Archived: Ambleside Lodge - Redhill

The people we met had complex learning disabilities and were not able to fully tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with relatives and staff to help form our judgements.

The care service worked in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

Staff knew how to recognise, and report abuse and were confident any concerns raised would be responded to by their managers. Relatives thought their family members were safe.

Risk assessments were in place to ensure people’s safety. Medicines were managed and administered safely. There were sufficient staff available to support people in their home and in the community.

There were a range of checks in place to ensure the safety of the home. Accidents and incidents were monitored to identify and address any patterns or themes. Learning from incidents was shared with the staff team. There were systems in place to manage infection control.

Staff received the right training and support to enable them to effectively support people. People’s complex needs were well planned for. Staff supported people to have good health care support from professionals.

Where people lacked the capacity to make decisions for themselves, their capacity to make these decisions had been considered. However, best interest decisions were not always documented by the home in line with the Mental Capacity Act 2005.

People were involved in choosing what they wanted to eat and were supported to have a healthy and nutritious diet.

Staff were aware of people's routines and preferences, and they used this information to develop positive relationships and deliver person centred care. Relatives told us staff knew their family members well.

Staff described how they supported people by treating them with respect and dignity. Staff recognised when people were not happy and responded appropriately to support them.

Relatives told us staff were caring. Staff were understanding towards people and people were comfortable in the presence of staff.

People participated in chosen activities and accessed the local community, staff encouraged people to participate in things of interest to them.

Care plans were detailed, and relatives told us they felt involved in their family member’s care. Relatives felt able to raise concerns with the staff or the manager directly.

The service had links with the local community. Statutory notifications had not always been completed to inform us of events and incidents.

There were systems in place to monitor and improve the quality of care and support provided.

We have made a recommendation for the provider to revisit the Mental Capacity Act 2005 in relation to people making decisions.

Rating at last inspection: Good (report published December 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

The inspection took place on 20 October 2016 and was unannounced.

The home 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.

We previously carried out an unannounced comprehensive inspection of this service on 25 August 2015. At that inspection six breaches of legal requirements were found in respect of staffing, the provision of person centred support, treating people with dignity, restrictions on freedom and governance. As a result the service was rated Requires Improvement and six requirement actions for the service to improve were set. Following that inspection, the provider sent us an action plan which identified the steps they intended to take to make the required improvements. This inspection found that the provider had taken the action they told us they had in respect of each of these areas and as such each requirement action had been met.

The culture within the service had significantly improved and both people and staff were empowered by how the service was now being managed. Improved monitoring systems had been embedded which had enabled the service to self-develop and operate in accordance with the principles of reflective learning.

Staffing levels had been reviewed and steps taken to ensure the service was appropriately staffed across the 24 hour period. Ongoing care staff vacancies meant that the service regularly used temporary staff. The impact of this had however been mitigated by the use of the same bank and agency staff who were familiar to people and their needs. The feedback was that collectively staff had the skills to support people effectively and that permanent staff knew people and their needs very well. The provider continued to take proactive steps to recruit more permanent staff.

There were systems in place to ensure staff were safely recruited and suitable to work with people whose situation and needs made them vulnerable. Information that demonstrated that appropriate checks on new staff had been undertaken was now readily available to the registered manager.

Staff training had been revised and staff now had better access to both mandatory and specialist training in order to perform their roles effectively. In particular, training and support was provided to staff to ensure they were able to communicate effectively with those people who used non-verbal communication to express their needs and wishes.

Risks to people were identified and managed in a way that balanced their safety and independence. People were safeguarded from the risk of abuse and their legal rights protected because staff understood their roles and responsibilities.

People received person centred care that was responsive to their needs. Each person had a detailed plan of care that was kept under regular review. Staff understood the importance of providing care in a way that protected people’s legal rights and they took steps to ensure people were not unnecessarily restricted.

People were routinely involved in making decisions about their lives and were supported to access a range of activities that were meaningful to them. People had opportunities to engage in activities that both interested and developed them.

People had positive relationships with the staff who supported them. Staff took active steps to promote people’s privacy and dignity and provide support to people in a genuinely caring and empathic way.

People were supported to maintain good health. The service worked in partnership with other health care professionals to ensure people kept healthy and well. People had a good range of nutritionally balanced meals and were supported to follow dietary advice given to them. Medicines were managed safely and there were good processes in place to ensure people received their medicines as prescribed.