Ambleside

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective because they did check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed before they started to use the service to help ensure these needs could be met. Information collected was transferred into care plans so that people’s needs and preferences were identified to support staff in meeting their needs. People’s needs were reviewed to ensure any changes in support were identified and reviewed as part of ‘resident of the day’ to ensure care needs remained accurate. Some relatives told us they had been involved in those discussions about how care should continue to be delivered in a way that met needs.

The provider did plan and deliver people’s care and treatment in line with legislation and current evidence-based good practice.

Recognised tools to monitor and evaluate people’s health conditions were used to determine the support and risk management people required to support positive outcomes. Where people required regular assessing to monitor for people’s likelihood of developing sore skin to their pressure areas, we observed pressure relieving equipment in place for those who needed it. This helped make sure, people received the right support to maintain their overall health and wellbeing.

Staff understood the national recognised tool used to determine a person’s food and fluid consistency so people could eat and drink in a safe way based on their individual needs. Staff described to us those people who needed thickener in their drinks, to reduce the risk of choking. Two people’s care plans we saw confirmed this. Staff completed individual food and fluid charts; however, we recommended staff also recorded the specific food that was given and followed up, where people’s fluid intake was less than their ideal target. In some examples, we saw people’s care information recorded them on a mince and moist diet, yet their care information said they liked snacks of crisps, cake, biscuits and fruit. The manager agreed to take action to address this.

The provider did not always endeavour to work well across teams to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had a handover meeting to share key information about people’s health needs. However, care staff told us they did not look at care plans, instead they asked more senior staff to tell them about people’s needs. Whilst the handover gave staff a brief summary of the person’s needs, it did not highlight how someone had presented over the last few days, or signs to look out for that may suggest a concern or improvement. Archived records meant staff did not always have a full picture of how people presented over a period of time. The regional director said they would improve this area, so staff had access to the information they needed.

People and staff feedback to us, showed positive changes had been made. One change was improved teamwork and communication between staff. Staff we spoke with said it was a much happier home. One staff member said, “If we are happy, people are happier and everyone wants to do their best. Communication is much better – staff feel supported.” We asked the manager what they thought about working together as a team, they said, “It’s a happier place to work.”

Relatives felt updated and they had recognised improved communication kept them informed. Planned meetings and opportunities to speak with staff and management were in place.

The provider did support people to manage their health and wellbeing, so people could maximise their independence, choice and control. Staff supported people to reduce their future needs for care and support.

There were a range of activities both within and outside of the home to support people’s overall health and wellbeing. This included for example, Tai Chi, chair exercises and ‘Namaste’ which focused on sensory activities including hand massages. Some people had been on a trip in the provider’s minibus to Weston Super Mare and had been supported by staff from the home to do this. People had access to health professionals such as the GP where they could receive support for any ill health. Staff also discussed any concerns relating to people’s health with GPs and any advice was added to people’s care plans.

We saw leaflets around the home that explained about health conditions such as dementia and Multiple Sclerosis to give people and visitors a better understanding of these conditions and what to expect. People and relatives felt people’s independence was encouraged and they gave us examples of how staff enable them to continue to do things for themselves, for example when washing, bathing or what they wanted to do.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We found no evidence people had come to harm. Where people required support that included repositioning them to maintain skin integrity or to have modified food and fluids, completed records did not always show this. For example, people who needed to be repositioned 2 or 4 hourly, were repositioned but on occasions, outside of specified time frames. Where people were encouraged to achieve 1200mls daily fluid intake, records showed 1 person had consumed less than 600mls per day, another person 800mls per day. There was no record of any action being taken to identify if this was correct, or whether staff recording needed to be more accurate.

Where people had modified diets and fluids, records did not always show what they had consumed. For 2 people were reviewed, their records said, ‘puree but not what was pureed. In another example, a person was recorded as requiring thickened fluids which was correct. However, other records said they did not. We also saw this person had lost weight, yet there was no evidence to show what action had been taken to manage this. We checked with senior staff, and this person did need thickened fluids, and they agreed to contact the GP regarding weight loss. We gave feedback to the regional director and manager who assured us they would review this. We could see checks of daily records were being completed, but they had not identified these issues. Accurate Information would enable health professionals to have a better understanding and make more informed decisions to support improved outcomes.

The provider did tell people about their rights around consent and always respected their rights when delivering care and treatment.

Our observations showed people were asked what they wanted to do, where they wanted to go or what they wanted to eat and drink. Staff understood the importance of seeking consent as well as seeking consent for people with limited understanding or communication. Staff told us they always explained what they were doing and looked at people’s visual cues, expressions or what they said, to determine what the person wanted. One staff member told us, “I take consent from them (people), we can’t force them.” A unit lead told us if they were to do something and the person said or implied no, or, pushed their hand away, they would not carry on. In most cases, explaining, giving time, leaving and returning after a short period of time, helped people to decide. Care plans showed where consent had been obtained for hourly welfare checks during the night. One care plan showed this had been agreed for a person where they were not able to use a call bell to alert staff themselves.