This inspection took place on 13 June 2016 and was unannounced.

Amberwood House is registered to provide accommodation with nursing and personal care to up to 54 people. The home specialises in the care of older people. At the time of the inspection there were 50 people using the service.

There was a new manager in place who had applied to the Care Quality Commission 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 2008 and associated Regulations about how the service is run.

On the day of the inspection there was a calm and happy atmosphere throughout the home. People were going about their day as they wished, and were enjoying engaging with staff and taking part in activities. People who wished to remain in their rooms were supported by Colton Companions. Colton Companions are members of staff who are employed to support people in their rooms to prevent isolation.

There were sufficient staff to keep people safe. People were well looked after and staff were knowledgeable about their needs and how to meet them. Staff were kind and interacted with people in a friendly and respectful way. People, relatives and staff were complimentary about the service and spoke highly about the manager and head of care. One relative informed us, “Staff are brilliant”. Another said, “We are happy, with the support provided, the manager is very professional”.

The service had suitable arrangements in place to help ensure people were safe and protected from abuse. The service had a whistleblowing policy and staff told us they were confident to use it. Records showed all staff had received training in safeguarding of vulnerable adults. We observed posters around the home instructing staff on what action to take if they thought a person was being abused. They also had appropriate recruitment procedure to ensure people were supported by staff with the experience and character required to meet the needs of people.

Care plans provided information about how people wished to be supported and staff were aware of people’s individual care needs and preferences. One person told us “The quality of care here is excellent, we are involved and our permission is always sought”. People’s needs were discussed with them regularly as the initiative ‘resident of the day’ and any changes agreed. All care plans included the person’s written consent to receive care.

Systems were in place to manage risks, safeguarding matters and medication which ensured people's safety. People were seen to be moved by staff who had the correct skills to use manual handling equipment. Following a manoeuvre a person told us they felt safe and secure whilst being moved, they told us “they always talk with me and tell me what is going to happen and check I am in my chair and comfortable before they [staff] leave me

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. People and visitors were complimentary of the food provided. Where people required specialised diets these were prepared appropriately. People’s choices were seen to be followed, including what size meal they wished, the chef showed us the different sizes of dinner plates, they explained “People often want smaller meals as they don’t like to waste food, they can always have more if they choose”.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. The manager told us “As a new manager to the home, I want to be able to assess and see what improvements need to be made, I have asked for a full audit of the home as a benchmark to work from”.

All

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Medication was stored securely with medicines handled and recorded appropriately. Amberwood House had a fire evacuation procedure in place and an up to date resident list which detailed the number of staff required to assist individuals in the case of emergency and these were regularly reviewed. A member of the management team was available on call in case of emergency.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager advised us that one person was subject to Deprivation of Liberty Safeguard (DoLS). We saw documentation that showed that the staff were following the correct procedure.

Is the service effective?

During our visit we observed that staff provided support and engaged with people positively. People appeared relaxed and comfortable in the presence of staff. Speaking with staff it was evident that they understood individuals’ care and support needs. We saw that care plans were based on people’s assessed needs and that risk assessments had been completed and were regularly reviewed.

Is the service caring?

People told us that they were happy with the care they received and felt their needs had been met. We saw staff treated people in a sensitive, respectful and professional manner. People’s privacy and dignity was respected. In people’s care plans we saw that there was information about what they needed help with and how staff should support them. One person told us, "The staff are very good and always ask what I want, they do things the way I want them done.” Staff had received training to meet the needs of the people living at the home.

Is the service responsive?

The staff told us that during the handover, all the individuals were discussed which ensured that staff were updated about the support people received were able to refer to individuals care plans. The home had quarterly meetings with the people who lived at the home and one person told us, “I have made suggestions and they were not ignored". People had access to a range to activities throughout the day. One person told us that the activities coordinators were "Excellent" with "Something always going on”.

Is the service well-led?

The home had quality assurance systems in place. These included daily meetings with the heads of departments, regular peer visits from other home managers within the group at night and monthly quality audits by the providers representative which looked at all aspects of the home’s operations. The provider had recently completed their annuals customer satisfaction survey and we saw that overall people’s satisfaction levels had increased.

Staff responded quickly to calls for assistance. People we spoke with told us, " You only have to ring your bell and they come." Another person said, " They (staff) are exceptionally good." We asked people if staff came just as quickly at night. One person told us, " Staff come at any time in the night as soon as you call for them."

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with told us the food was very good and they had a variety of choices each day. One person told us, "They use wonderful ingredients, nothing wrong with the quality of the food."

People told us the home was clean, one person said "They clean my room and ensuite every day." Another person told us " The home is always immaculate."

There were enough staff to meet people's needs. People told us they were supported by staff who took time to help them. One person told us, " You can't fault the staff." There were eight health care assistants supporting 44 people living in the home. There were also two qualified nurses on duty.

People's views and opinions were valued.There were regular meetings, every three months, with people living in the home and family members.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. One person told us " Nothing is too much trouble even when I am not happy they always make it right."

People told us they were treated with respect and dignity. They told us that staff spoke with them in a positive way and understood their individual preferences. People said that they were able to make choices about their care and the way they spent their time in the home. Systems were in place to enable people, and their relatives, to contribute to reviews of their care and discuss, for example, how their care could be improved.

People had concerns about staffing in the home. They told us that although people's basic care needs were met, this did not always happen in a timely way because there were times in the day when there were not enough staff available. People were concerned that quality of care was affected because of staff being under pressure. People expressed concerns about the number of changes in staff in the home which they felt potentially impacted on consistency of care. The home was in the process of implementing a plan which they anticipated would improve staffing in the home and address the concerns raised.

Although people were not always aware of the home's complaints procedure they told us they felt able to talk with the registered manager and staff about any concerns. People were confident that the manager would listen to them and take action to put things right. People valued the manager's open approach to complaints and told us that any issues they had raised had been responded to promptly.

We received mixed feedback from people living in the home about their experiences. People told us that most of the staff were “Very good” and that “Some are better than others”. One person told us that “it is a lovely place” and that the staff were “Very nice, smiley, cheerful” and that nothing was too much trouble. We also spoke with a relative who told us that “It is very good” and that the staff were “Excellent”. One person told us that the staff were mostly friendly but “There is one or two who are a bit sharp”.

People who lived in the home and staff told us that people were able to make choices about daily activities such as what they ate and what they wore.

We observed staff interacting with people who lived in the home. Staff spoke to people in a friendly manner. During our visit we observed members of staff knocking on doors before entering. We also observed times when staff were not respectful, one example was two members of staff feeding more than one person at a time at lunch time.

People were not always involved in their care planning. We looked at care records. There was some evidence of people consenting to treatment or care however this was not evident across all of the records we reviewed. Care plans were not always person centred and did not always reflect the care delivered.

There were facilities for visitors and people who used the service to make drinks for themselves on each floor.

Staff received regular training and this was updated to reflect their training needs. Staff also received regular supervision.

Written complains were dealt with appropriately however verbal or informal complaints were not always dealt with.