Ambleside Bank Care Home

Ambleside Bank is a purpose-built care home situated close to Wigan town centre, which provides

accommodation and personal care for up to 40 people. The home is registered to support younger and older adults and people living with a dementia. At the time of inspection 38 people were living at the home.

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

People and relatives spoke positively about the care and support provided at Ambleside Bank. People told us they received safe care from staff who knew them well. One told us, “If you need looking after, this is the place to be. The staff are great, nothing is too much trouble.” Staff had received regular training in safeguarding and know how to identify and report any concerns. Enough staff were deployed to meet people’s needs and keep them safe. The provider was happy to increase staff should people’s needs change. Accidents, incidents and falls had been documented along with actions taken. The home was clean with effective cleaning and infection control processes in place.

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.

People, relatives and staff spoke positively about the home and how it was run. Management were reported to be open, approachable, and worked hard to guarantee standards were upheld, whilst ensuring the home was a nice place to work. People’s views were sought through meetings and questionnaires, with updates provided so people knew what actions had been taken based on their feedback. A range of systems and processes were used to monitor the quality of the service provided. Action plans were used to help drive improvements.

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 the service was good (published 16 June 2018).

Why we inspected

We undertook this focused inspection to assess whether the current rating of good was still accurate. This report only covers our findings in relation to the key questions safe and well-led, as these were the only key questions inspected. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ambleside Bank is a purpose-built care home situated close to Wigan town centre and is registered to provide accommodation for up to 40 people who require personal care and support. At the time of inspection 29 people were living at the home.

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

The home was adhering to government guidelines in relation to infection prevention and control (IPC) processes. We suggested additional measures which could be implemented in line with best practice. This included the screening process for all types of visitor, cleaning documentation and completion of IPC training. The home had a plentiful supply of PPE and completed regular audits of the environment and hand hygiene practice. The home was currently receiving support from the local authority’s health protection team, who had visited and provided an action plan to further promote good practice.

People told us they received enough to eat and drink. People did not always like the meal option provided but confirmed they could request an alternative. Detailed records of what people had eaten and drank had been kept, with their weight monitored in line with guidance. Where unplanned weight loss had occurred, referrals had been made to the necessary professionals.

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 June 2018).

Why we inspected

We undertook this targeted inspection to check on specific concerns reported to us about nutrition, weight management and infection control. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the safe and effective sections of this full report.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During the last inspection, although the home was rated as good overall, it was rated as requires improvement in the key line of enquiry (KLOE) effective, as we identified a breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staff training. During this inspection we found the provider had addressed the previous regulatory breach and was now meeting all requirements of the regulations.

The service had a registered manager. 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.

People told us they felt safe living at Ambleside Bank Care Home. Relatives were also complimentary about the standard of care provided. We saw staff had received training in safeguarding and were clear about how to report concerns.

People, relatives and staff all confirmed enough staff were on duty to safely meet needs. Staffing levels were based on people’s dependency levels and rotas viewed confirmed the required number of staff had been deployed at all times.

Care files contained detailed risk assessments, which had been reviewed regularly to reflect people’s changing needs. This ensured staff had the necessary information to help minimise risks to people living at the home.

We found medicines had been managed safely. The home had effective systems in place to ensure medicines were ordered, stored, received and administered appropriately.

The provider used a training matrix to monitor the training requirements of staff. Training had been developed over the last 12 months, with the introduction of e-learning alongside practical training sessions. We found staff received appropriate training, supervision and appraisal to support them in their role.

People living at the home were encouraged to make decisions and choices about their care and had their choices respected, whilst being supported in the least restrictive way possible; with the policies and systems in the home supporting this practice. People's consent to care and treatment was also sought prior to care being delivered.

People’s nutrition and hydration needs were being met, with clear guidance in place for staff to follow. Meal times were seen to be a positive experience, with people being provided with a choice of meals and alternatives facilitated should they not like or want what was on offer.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect.

Care files contained detailed, personalised information about the people who lived at the home and how they wished to be cared for. Care plans provided staff with clear guidance on how to meet people’s needs, and risk assessments helped ensure their safety was maintained.

The home had a complaints procedure in place and whilst people told us they had no cause to complain, they knew how to do so, should they need to.

Peoples’ social and recreational needs were met through the provision of a comprehensive activities programme. Alongside in house activities, the home arranged visiting entertainers as well as group outings to places people had chosen to attend through discussion or meetings.

The provider had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Action plans were drawn up, to ensure any issues had been addressed. Feedback of the home was sought from people, relatives and staff through completion of surveys, which was used to drive continued improvement.

The home was last inspected on 03 June 2014 when the service was found to be meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of staffing. We also made a recommendation regarding the documenting of peoples health needs.

Staff reported that they received enough training and that this was regularly refreshed. However the home’s training matrix showed that not all care staff had completed scheduled training sessions in areas such as safeguarding, manual handling, infection control, dementia awareness and challenging behaviour. This is a breach of Regulation 18(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, staffing, because the home did not ensure that staff received the appropriate training and professional development to enable them to carry out the duties they are employed to perform. You can see what action we told the provider to take at the back of the full version of the report.

