This inspection took place on 23 May 2018, with an announced follow up visit on the 24 May 2018. At the last inspection completed on 7 March 2017 we rated the service Requires Improvement.

At this inspection we found improvements had not been made and the provider was not meeting the regulations for staffing, safe care and treatment, and governance arrangements. You can see what action we asked the provider to take at the end of this report.

Amberley House Care Home 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.

Amberley House Care Home accommodates up to 71 people in one adapted building. At the time of the inspection there were 62 people using the service.

There was not a registered manager in post at the time 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.

People were not supported by sufficient staff to meet their needs. Risks to people’s safety were not always planned for and staff did not always follow guidance to keep people safe. People were not always safeguarded from potential abuse. Governance systems were not always effective in identifying concerns and driving improvements.

Staff had received training, however further work was required to ensure this was kept up to date and staff competency was checked effectively. Improvements were needed to ensure the environment was suitable for people living with dementia. People did not always receive consistent care.

People received support from staff that were caring, however improvements were needed to make sure that this was consistent. People’s preferences were not always understood by staff. People were not consistently supported to follow their interests or religion.

People were not always supported to have maximum choice and control of their lives and staff were not always aware of how to support them in the least restrictive way possible; the policies and systems in the service were not always supportive of this practice People were not consistently supported to meet their dietary needs. People were not always supported to make decisions and their communication needs were not always met. People were respected, however sometimes care was received that was not always dignified.

People were supported to take their prescribed medicines. People were protected from the risk of cross infection. Staff were safely recruited. People were supported to maintain their health and well-being.

People were supported to identify how they wanted to be cared for at the end of their lives. People understood how to make a complaint and these were responded to and used to make improvements.

Notifications were submitted as required and the manager understood their responsibilities. We found people; their relatives and staff felt supported by the manager and were able to be involved in their care.

This unannounced inspection took place on 6 March 2017. At out previous inspection in August 2016 we had concerns that the service was not consistently safe, effective, caring, responsive or well led and we had found five breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that some improvements had been made in all areas, however, further improvements were required.

Amberley House Care Home provides nursing care to up to 74 people. At the time of the inspection 54 people were using the service. The service was split into three areas, a nursing care area, an area for people living with dementia and a special care unit.

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.

Risks of harm to people were assessed however people's risk assessments were not always followed to ensure they remained safe. Not all the equipment that people had been assessed as requiring was being used safely.

The systems the provider had in place to monitor and improve the service were not consistently effective.

People had comprehensive care plans to inform staff how to support them when at times they were anxious or aggressive. Staff had received training to be able to support people safely at these times.

People's medicines were stored and managed safely and there were sufficient numbers of staff to keep people safe. New staff had been recruited through safe recruitment procedures to ensure they were fit and of good character.

The principles of The Mental Capacity Act 2005 (MCA) were being followed to ensure people's rights were being upheld. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves

People were being cared for by staff who were supported and trained to fulfil their roles effectively.

People's health care and nutritional needs were met. People had access to a range of health care professionals when they became unwell or their health needs changed.

People were treated with dignity and respect and their right to privacy was upheld. People's right to make choices was respected.

People received care that was personalised and met their individual preferences. There were hobbies and activities available to people who wished to join in.

The provider had a complaints procedure and people knew who to speak to if they had any concerns about their care.

There had been improvements to the quality of the service since the last inspection and staff and people who used the service told us that the registered manager had affected change.

This inspection took place on 11 August 2016 and was unannounced. At our previous inspection we had judged the service as requiring improvements throughout. The service was not consistently safe, effective, caring responsive and well led. We had issued the provider with requirement actions and asked them to improve. Since our last inspection the service had been placed into Large Scale Investigation (LSI) by the local authority due to the amount of safeguarding concerns they had received. At this inspection we found that no improvements had been made and the provider was now in breach of several Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Amberley House provides nursing care to up to 74 people. At the time of the inspection 71 people were using the service. The service was split into three areas, a nursing care area, an area for people living with dementia and a special care unit.

There was a new manager in post who was yet to register with us. 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 manager had identified areas that required improvement but had not acted to make the desired improvement in relation to insufficient staff. Systems in place to monitor and improve the service were ineffective.

Relatives and people told us they knew how to complain but were not confident that complaints would be acted on.

