CQC report explained · a residential care home
What the CQC found at Amberley House - London
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, January 2024
Rated Requires Improvement; the home has improved since an Inadequate rating and is no longer in special measures, but inspectors found gaps in risk checks, training and oversight.
Inspectors visited on 1 November 2023 and reviewed information until 11 December 2023. They spoke with people, a relative, staff and managers. They also reviewed care plans, risk assessments, medicines records, staff files and management records.
The home had improved since the previous inspection. People said they felt safe. Medicines were generally managed safely, staffing had improved, healthcare referrals were timely, and activities and care plans were more personalised.
However, important problems remained. Some risks were not properly assessed or monitored. Staff training was incomplete or out of date, including training on safeguarding, fire safety, the Mental Capacity Act and special diets. The systems used to check the quality of care had not found these problems.
The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. The home was previously rated Inadequate and had been in special measures, but it left special measures after this inspection.
Medicines
Medicines were generally given safely and on time. Records showed no missed administration entries, and stock checks were accurate.
“Medication Administration Records showed people received their medicines on time and there were no omissions in documenting this.” from the report
Staffing at the inspection
There were enough staff for the 3 people living at the home during the inspection. The home had also employed an external cleaning company and a full-time cook.
“There were enough staff to meet people's care and support needs.” from the report
Healthcare support
People were supported to attend routine and specialist appointments. Staff made referrals to the local care home assessment team when they had health concerns.
“Relatives told us they felt people received timely referrals to healthcare professionals and were monitored.” from the report
Personalised care
Care plans had been rewritten with more information about people's needs, preferences and what a good day meant for them. Families were involved in planning.
“At this inspection, care plans were more person centred and contained more detailed information on people's care and support needs.” from the report
Activities and communication
People were supported with activities linked to their interests, faith and language. Staff understood how people communicated, including someone who did not speak English.
“Activities focused on things people enjoyed.” from the report
Premises improvements
The home had been deep cleaned and decorating was under way. Hallways and doors had been repainted, and some rooms had been decorated.
“The provider had ensured the home had been deep cleaned.” from the report
Staff training gaps
seriousSeveral staff had not completed important training, and some training had not been refreshed for years. The cook had not been trained in swallowing problems or different diet textures, despite preparing soft diets.
“There were significant gaps in staff training.” from the report
Weak management checks
seriousQuality audits had not picked up the problems with training and risk assessments. Some daily safety audit forms did not record findings, making progress difficult to monitor.
“We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed.” from the report
- 01Which residents currently need fluid or weight monitoring, and what exact action will staff take if their intake or weight changes?
- 02Have all staff completed and refreshed training in safeguarding, fire safety, the Mental Capacity Act and health and safety?
- 03What training has the cook received for soft diets and swallowing difficulties?
- 04How will the home check that risk assessments and care plans remain accurate and consistent?
- 05How would staffing, cooking, cleaning and activities change if the home increased from 3 residents towards its 30-place capacity?
This was an unannounced inspection covering Safe, Effective, Responsive and Well-led, including the premises and infection control; no separate Caring rating was given and only 3 people were living at the home. This explanation was written from the published report of 6 January 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2023
Rated Inadequate and placed in special measures; inspectors found serious risks, poor care planning, limited activities and weak management despite kind staff.
This was an unannounced focused inspection. Inspectors visited on 20 December 2022 and gathered further feedback on 10 January 2023. They spoke with people, relatives, staff and health professionals, observed care, and checked medicines records, care plans, risk assessments and management records.
People and relatives said they felt safe and cared for. Inspectors also saw kind interactions. However, they found significant concerns. Risks were not always assessed properly, some weight loss was not acted on quickly, parts of the home were dirty or damaged, and staffing levels were not enough to meet people's needs fully.
People had limited involvement in food choices, activities and care planning. Activities were not meaningful or regular, and people were rarely supported to go outside the home. The home lacked effective checks by managers, and similar problems had not been put right since earlier inspections.
The overall rating changed from Requires Improvement to Inadequate. Safe, responsive and well-led were rated Inadequate, while effective remained Requires Improvement. The caring question was not inspected in this focused visit, so its previous rating carried over.
Kind interactions
People and relatives spoke positively about staff. Inspectors observed staff being kind and caring during the inspection.
“We observed kind and caring interactions between people and staff throughout the inspection.” from the report
Medicines
Medicines were generally managed safely and given on time. Staff had regular medicines training and checks were carried out.
“Medicines were managed consistently and safely in line with national guidance.” from the report
Safer recruitment
The staff files checked contained appropriate recruitment checks, including references, identity checks and DBS checks.
“Staff were recruited safely. Staff files showed a range of recruitment checks including two written references” from the report
Safeguarding awareness
Staff had safeguarding training and understood how to recognise and report possible abuse.
“Staff had received training in safeguarding and understood how to recognise and report signs of abuse.” from the report
Mental capacity practice
The report found that the home was working within the principles of the Mental Capacity Act. Capacity and Deprivation of Liberty Safeguards information was recorded in the care plans checked.
“The provider was working within the principles of the MCA-” from the report
Unassessed risks
seriousSome known health risks were not assessed, or the assessments did not give staff enough personal guidance. Significant weight loss had not always led to timely healthcare referrals.
“Risks to people's health, safety and welfare were not always identified or managed effectively.” from the report
Unsafe and unclean areas
seriousInspectors found dirty bathrooms, peeling paint, damaged furniture and trip or injury hazards in bedrooms and bathrooms.
“The failure to ensure the premises and equipment were adequately maintained and suitable for the intended purpose is a breach of Regulation 15” from the report
Not enough staff
seriousThere was no cleaner or activities coordinator, so care staff also had to clean and lead activities. Inspectors said staffing levels were not enough to meet people's full needs.
“There were not enough staff to ensure people's needs were comprehensively met.” from the report
Limited activities
seriousPeople were not involved in planning activities and were generally not supported to go out. Inspectors saw little engagement and limited meaningful activity.
“There were no structured activities in place to ensure that people were supported to reach and maintain a state of wellbeing.” from the report
Poor care planning
seriousMany care plans used general descriptions of medical conditions rather than explaining how each person experienced them or what support they needed.
“The lack of person centred care planning means that the service was in breach of Regulation 9” from the report
Weak management checks
seriousAudits did not identify problems with care plans, risks, cleanliness or repairs. The report says similar governance problems had continued across three inspections.
“There has been a failure to learn from previous issues identified by CQC during two consecutive inspections and to embed positive and lasting change.” from the report
- 01What has changed since the inspection to make sure every person's health risks, including diabetes, falls, constipation, skin care and weight loss, are assessed and acted on?
- 02How many staff are now on each shift, and how are staffing levels matched to people's needs?
- 03Who now cleans bedrooms and bathrooms, and how are repairs and safety hazards checked and recorded?
- 04How are people involved in choosing meals and planning activities that reflect their interests, culture and ability?
- 05What audits are now completed, who reviews them, and how can relatives see evidence that earlier problems have been fixed?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not inspected and the report says ratings for questions not inspected carry over from the last inspection. This explanation was written from the published report of 25 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Amberley House - London
6 rated inspections over 9 years: the service has slipped, from Good to Requires improvement.
- January 2024Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2023Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementResponsive: InadequateWell-led: Inadequate
- May 2020Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2019Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- March 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2013
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 7 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Enfield
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 79 can care for a couple. 11 years' experience on average.
“Over the time he spent with them he got to know our parents very well and became like part of the family, even joining in family celebrations.”
“Charity would take Nan on holidays day trips and shopping adventures”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.