Ambleside

On this page

• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The previous inspection identified people, relatives and staff had concerns with the culture in the home and a management team that were not always listening, learning or acting on feedback. At this inspection, people, relatives and staff praised the actions of the new manager. One relative told us, “I was surprised with the rating displayed and wondered why. I soon realised that they had no proper leadership. I think that things are much better with the change of manager, the staff are much happier, and the staff are more approachable now. There is a calm atmosphere, and no one is rushing about.” Our observations supported this.

The manager told us how they listened to people, made themselves available and worked with staff to be on hand to help and support where needed. Staff welcomed this. All staff said they could approach the manager, raise any concerns and they felt confident things would change. Staff said because of this, people received more consistent and improved outcomes. Staff said they learnt about any changes needed in ‘11am meetings’ that took place each day. Changes of practice demonstrated learning. For example, where 1 person had rolled out of bed on several occasions, arrangements were made for them to have bedrails on their bed (with their agreement) to help prevent this from happening again.

Audits and checks reviewed incidents, accidents and clinical tasks and where improvements were needed, those were taken. One improvement that made a positive difference was reviewing people who were on antipsychotic medicines. The manager and unit lead said reviewing these medicines and reducing or removing them, but giving people the time and support they needed, gave people better outcomes and reduced incidents. Following our visit, the manager completed lessons learnt by using what they had learnt at this inspection and sharing it with staff as a case study to improve future practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Relatives told us they were kept updated about any changes to their family member’s support. One relative said, “Staff will get in touch with me if they have any health concerns.” A person told us they felt their care was supported by external professionals where needed. This person said, “I can see the nurse if I need to, chiropodist and I go to my own barber.” Another person said they saw podiatrist and a GP.

Staff told us and records showed they worked with other health professionals to ensure people received safe care. For example, 1 person was not eating and they were losing weight. A referral was made to the Speech and Language Team who suggested offering the person pureed food to try and increase their food intake. We saw the person was also being provided with a food supplement to help maintain their weight.

When people needed to be admitted to hospital, information was shared about the person to ensure they continued to receive person centred care. One staff member told us,“When people go to hospital there are care plans in a folder all ready, and they take a red bag with them with bits and pieces they might need.” The provider’s systems captured personalised information about people’s histories, risks to people’s health, their medication and wishes for future care. This information was shared with other healthcare professionals where necessary to ensure support was joined up.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People felt safe living at Ambleside. Relatives felt their family member were safe and protected. A person told us, “I feel safe because there are always staff around.” A relative said, “I feel that [Person] is safe here, they (staff) are on the ball if they get really ill.” Staff told us they knew what safeguarding issues they needed to report. One staff member said, “Physical, sexual and financial abuse. If I saw anything I would report it.” Other staff told us they would report to senior managers, CQC or the police if necessary. One staff member said, “I would report things like nasty comments to people and that sort of thing. I would report to the manager and if they didn’t do anything I would go higher, I would not leave it. I have never seen anything (of concern).” The manager and provider knew what to report and had notified us of incidents they had referred to us and safeguarding teams.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Staff and management worked within the principles of the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were appropriately applied for and overseen. In some cases, we saw best interests’ decisions had been completed, but some decisions reached, did not always show, how the decision was reached. The manager agreed to review those decisions to ensure people received the right support. Where people needed support, family and a power of attorney (A power of attorney is a legal document that lets you name a trusted person to make decisions for you), they were involved.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Assessments were carried out to identify any risks to people’s health and wellbeing. Care plans guided staff of the actions they needed to take to promote people’s safety. Where people needed specialist equipment to maintain their safety, this was identified and risk assessed. For people who required pressure relieving mattresses to help protect their skin integrity, these were set correctly which helped manage the risk. Whilst risks were mitigated, more accurate recording would help support staff’s actions to manage risk. Management assured us this would be addressed. Staff told us people had regular care reviews where people were involved in decisions about their care. Staff completed “resident of the day” where extra focus was placed on that person’s needs to ensure their wishes, preferences and risks related to their care, were revisited. A relative told us staff worked with them to ensure the care their family member received was how they wished. We saw the person’s care plan showed what time they liked to be assisted in the morning, times they liked to go to sleep and how they liked their drinks.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People told us they liked the home and the facilities available. One person said, “They encourage you to bring in things to make your room more homely.” We saw people and relatives spent time in the bistro, enjoying drinks and snacks, whilst talking to each other. Some people enjoyed spending time in the garden. Areas of the garden were covered which provided people some protection from the outdoor sun. People’s rooms were spacious and there were many communal areas and spaces that people could spend time in groups or on their own. Some people told us they enjoyed sitting in a certain part of the home which we saw. A refurbishment programme had taken place since our last inspection and we were told, further plans to the outside area space were being considered.

Checks on the environment were undertaken to ensure people’s health and safety was managed. Regular checks included water quality checks and fire safety checks to ensure people received care in a safe environment.

The provider made sure there were enough qualified, skilled and experienced staff. The provider made sure staff received effective training and guidance, supervision and development. Staff told us they worked together well to provide safe care that met people’s individual needs.

There were enough staff to meet people’s needs, however we received mixed feedback from people and relatives. Most people felt there were enough staff, whilst a minority felt they needed more staff. Where people felt they needed more staff, they did not tell us how this had impacted on them. Staff said there were enough of them to meet people’s needs. Our observations through the day showed staff were on hand to support people, whether in their own rooms or communal areas. Unit leads had supernumerary days to review paperwork and undertake medicine management tasks, reducing the pressure during care shifts. Staff were able to take people out on day trips, support during celebratory events and to take people into garden areas to enjoy the good weather. We did not hear call alarms ring often; however, we found a high number of call alarm cords were out of reach for those people who remained in their room. We told the home manager who agreed to ensure call alarms were within reach.

The provider had effective processes to ensure all safe recruitment checks had been completed prior to staff starting with the service. Recruitment checks included staff identity checks, references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions.

The provider assessed and managed the risk of infection. They did detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

People and relatives raised no concerns about cleanliness. One person said, “My room is clean.” Our observations showed staff wore PPE at the appropriate times. In people’s care files, they confirmed their specialist equipment had been cleaned regularly to maintain good hygiene. For example, records showed a person’s wheelchair, mattress and walking frame had been cleaned at least once a week with the frequency increasing when needed.

Housekeeping staff maintained the home and used relevant mops to reduce the cross-infection risks. Signage was displayed in communal bathrooms to inform and remind people and visitors about good hygiene practice. Foot-operated bins helped reduce contact points to limit risk of cross infection. Bins were emptied during our visit to minimise the risk of cross contamination.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Records demonstrated people received their medicines as prescribed. Electronic medicines administration records (EMARs) were completed accurately, with no unexplained gaps or omissions identified in those records we saw.

Some people were prescribed medicines on an ‘as required’ basis (PRN). PRN protocols were completed in a person-centred manner, reflecting GP or prescriber recommendations. Unit and team leaders demonstrated confidence in administering medicines to people. One unit lead told us how they identified risks when they and other trained staff, administered a prescribed medicine that required specific handling to keep everyone safe. Where people received their medicines via a patch applied directly to their skin, best practice guidelines were followed and application sites recorded on body maps.

Some improvements were needed to make sure specific eye drops were stored safely and as per instruction, and where medicines were given in food or drink, clear guidance needed to be in place to support staff to do this safely. We shared our findings with the manager who told us after our visit, they had sought advice and made changes to ensure the person remained safe when receiving their medicines. Staff told us they had medicines training and their competency to administer medicines safely was checked.