Archived: Amber House - Didcot

We found the following examples of good practice.

Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow device test result, proof of vaccination against COVID-19, the requirement to show a COVID-19 pass, hand sanitisation and wearing personal protective equipment (PPE).

The service was clean and fresh, staff carried out a regular cleaning schedule. Regular infection control audits took place and actions had been followed up when required.

Staff had received training on infection prevention and control guidance. This included updates on the use of PPE and how to put it on, take it off and dispose safely. There was a programme of training refreshers to ensure staff knowledge was kept up to date.

The management were aware of zoning guidelines but did not need to implement it as no people were COVID-19 confirmed or suspected in this location.

The provider ensured there was a sufficient stock of personal protective equipment (PPE) and the vetted supplier ensured it complied with the quality standards. Staff had infection control training and understood the correct donning and doffing procedure.

The registered manager considered risks and impact of an outbreak on staff and people using the service. Everyone had an individual COVID-19 related risk assessment in place which were reviewed regularly by the registered manager during monthly audit checks.

Regular testing for COVID-19 was conducted for both people living at the service and staff.

The provider ensured people's relatives were able to stay in touch with people. For example, by using technology and through safe, face to face visits in well ventilated spaces and outdoors, then as restrictions were lifted, through visits in line with Government guidance.

There was a comprehensive contingency plan of what to do in case of an outbreak.

Amber House is a care home for up to six people who have been discharged from hospital and who require care, support and accommodation for mental health issues. At the time of our inspection three people were using the service.

People’s experience of using this service:

• People continued to benefit from kind and committed staff. People complimented the support received and told us they formed meaningful, caring relationships with the staff. Staff knew what was important to people and ensured people had care that met their needs and choices. People's dignity, confidentiality and privacy were respected and their independence was promoted.

• People received support that met their needs and was in line with care plans and good practice. People's rights to make own decisions were respected. People were encouraged to maintain good diet and access health services when required.

• The registered manager ensured people received safe care and treatment. People complimented the continuity of care provided by skilled and competent staff. People received their medicines safely and as prescribed. Risks to people's well-being were assessed, recorded and updated when people's circumstances changed. The staff ensured any lessons learnt were reflected to improve the service delivery.

• The service was well run by the registered manager who was supported by a team of committed staff. The provider's quality assurance processes were effective and there was a focus on continuous improvement. Where an area for improvement had been identified there was a prompt action taken to address it.

• People, staff and relatives were involved and felt listened to. The team at Amber House worked well in partnership with other agencies, social and health professionals and external organisations.

More information is in the detailed findings below.

Rating at last inspection:

Good, report published 21 February 2017

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Amber House is a care home for up to six people who have been discharged from hospital and who require care, support and accommodation for mental health issues. At the time of our inspection four people were using the service.

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.

We carried out an unannounced comprehensive inspection of this service on 23 August 2016 and found breaches to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014).

After the last inspection on 23 August 2016, we took enforcement action and issued a warning notice. We asked the provider to take action to make improvements in relation to the management of incidents and accidents and in relation to notifying the commission about important events.

This inspection in January 2016 was to check they had met the legal requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to good governance.

We also checked they had met the legal requirements of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014), which relates to notifying the care quality commission of notifiable events.

Since August 2016 the provider had improved their practices in relation to maintaining a complete and accurate record of accidents and incidents within the home. Incident and accident forms were accurate and enabled the service to monitor the ongoing quality and safety of the care being delivered.

Since August 2016 the provider had also improved their practices in relation to notifying the Care Quality Commission of notifiable events that occurred within the service.

Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery. The service had systems to assess the quality of the service provided. Learning from audits took place which promoted people's safety and quality of life. Staff spoke positively about the registered manager.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Amber House Didcot on our website at www.cqc.org.uk

Amber House is a care home for up to six people who have been discharged from hospital and who require care, support and accommodation for mental health issues. At the time of our inspection four people were using the service.

There was not a registered manager at the service. The home had a manager in place who was in the process of registering with the Care Quality Commission to manage the service. 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.

We carried out an unannounced comprehensive inspection of this service on 15 July 2015. We found the provider was not meeting the legal requirements of four of the fundamental standards. After the comprehensive inspection, we issued requirement notices to the provider to meet the legal requirements of the four fundamental standards.

This inspection in August 2016 was to check they had met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to people’s safe care and treatment. We also checked they had met the legal requirements of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to staffing. Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to person centred care and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to governance.

Since July 2015 the provider had made significant changes and improved their practices in relation to mitigating the risks associated with people’s care. The service had improved its practices in relation to the deployment of staff and safe recruitment procedures. The service sought feedback from people using the service in order to evaluate and improve their practice. Staff were deployed effectively and people received person centred care. However we identified further concerns in relation to good governance and record keeping.

Accidents and incidents were recorded. However incident forms did not always contain information on what steps had been taken by the service following the incident.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. The manager of the service had not always informed the CQC of reportable events. The manager had not reported concerns to the local safeguarding team.

Services are required to display their most recent ratings on their website and at the provider’s principle place of business. Ratings of the July 2015 inspection were displayed at the location of the service. However we noted that the most recent ratings were not displayed on the service’s website.

People’s care plans contained risk assessments which included risks associated with their mental health and the environment. Where risks were identified plans were in place to identify how risks would be managed.

Since July 2015 the provider had made significant changes to how they deployed staff. We observed, and staffing rotas confirmed, that there were enough staff to meet people’s needs. Staff rotas confirmed planned staffing levels were consistently maintained. Records relating to the recruitment of staff showed relevant checks had been completed before staff worked unsupervised.

People told us they were safe. People were supported by staff that could explain how they would recognise and report abuse and staff were also aware they could report externally if needed. Measures were in place to mitigate the risk associated with infection control.

Staff we spoke with knew the people they were caring for and supporting, including their preferences and personal histories. People were involved in their care.

People had their medicines as prescribed. The staff checked each person’s identity and explained the process before giving people their medicine. Medicines administered ‘as and when required’ included protocols that identified individual strategies to try before administering medicines.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with the staff who had a caring approach to their work. Staff spoke positively about the support they received from the manager. Staff had access to effective supervision.

The manager was knowledgeable about the Mental Capacity Act (MCA) and how to ensure the rights of people who lacked capacity were protected; this included Deprivation of Liberty Safeguards (DoLs). People were supported by staff who understood the principles of MCA. Records showed staff had been trained in the MCA.

We found two 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.

We reviewed three care plans including risk assessments, care programme approach information and daily notes of care. A person said of key workers 'basically they take care of you'. Another person told us that 'I have a good network of people looking out for me.'

We saw two staff files and records of supervision. These provided evidence that staff received appropriate training and regular individual supervision. One member of staff said that their supervision was 'top' and that the manager spent 'as much time as needed' to support them.

People were able to make comments or to express concerns about the service.

We spoke with two members of staff, who confirmed they supported people to understand their rights and to give their consent to treatment and care This may include the involvement of health and social care professionals.

One person told us "very happy here","staff are nice","manager lovely" and "staff took me to see my X by train".

We saw evidence that regular staff meetings took place and staff received regular one to one supervision. One member of staff said they felt well supported and enjoyed working in the service.

We were told that the views of people were sought using a feedback form. Quality assurance audits are completed every three months. We saw a sample of monitoring forms completed.