Ambleside Care Home is a care home for up to 20 older people that require support with personal care and who live with dementia and those who live with behaviours that are challenging. At the time of the inspection there were 18 people living in the home. The service is a large detached house and is owned by Grace Care Homes Limited and is located in Bexhill on Sea, East Sussex.
At a comprehensive inspection in November 2014 the overall rating was requires improvement. Breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found there were risks to people due to the management of nutrition. People in the service had not received care and support that was individualised to their needs and people had not been protected against unsafe treatment by the quality assurance systems in place.
During our inspection on 01 July 2016, we looked to see if improvements had been made. We found that many improvements had taken place and the breaches of regulations had been met.
There was a registered manager in post. 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.
Not everyone could tell us of their experiences, but those that could spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. People had confidence in the staff to support them and we observed positive interactions throughout our inspection.
At this inspection, we found that people were safe. Care plans and risk assessments were reason specific and included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.
People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe here. It’s nice here.” A visitor said “Lovely staff and it’s a real home here.”
When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. Staff retention was good and most staff we spoke with had worked at Ambleside for many years.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.
Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.
Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.
Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes and dementia. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.
People were encouraged and supported to eat and drink well. One person said, “I like the food, its nice food.” There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.
People could choose how to spend their day and they took part in activities in the home when they wanted to. Staff told of peoples particular favourites, such as ball games. People themselves told us they enjoyed the activities, which included singing, puzzles and films. The home have introduced their own pets, rabbits and guinea pigs which people spoke fondly of. People were encouraged to stay in touch with their families and receive visitors.
People felt well looked after and supported, and were encouraged to be as independent as possible. We observed friendly and genuine relationships had developed between people and staff. One person told us, “They treat you well here.” One person told us the staff supported them with their hair and make-up and it made them feel ‘good’.
People were encouraged to express their views and completed surveys, and feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, I tell the staff.”
Staff were asked for their opinions on the service and whether they were happy in their work. Staff enjoyed their work and felt that they were a family. They felt supported within their roles, describing an ‘open door’ management approach, where management were always available to discuss suggestions and address problems or concerns.
The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.