People were at risk of unsafe care as there were insufficient suitably trained staff to meet the needs of people who used the service. People had to wait to have their care needs met and staff were unable to spend quality time with people in some areas of the service.

Risks to people were assessed but risk assessments were not always followed to minimise the risks of incidents occurring again.

The provider did not consistently work within the guidelines of The Mental Capacity Act 2005 (MCA) to ensure that where people lacked mental capacity they were supported to make decisions with their legal representative.

Although staff felt supported they had not received all the training they required to keep themselves and other people safe from harm whilst working with people who may become anxious and aggressive.

People's privacy was not always respected and people were not always treated with dignity and respect as staff did not have the time to spend quality time talking to people.

People did not always receive care that reflected their needs and preferences as there were insufficient staff to ensure that people's emotional needs were met.

People were encouraged to engage in hobbies and interests. Individual and group activities were organised.

People received health care support when they needed it and were supported to maintain a healthy diet.

People’s medicines were stored and administered safely by trained staff.

Staff knew what to do if they suspected a person had been abused. The manager reported incidents of suspected abuse to the local authority for further investigation.

Safe recruitment procedures were followed to ensure that new prospective staff were fit work with people.

This inspection took place on 26 January 2016 and was unannounced.

The service was registered to provide accommodation and nursing care for up to 74 people. At the time of our inspection 72 people were using the service. People who used the service had physical health and/or mental health needs.

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 were not always deployed effectively to meet people’s needs and we saw that people had to wait for the support they required. People's risks were assessed though the management plans in place were not always followed to ensure people were kept safe.

Staff were aware of how to recognise the different types of abuse that may occur and how to report concerns. Systems were in place to protect people from avoidable harm and abuse and these were used when required. People’s medicines were managed safely so that they received their medicines as prescribed.

People's meal time experiences were mixed and people did not always have a choice about their food. People were not always supported and encouraged to make their own decisions about their day to day care. When people were unable to make more major decisions we saw that current legislation and guidance was followed to ensure that people’s legal and human rights were respected.

Staff were trained to deliver effective care to the people who used the service. People had access to healthcare professionals and were supported to monitor their health needs.

People’s privacy and dignity was not always respected and confidential information was not kept securely. People told us they were treated with kindness and compassion by staff and we saw some examples of this.

People did not always receive personalised care that met their preferences. Care plans contained information about people's history and preferences but this information was not always used to provide individualised support.

People and relatives knew how to make complaints and we saw that complaints were dealt with in line the provider's procedure.

People, relatives and staff had mixed views about the whether the management were approachable and supportive. The registered manager offered a number of ways for people to share their experiences and feedback.

The management team and provider completed quality checks and acted upon any issues identified. However, the quality checking systems had not identified some areas which required improvement.

We found that the provider had systems in place to gain consent for care and treatment from people who used the service. We spoke with staff who told us that they respected people’s decisions and understood their responsibilities with regards to the Mental Capacity Act 2005.

People told us they were happy with the care they received and staff were responsive to their needs. One person told us, “It’s gorgeous here. Staff do exactly what I need and the way I want it done”. Another person told us, “Staff treat me well. They do their very best for me”.

Staff we spoke with were aware of the safeguarding procedures to follow if they had any concerns. People told us that they were treated well by the staff and they treated them in a caring way.

The provider had made improvements to ensure that there were enough suitably qualified staff to provide support to people who used the service.

We found that records were stored safely and securely. Records were well organised, accurate and up to date.

We spoke with 10 people and five visitors about their thoughts on the home. All felt the staff treated people living at the home with respect. One person told us, “The care workers are very good and look after me.” A visitor told us that all the staff were, “very nice” and that they ‘Couldn’t fault them.” We asked one person if they were happy in the home. They told us, "Not really happy but is okay!” Another person told us, “I do not think there is any place better.”

People and their relatives were involved in making decisions about their care. The assessment of people’s care and support included a discussion with people and their relatives about their choices and preferences. Care plans provided sufficient information to ensure staff had clear guidance and information on how to support people and keep them safe. The training of staff ensured people were supported by staff with the necessary skills and knowledge.

There were processes in place to monitor risks to the quality and safety of care. There was evidence that learning from incidents took place and appropriate changes made. The provider asked for people's and relatives opinions and feedback on the care and support received. We found that all areas of the home were clean and suitable for people to live in and for care to be provided.

