Ambleside

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant people’s needs were not always met.We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant people’s needs were not always met. The service was in breach of legal regulation in relation to person centred care. People’s care information did not always contain up to date, correct information and we could not be confident, some people received the right levels of support.

This service scored 61 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. People’s care plans lacked accuracy to describe how a person presented or how their needs had changed. Almost everyone told us they had not been involved in any care reviews, so people’s voice was not included in how their care was recorded and delivered. We found 2 people's care records for people assessed as living with a cognitive impairment were assessed as a choking risk, so this was a blanket approach rather than a person-centred view. Some people requiring repositioning to alleviate pressure on their skin, were not repositioned at set intervals and for 1 person, had insufficient equipment to keep them in a position that mitigated their identified risks. One person’s behaviours had recently changed resulting in them putting all their personal belongings on their bedroom floor. There was no information in the person’s care plan informing staff how to respond to the person’s anxiety and distress in relation to their belongings. One relative told us their family member had always taken pride in their appearance, yet now they found their family member was not always well presented. This relative said, “Appearance was really important to [Person name]. Recently, he was wearing someone else’s clothes.” The relative told us staff helping their family member to dress had not considered the importance of their appearance to their family member. Following our visit, we received some feedback from a health professional who shared some of our concerns. The health professional said, “We have taken it upon ourselves to deliver continence and basic pressure area training due to issues we were finding. We felt it necessary to try and reduce some of the referrals coming to us that could have been avoided.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Health care professionals were involved in supporting and advising on the care people received. There were regular GP visits and if emergency appointments were required, these were facilitated. Some people were encouraged to make their appointments to suit their needs. Other health professionals such as dieticians, opticians and dentists were involved. However, following our visit we received some feedback from a health professional. They said, “some days are better than others but I am aware staff do work on different units and don't always know the patients. Generally, most staff are accommodating and greet us, but again it is inconsistent.”

The provider supplied information in formats that were tailored to individual needs. People’s communication needs were assessed. Care plans informed staff what aids people needed to support their communication and the most effective ways of communicating with them. We saw staff were unhurried in their communication with people and ensured they talked to them at their level to support people’s understanding. Where a need was identified, visual prompts were used, for example, show plates to help people understand the menu options available.

We received mixed feedback from people about how they did not feel listened to because actions were not always taken. People were invited to ‘residents’ meetings’ where they were invited to give feedback about menu choices and the dining experience. However, we have reported people did not feel involved in how their care was tailored to them and told us they were not always involved in care reviews. Some people gave us other examples. One person said, “I’ve lost clothes here and I have raised it, but it’s been going on for months. I complained to another carer, but management told me off for complaining, it was last year.” Another person said, “On Wednesday next week there is a resident meeting. The trouble is they don’t do what we ask. In 2 meetings I fell out with the manager.” Other people felt able to share feedback and would rely on relatives for those discussions. One comment was, “I’m supported quite well, it’s like a family here. I think the carers all work quite well together, they understand fully what’s needed.” Another person told us, ‘I’m involved as much as I need to be. I’m very happy with my support.”

The provider made sure that people could access the care, support and treatment they needed when they needed it. Staff recognised some people could not verbally inform them if they felt unwell and recognised that they might demonstrate a deterioration in their health through their reactions and responses. One staff member told us, “You see how they walk, how they stand, how they move, their reactions, their body language."

We could not be assured staff and managers actively listened to all information about people who were most likely to experience inequality in experiences and outcomes. Care plans did not always provide guidance on how to manage known risks and people and relatives felt their concerns were not always heard. A relative of a person living with a cognitive impairment felt staff did not always understand how to care and involve someone living with dementia. They also told us they felt there was a lack of understanding and consideration in how a person once presented and how they were currently supported. A health professional shared information with us that indicated some referrals could have been avoided.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. People’s care plans some information about their wishes in respect of the care they wanted to receive if they became very unwell. This included in relation to whether they wanted to be admitted to hospital or remain at the home and those people they wished to be informed as their health deteriorated. Where people were identified as moving to end of life, other healthcare professionals were involved to ensure people remained pain free. Where required, anticipatory medicines and support from advanced nurse practioners was in place.