Ambleside

Updated 30 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors carried out the inspection.

Service and service type

Ambleside is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ambleside is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed interactions between people and staff. Although we interacted with 3 people, they were unable to provide a view of the care provided to them, we therefore sought the views of 6 representatives in relation to the care and support their relative received. We spoke with 8 members of staff which included the registered manager, operations manager, compliance and quality manager, 4 care staff, a cook and housekeeper.

We inspected 3 people’s care records and 11 people’s medicine administration records. We inspected 5 staff recruitment files, which included evidence of induction training and supervision sessions. We reviewed the service’s staff training record.

We inspected records related to health and safety checks, maintenance, and servicing completed by contractors. We reviewed audits completed by the senior management team and registered manager, including a selection of policies and procedures.

Updated 30 September 2023

About the service

Ambleside is a residential care home providing accommodation and personal care to up to 18 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 16 people using the service. People were accommodated in one adapted building across 3 floors.

People’s experience of using this service and what we found

People’s medicines were not always managed safely. This included unsafe administration practices and a lack of clear guidance for staff on the use and administration of some medicines.

The provider was making improvements to their fire safety arrangements following recommendations made by the local authority fire safety team. However, people’s personal emergency evacuation plans (PEEPs) required up-to-date information about what support people required in the event of a fire.

Staff were aware of the risks which could potentially impact on people’s health and safety and knew what action to take to reduce harm to people. However, relevant records did not always accurately reflect people’s risks and the actions needed to keep them safe. Risks were not always suitably assessed or reassessed when people's needs or circumstances changed, to ensure appropriate and suitable risk mitigation actions were in place.

The provider's systems for monitoring the quality and safety of the service had not been effective in identifying and addressing the shortfalls identified in this inspection.

Relevant information was shared with external agencies, including health and social care professionals and the local authority, when incidents occurred, or when people’s health altered, so they could review or reassess people’s needs as required.

Both managers and staff told us they felt comfortable with the numbers of staff deployed to care for people. Additional staff were employed to clean, cook, and support people with social activities. Staff were recruited safely.

Regular safety checks including, maintenance and servicing took place to ensure all systems, utilities and equipment remained safe.

The senior management team shared responsibilities and management tasks when managing the service. They were clear about the areas they were responsible for, and the staff were clear about which manager to report concerns and issues to. The registered manager and provider were kept well informed of all incidents, accidents and events which took place in the care home.

The registered manager worked regularly with staff to provide support, review their practices and competencies and to monitor workplace culture. They attended staff handover meetings and held regular staff meetings to keep staff informed and to gain feedback. Feedback was also sought from people who used the service and actions taken in response to the feedback.

Staff and people’s relatives told us they found the senior management team to be approachable, supportive and inclusive.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 8 August 2022).

Previous recommendations

At our last inspection we recommended the provider consider how they recorded actions for improvement along with the completion of those actions. At this inspection we found actions for improvement were recorded but there was not always a record of whether these actions had been completed.

Why we inspected

The inspection was prompted in part by notification to CQC about an incident following which a person using the service sustained serious injuries and died. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of that incident.

For those key questions not inspected, we used the ratings awarded at the last inspection in which those were inspected to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ambleside on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines, review and reassessment of risks and the provider’s monitoring processes. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.