Our observations during the inspection supported that care staff sometimes could not keep up with people's support needs.

This was a visit to check the progress that the service had made towards addressing the concerns we had raised when we visited during October 2011.

We had identified on our last visit that people were not fully involved in planning their own care and that people’s preferences were not being taken in account when care was provided. On this visit we saw that there had been some improvements. The service had started meeting with people and relatives, where appropriate, to discuss and agree their care. A relative told us, “brilliant – anything that happens I get to know straight away”. We saw that staff were talking more with people but this should be further improved. We also saw that the service was in the process of developing life histories that would identify issues that were important to people.

On our last visit we identified areas where people’s health and welfare needs were not being fully met and that the arrangements of managing medication were not keeping people safe. There was also a need to develop activities for people. On this visit people told us that they were happy at the service and we were told there had been improvements in their care. A relative said that the care was “much better now”. Our observations also showed that the service had made improvements although the amount and type of activities could be further developed. The medication arrangements were now keeping people safe.

We had previously identified that some improvements were needed in staff training and support to make sure that people were competent to provide care. All staff had completed training in dementia care and further comprehensive training was planned. A system of planned individual supervision had recently started.

We had seen on our last visit that care plans were not always up to date and that some information was not kept securely. We saw that this had now been addressed.

We have completed this inspection of the service due to a high number of safeguarding incidents where people were not kept safe. There had been concerns about the quality of care provided and the failure to refer incidents of potential abuse. These incidents were fully investigated by the local authority. The provider had provided an action plan showing how it was addressing these issues. The local authority had informed us that there were improvements in the care provided to people that lived there.

People told us that they liked living at the service. They told us they had choices about how they lived their lives including where they spent their time and the meals they ate.

People with dementia care needs were having their personal care and health care needs met and their privacy promoted. Staff were not always aware of people's preferences and how they communicated their needs. Staff were not spending much time with people talking with them or promoting social activities.

People had plans of care but we saw that these were not always completely up to date and had some gaps in them. Staff were not using the plans to inform them of people's care needs.

There were serious concerns over how people's medication was being managed by the home.

Systems were in place to check and monitor the care people received. Issues that were identified were acted upon.

We inspected Amberley House Care Home on 13 and 14 November 2014 and we arrived unannounced. Amberley House is registered to provide accommodation and nursing care for up to 74 people. The service provided care over three separate units. People who use the service had physical health and/or mental health needs, such as dementia.

The service did not have 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 and associated Regulations about how the service is run. At the time of the inspection the registered manager had recently left the service and we had been informed the week prior to the inspection that the project manager had taken over the running of the home in the interim.

People told us that they felt safe when they were supported by staff. Staff were able to explain how they kept people safe from harm and the actions they needed to take if they felt someone was at risk of harm.

We found that people received their medicines as prescribed. Some improvements were needed to ensure that appropriate advice was sought when administering medicines covertly.

People’s risks were assessed and managed. We saw that staff carried out support in a safe way and followed the guidance contained in the care records.

We saw that there were sufficient qualified and experienced staff available to meet people’s assessed needs. The provider had effective recruitment procedures in place that ensured people were supported by suitable staff.

People who used the service and their relatives told us the staff treated them with compassion, dignity and respect. We saw that staff listened to people and encouraged them to make choices and decisions about their care.

Staff received regular training but this did this was not always effective as staff were unsure of their responsibilities under the Mental Capacity Act 2005.

We found that some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being met by the provider. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests when they are unable to do this for themselves.

People had opportunities to be involved with hobbies and interests that were important to them. The provider had recently implemented a new way of engaging with people who had dementia through touch, smells and sensory environment.

There was a complaints policy in place that was followed by staff and management. People we spoke with knew how to complain and were happy with the action taken when they had raised concerns.

We saw that the provider promoted an open and inclusive culture. People and staff told us that the management were approachable and that they listened to them. People, relatives and staff were given opportunities to provide feedback on changes and improvements to the service.

The manager regularly monitored the quality of the service provided and action plans were in place where improvements were needed. The provider was involved with the service and undertook visits to assess and monitor the quality of the service provided and gain views about people’s experiences.