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 inadequate. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the regulation in relation to safe care and treatment. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At our last assessment of this service, people were exposed to risks because the provider did not always operate an effective system or process to record, recognise or act on risks. This included risks around people’s individual needs, medicines administration and environmental risks.

At this assessment, we found the provider had made improvements. However, further time was required to ensure improved practices were embedded and formed an on-going part of the providers risk assessment and management processes.

Daily notes and records clearly showed required monitoring had been regularly checked and completed. Charts and risk assessments had been reviewed, updated and checked regularly. These included turning charts, skin integrity, catheter care and mattress checks. Personal Emergency Evacuation Plans (PEEPs) had been updated.

The registered manager had implemented a dependency tool used to assess staffing ratios according to people’s assessed needs and individual risks. Each person had an assessed supervision level of low, medium, high or one-to-one care. This was reviewed monthly.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

At our last assessment of this service people were exposed to environmental risks because the provider had not always ensured the kitchen was clean. Hot water temperatures and fridge temperatures had not been regularly checked and monitored. The home environment, fire and asbestos safety had not been fully maintained and managed.

At this assessment, we found the provider had made improvements. However, further time was required to ensure improved practices were embedded and formed an on-going part of the providers environmental risk assessment and management processes.

We observed the garden was overgrown with some rubble and old equipment stored in places. It was not fully or safely accessible for people and required a risk assessment. We spoke with the registered manager about our findings at the time of the inspection who took immediate and appropriate action.

We reviewed the fire risk assessment and action plan and found all actions had been completed. A fire equipment service audit schedule was in place and included areas such as emergency lighting, gas and electrical safety and fire extinguishers. Weekly checks were in place to monitor, amongst others, call bell usage, fire drills and water temperatures.

Asbestos checks were in place and had been assessed by an external professional who found no actions or recommendations required.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

At our last assessment of this service people were exposed to risks because the provider did not always operate an effective system or process to monitor the cleanliness of the home and storage of food items.

At this assessment, we found the provider had made improvements. However, further time was required to ensure improved practices were embedded and formed an on-going part of the providers infection prevention and control processes.

We found improvements had been made to the cleanliness of the kitchen. A new chef had been appointed who was managing the kitchen cleanliness, monitoring and storage well. New night cleaning schedules were in place, fridge temperatures were regularly checked and were within the required range. Food was stored correctly. There was a safety management system in place (Safer food, better business SFBB), developed by the UK Food Standards Agency (FSA). The ‘4C’s approach’ checked cross-contamination, cleaning, chilling and cooking had been implemented. It included a diary to record daily checks, staff training, and improvements required.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

At our last assessment, we found medicines were not being managed safely. At this assessment, we found the provider had made improvements. However, further time was required to ensure improved practices were embedded and formed an on-going part of the providers daily medicines management and auditing process.

One person required the administration of their medicines covertly. The lawful authorisation of administering their medicines covertly was not recorded accurately in the person’s medicines care plan and the deprivation of liberty safeguards care plan. An updated application had been completed and sent to the local authority to review and add the administration of covert medicines to the person’s Deprivation of Liberty Safeguards (DoLS) authorisation.

We also found some recording discrepancies in some documentation. For example, we found there were 2 gaps on the cream chart on 2 different dates for 1 person who required topical cream daily. There was, however, a topical medicines application record body chart which had been highlighted so staff knew where to apply prescribed cream on the person’s body.

One person was prescribed a pain killing medicine to take as and when they required it. We found 2 different protocols in place with slightly different information. One had a clearer explanation of how and when to escalate and request a medicine review, if the person was requiring more regular administration. We spoke with the registered manager about our findings at the time of the inspection who took immediate and appropriate action.

Another person had an inhaler prescribed as needed, but this was not recorded on the MAR and there was no PRN protocol in place.

We found that people receiving controlled drugs had received a medicines review by the visiting GP. Other records were well completed.

We spoke with the GP surgery clinical pharmacist who told us medicines administration, auditing, recording and medicines reviews were much improved. Communication with the surgery regarding medicines was better and the registered manager was engaged, proactive and shared information freely. They told us, “There seems to be more of a positive culture around meds…I am feeling positive about it here.” Structured medicine reviews were now taking place regularly and the provider was more accepting of support and guidance.