Ambleside Bank is registered to provide accommodation with personal care for up to 40 people. The home is set within its own grounds with car parking facilities. It is close to Wigan town centre and local transport networks.

Ambleside provides residential accommodation and day care. Facilities include assisted bathrooms, an orangery and a day care centre. All rooms are en-suite and there are two double rooms available. Well-appointed living rooms include a TV lounge, a ‘quiet’ lounge and a separate lounge for those people who wish to smoke. The home also has a dedicated hairdressing salon and a mini bus service that is used to take people on day trips and visits.

The home did not have a registered manager. ‘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.’ The previous registered manager had left the home on 16 June 2016. We were told during the inspection that the new manager would be commencing employment on 4 July 2016. Although the registered manager had left, an action plan had been put in place to cover the two week period until the new manager commenced their role.

We saw that the home was clean and fresh with no mal-odours. The Local Authority had given the home a rating of 96% during their last infection control audit and this standard had been maintained.

All the people we spoke with told us they felt safe. We saw that the home had appropriate safeguarding policies and procedures in place and the staff we spoke to knew how to report any safeguarding concerns and when it may be necessary to do so.

The home did not use a dependency screening tool to determine staffing levels, however we saw that dependency assessments had been completed and that staffing levels were appropriate to meet people’s needs. The people we spoke to confirmed this, saying they were well supported and cared for.

Robust recruitment checks were in place to ensure staff working at the home had met the required standards. This included everyone having a Disclosure and Barring Service (DB S) check, full documented work history and at least two references on file.

We saw that medicines were managed and administered appropriately. We saw that staff who gave out medicines had their competency assessed before being able to do so and regular medicines audits were carried out at both the location and provider level.

We saw that the dining experience in the home was a positive one. People we spoke to were very complimentary about the food provided. The home offered a wide choice of meals and catered for individual wishes, including those made on the day. We saw that people’s likes, dislikes, allergies or specialist diets were accounted for, with systems in place to ensure this was recorded.

Staff we spoke to had a clear knowledge and understanding of the mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone who does not have capacity needs to be deprived of their liberty in their own best interest. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the provider had followed the requirements in the DoLS. Related assessments and decisions had been properly taken.

Staff also told us that they felt supported and listened to through the completion of supervision meetings and yearly appraisals. They also told us that team meetings were held and they were encouraged to attend and have input with the agenda.

Throughout the inspection we saw evidence of positive and caring interactions between staff and people who lived at the home. Staff were observed treating people with kindness, dignity and respect. The people we spoke to told us how much they enjoyed living at Ambleside Bank and how well the staff looked after everyone.

We saw that the home had a comprehensive activities programme, which was supported by a spacious and well equipped activities room. We saw lots of activities being completed throughout the day and people we spoke to were complimentary about the choice and amount available.

People we spoke with told us that the home was well-led and managed and they would recommend living there. Staff stated that they enjoyed working at the home and felt supported.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies. One relative said: 'I feel he's safe and well looked after.'

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse.

Is the service effective?

People told us that they were happy with the care that had been delivered and their care records were up to date and signed by them. One relative said: 'My dad is getting belting care. He's well looked after and well fed.'

Care records confirmed people's preferences and needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said: 'It's the best thing we ever did (bringing him here).'

We heard that information was shared effectively between staff. Several ways of sharing information included management team meetings, handovers, daily records, and monthly reviews.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: 'They really care for the residents.' One person who lived in the home said: 'I think it's absolutely brilliant.'

Is the service responsive?

People's needs had been assessed before they were admitted to the home. Their needs for support and treatment were carefully described so that care workers knew exactly what tasks to undertake. Changes in people's care needs were reported to the senior carers and they briefed care staff. One person said: 'They ask me questions to check if I have any problems.'

A recent survey had highlighted some suggestions for day trips which the activities coordinator had actioned.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received satisfaction surveys and we saw evidence that feedback had been acted upon. The registered manager had introduced grumble and praise boxes to encourage more feedback and comments. Staff told us they were clear about their roles and responsibilities and were well supported. One said she had gained two qualifications whilst she had been working at Ambleside and commented: 'I've got a lot out of working here.'

The staff members we spoke with could show that they had a good understanding of the people they were supporting and they were able to meet their various needs. We saw that they were interacting well with people in order to ensure that they received the care and support they needed. The relationships we saw were warm, respectful, dignified and with plenty of smiles and laughter.

We received wholly positive comments about the quality of food that people were being served. One person said, 'The food is excellent.'

The home had an adult protection procedure that was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

The home sent out a suggestions and compliments form, an environment questionnaire plus a staff member of the month nomination form to the people using the service and their family representative each month as part of the care plan review system. This was a well thought out system that enabled people to have a regular input into both the care provided and the running of the home.