the home had taken effective remedial action to safeguard people from health risks associated with inadequate pressure area care and inadequate nutrition, including both food and drink.

People who we spoke with said that they were satisfied with the standard of support and care they received. They told us that they felt, “Comfortable” while lying in bed and sitting in their chairs. People also told us that they always had enough to eat and drink. We saw that people had access to cold and hot drinks and were supported with taking these.

From information provided by the home’s internal audit and thorough speaking with senior clinical and managerial staff of the home, we found that there was a significant increase of numbers of people acquiring pressure ulcers while living at the home. This increase notably commenced since July 2012 which affected 11 of the current 104 people who used the service.

Staff who we spoke with said that since the change of management of the home in September 2012, they were given clearer direction, guidance and improved training and support to be able to provide safer care to people who were at risk of developing pressure ulcers.

Improved quality assurance systems were now in place to report, monitor and review people's health care needs.

People we spoke with about their medicines said they were happy for staff to administer their medicines and said they did so with kindness.

We did not speak with people about their medicines during this inspection.

We did not speak with people about their medicines during this inspection.

People living in the home, visitors and families told us that they think the home is good, staff work hard and know how to support and care for people. We were also told that the home is clean and free of odours when they visit.

Some people were doing activities in the large entrance area. They were smiling and appeared to be enjoying their time. One person waited to say 'I am very happy here, staff are good and I like it very much'.

Some people did think that while staff are very good, they are busy and more staff are needed to allow more time to talk and fully support needs.

Visitors told us that the people they visit in the home are very happy, well cared for and anything that needs dealing with is quickly sorted.