Amberley House - London

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked at four quality statements under the key question of safe. People told us they felt safe with the staff caring for them at Amberley House. Risks to people were appropriately assessed which allowed people to be safe in their environment. There were enough staff to ensure people’s care and support needs were met. The home was in the process of being redecorated and any maintenance issues were identified and addressed quickly.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at Amberley House and felt the staff were very supportive. One person said they felt safe at night if they needed help because, “They [staff] come straightaway, that’s comforting.”

The manager demonstrated a good knowledge of safeguarding and understood when to escalate any safeguarding concerns to the local authority. Staff were able to explain how to recognise any signs of abuse and who to report it to if they had concerns. Staff also knew how to whistleblow if they felt their concerns were not being listened to. A staff member said safeguarding was, “Protecting the interest of service users. I will ask what happened, report to manager, I can whistleblow.”

During the inspection we observed several instances where people needed hoisting to be able to safely transfer. Staff had received training in manual handling and carried out hoisting safely and with compassion for the person. We also saw staff checking people’s safety, for those that were mobile, as they were walking around the home. For example, ensuring people were using their Zimmer frames. The environment was safe and free from trip and falls hazards.

Staff had training in safeguarding and understood how to recognise and report any concerns. The safeguarding policy was up to date. DoLS and mental capacity was well understood by staff and the manager. Where people were on DoLS, this was documented in their care plan. DoLS authorisations were in date and there was a process to ensure they were reapplied for in a timely manner.

Staff worked with people to help them understand their own personal risks and how they could avoid risks from occurring. For example, talking to people about why it was important for them to use their walking aids. Where appropriate, we saw people knew what type of special diet, such as puree food they needed to have. Puree or specific texture food is given when people have difficulty swallowing and may be at risk of choking. Where people were able to be involved, the manager had involved them in reviewing their risk assessments.

The manager had reviewed and updated risk assessments for all people living at the home. The manager told us they felt the risk assessments were now more reflective of people’s individual needs and specified what steps staff needed to take to help people manage risk. The manager also commented people needed to be involved so they could understand why things were being done in a certain way to keep them safe. Staff said they had easy access to read risk assessments and felt the new risk assessments were clearer and gave the more information.

At our last inspection we found there was a failure to robustly assess the risks relating to the health safety and welfare of people. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12. Risk assessments were greatly improved form the last inspection. Risks were now separate from the care plan which prevented any confusion of there being some risk assessments in the care plan and some separate, or not completed. Risk assessments were clear, each person’s risks had been reviewed since the new manager came to post. Risk assessments provided information on the specific risk and clear guidance for staff.

People were able to mobilise safely around the home. There were large corridors and lifts so people could navigate using various walking aids. People said they were aware lots of ‘redecorating’ was going on and felt the home had been in need of updating.

During the inspection, we spoke with the owner of the home. They said they had a plan of works to update, decorate and replace furniture in all bedrooms. Some rooms had been completed and they were working on ensuring the rest of the rooms and facilities were updated. The manager was aware of previous concerns around the environment and said this was something they were monitoring daily.

There was an improvement in the environment, furniture and equipment. We looked at several rooms and found these had been redecorated and where necessary, furniture replaced. However, we did find a chest of drawers and wardrobe which were not safe. This was replaced by the end of the day. All hallways had been redecorated and looked brighter and more welcoming.

Certificates showed all equipment and premises were checked regularly. We saw checks for things such as hoisting equipment, lifts, fire systems and water safety. Environmental risks such as extreme weather were also assessed. This included a ‘hot weather protocol’ if there were excessive temperatures. Older people and those with sensory impairment can be negatively affected by extremes in temperature and require this risk to be effectively managed. There was a clear reporting process for any maintenance issues and staff understood how to report any concerns. We saw documentation which showed when issues were reported and when they had been addressed.

People told us they felt there were enough staff and were able to ask for, and receive, help whenever they required.

We spoke with the owner and manager about staffing levels. At the time of the inspection, there were four people living at the home and staffing was well organised. However, when the home may begin to take new referrals, we sought reassurance that there would be a way of assessing people’s needs and adjusting staffing accordingly. The manager said at present they were not using a dependency tool to assess staffing levels as there were few residents but there was a dependency tool which was in place for when they had more people. This means the manager would be able to accurately assess needs and ensure staffing was appropriate going forward. The manager said they were aware of the issues found at the last inspection around training and was working to get all staff up to sped with their training. The owner said they were aware of the importance of training and had confidence the manager would assess and book training where needed. The manager acknowledged staff supervision had not always been regular and explained they had a plan in place to ensure regular staff supervision. The manager explained they felt staff supervision was important for staff to be able to review their work and discuss any concerns they may have as well as positive feedback. Staff told us they were happy more training was being provided. One staff member said they had done, “Fire safety, nutrition, first aid, manual handling, dysphagia. I receive all needed training.” Staff also confirmed they had supervision since the new manager came into post.

We observed there were enough staff to meet people’s needs. As there had been no new staff taken on since the last inspection, we did not look at staff recruitment at this inspection. Each staff member has received supervision in May 2024 and the manager was putting a system in pace to ensure staff received regular supervision. There were plans in place to ensure all staff had an annual appraisal.

At our last inspection we found a lack of staff training and ensuring staff training was refreshed meant that the service was in continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 18. The manager had a training plan in place which monitored staff training. Staff had received multiple training sessions since the last inspection and further training was booked. We also discussed dementia specific training, as the home worked primarily with people living with dementia. The manager and owner said they would look into providing this for staff.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.