Ambleside Lodge - London

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 good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 did not always make sure people’s care and treatment were effective because they did not always ensure assessed needs were fully included in people’s care plans.

The provider did not always ensure people's assessed needs were fully reflected in their care planning records. Assessments were completed before people moved into the service and included information about communication and support needs. However, needs identified during assessment were not always transferred into people's care plans and risk assessments. We found examples where information relating to people's health needs was recorded elsewhere in care records but had not been incorporated into care plans. In addition, one person's care plan had not been formally reviewed within the previous year. Although the registered manager told us reviews took place regularly, there was no clear system for recording these reviews.

Despite these concerns, people were involved in discussions about their care and support needs. One person told us, “We have meetings about my care and what I want." Another person said, “Yes. I don't think I need any support, but they did ask. We have meetings if that's what you mean." These comments showed that people were involved at the point of assessment and in ongoing discussions about their support.

Staff understood the importance of assessing people's individual needs and preferences. However, gaps in recording and review processes meant the provider could not always show that staff consistently monitored assessed needs and reflected them in care plans.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them in their care plans.

People’s care records did not always reflect evidence-based approaches to supporting people's mental health and emotional wellbeing. Although care plans referred staff to community mental health teams when concerns arose, they did not consistently provide detailed guidance about actions staff should take themselves to help people manage anxiety, distress or deterioration in mental health. Positive behavioural support approaches were not clearly recorded within several people's care records.

There was evidence the service worked closely with community mental health teams and staff received updates about good practice through team meetings and supervision sessions. Staff had received appropriate training and understood people's needs.

Staff demonstrated a practical understanding of supporting people experiencing anxiety or distress. One staff member told us, “If they seem distressed or their mood changes this may be because of their mental health and we spend time talking with them to help them be calm." Staff also described how they worked with people to support anxiety-related behaviours, and we observed staff spending individual time engaging with people during the inspection. However, the failure to record staff practice meant we could not always be sure this good practice was consistent.

The provider worked well across teams and services 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.

The provider generally ensured care was coordinated with relevant professionals to meet people's needs. People's records contained information from mental health teams, commissioners and other health and social care professionals. There was evidence of meetings and ongoing engagement with professionals involved in people's care and support.

The registered manager described how information was shared appropriately and with consent. They told us they only shared information on a need-to-know basis with professionals involved in people's care, unless safeguarding concerns required information to be shared more widely. The registered manager also described supporting people to move successfully to more independent services when appropriate, including supporting one person's transition to supported living.

Staff spoke positively about multidisciplinary working and relationships with external agencies. A staff member told us, “The team is great. It feels like a family." Another said, "A lot of contact with social workers and the mental health teams. I think we have a good relationship."

People's experiences supported these findings. One told us how the registered manager and staff had liaised with health professionals to ensure they received appropriate support following a hospital discharge. This demonstrated joined-up working helped support continuity of care when people moved between services.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported to manage their health and wellbeing. Staff monitored people's health needs and supported them to arrange and attend health appointments when required, including regular blood tests associated with prescribed medicines. People were encouraged to make healthy food and drink choices and staff promoted wellbeing during a period of hot weather by ensuring access to cold drinks, comfortable room temperatures and fans where required.

Most people were independent and able to access the community. Where additional support was required, staff encouraged people to remain active. One person described how staff supported them to go out into the local community for walks and shopping. Another person told us,” Staff go with me to appointments."

Staff described how they supported healthier lifestyles. One staff member told us, "We help them make appointments and remind them. Go with them if they want us to." Another explained, “We are here for them and as soon as there is a problem we will contact the doctor." Staff also encouraged people to choose healthy foods and to stay hydrated.

The registered manager told us organised activities were limited as most people chose to spend their time independently in the local community and to organise their own activities.

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

The provider did not always effectively monitor outcomes for people or demonstrate progress towards agreed goals. Although people met regularly with their key workers to discuss their wishes and plans, records of these meetings did not routinely capture progress against objectives or outcomes achieved. Care plans also lacked sufficient information about how staff were supporting people to develop skills and confidence to achieve greater independence and move on to independent living services where appropriate

There were examples of support intended to improve outcomes. Staff described supporting people to become more independent and more confident in the community. One staff member told us, “People generally able to look after themselves and go into community independently. Where people need support we give it." Another staff member told us about the support they had provided to a person, and said, "It's good to see him become more confident."

However, while staff could describe positive outcomes, the provider's recording systems did not consistently evidence how progress was measured or reviewed. This meant the provider could have missed opportunities to evaluate the effectiveness of care and drive improvement.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were supported to make decisions about their care and treatment, and staff understood the importance of gaining consent. During the inspection we observed staff offering people choices and seeking their agreement before providing support. There was evidence people were involved in reviews of their care, and most people understood their care and support arrangements. Staff had received training in the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and the Mental Health Act. The registered manager had also made DoLS applications to the local authority where appropriate.

Although information about people’s ability to make decisions was included in their care plans and risk assessments, we found the provider had not completed capacity assessments for people living at the home. We raised this with the registered manager and noted that individual capacity assessments were subsequently completed during the inspection.

People told us staff respected their choices. One person said, “Staff ask if they want to do something with me. I can get up and go to bed when I like." Another person told us, “I can choose what I do and when. I go out often."

Staff demonstrated an understanding of supporting decision-making. One staff member told us, “People make their own decisions and we support them. If there is a risk we discuss with them." These findings showed people generally exercised choice and control over their day-to-day lives and care.