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Reports


Inspection carried out on 7 January 2017

During a routine inspection

This inspection took place on 7 January 2017 and was unannounced.

Ambleside nursing home is registered to provide accommodation and nursing or personal care for up to 20 people. There were 18 people living at the service at the time of inspection. The home is situated in Weston Super Mare and offers accommodation split over four floors. There is a communal lounge on the ground floor and a separate dining area on the basement floor. There is lift access to each of the floors and the service was in the process of having a wet room installed with an accessible shower.

There was not 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. The current manager had applied to CQC to become the registered manager and this application was being considered at the time of inspection.

Staff were recruited safely because the provider undertook a variety of checks prior to staff starting work.

Assessments were made in line with the Mental Capacity Act(MCA), however best interests decisions did not include evidence about the options considered or whether decisions made were the least restrictive for the person.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

Staff were aware of the risks people faced and understood their role in reducing these. People had individual risk assessments which identified risks and actions required by staff to ensure that people were supported safely.

There were enough staff available and people did not have to wait for support. People had support and care from staff who were familiar to them and knew them well. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs.

People received their medicines on time. We saw that people were supported by staff who had received appropriate training to administer medicines and that they followed safe procedures when giving people their medicines.

Staff had the necessary skills and knowledge to support people and had received training which was relevant for their role. Some training offered was considered essential by the home and other training was offered based on the needs of people living at the home and the development needs of staff.

People spoke positively about the food and had choices about what they ate and drank. The kitchen were aware about people’s dietary needs and where people required a special diet or assistance to be able to eat and drink safely this was in place.

Staff knew people well and interactions were relaxed and caring. People were comfortable with staff and we observed people being supported in a respectful way. People were encouraged to make choices about their support and staff were able to communicate with people in ways which were meaningful to them.

People had care plans which were person centred and included details about their likes and dislikes and how they wished to be supported. Staff were able to confidently tell us about people’s preferences and care plans were regularly reviewed with people and their loved ones where appropriate.

People were able to engage with a range of activities including one to one time with staff. People told us that they had enough to do at the home and although there were planned activities, staff were also encouraged to spend unplanned time engaging people in activities.

Relatives spoke positively about the staff and management of the home. They told us that they were always welcomed and visited when then chose. Both relatives and people told us that they would be confident to complain if they needed to.

Staff felt supported by the manager at the home and were confident in their roles. The manager had undertaken some improvements since starting in the role and these were in place and working well. There were further developments planned which the manager was confidently able to explain to us. Staff were encouraged to have input into the development of the home and communication between staff and the manager was effective.

Feedback was gathered both formally and informally and used to drive improvements at the home. Quality assurance measures were regular and also used to identify gaps and trends which were then used to plan actions to drive high quality care.

Inspection carried out on 23 April 2014

During an inspection to make sure that the improvements required had been made

We were able to considered within this inspection findings to the following answer, Is the service safe?

At our inspection on the 14th Oct 2013 we found that people were not protected against the risks associated to cleanliness and infection control. This was because the home did not have clear policies in place, the laundry area had a broken floor and there was not an identified individual responsible for the monitoring and management of the Infection control policy and guidance. The purpose of this inspection was to check suitable actions had been taken to address the issues raised. We found that improvements had been made and people were better protected from the risks associated with infection control.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service their relatives and the staff supporting them. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us and our observations showed, that the environment was clean, hygienic and tidy.

There were schedules in place for each room identifying daily and weekly cleaning required. Staff confirmed they used the schedules and documented when they had undertaken that task. There was no overall audit available at our inspection on the cleanliness of the environment but we saw that all areas were clean and tidy. We were sent a copy of the last Infection control audit which had been undertaken on the 16th Feb 2014. All the people who we spoke with told us their rooms were always clean and tidy.

Actions had been taken to rectify the broken surface in the laundry making this area safe and hygienic. We also saw that policies had changed to reflect up to date legislation and the implementation of the Department of Health’s Code of Prevention and Control of infection in care homes. There was now a registered manager who was responsible for leading on Infection control for the home.

We did however see that there was a medicines trolley which was unlocked within one person’s bathroom. We raised this with the registered manager who quickly resolved the situation.

We also saw equipment stored in two communal toilets and one bathroom. We fed this back to the registered manager as storing equipment in a bathroom/toilet area presented an infection control risk.

Inspection carried out on 14 October 2013

During a routine inspection

There were 15 people living in the home at the time of the inspection. During our visit we spoke with four people and a visitor to the home. We also spoke with the staff on duty during our visit and the acting manager.

People who lived in the home were very complimentary about the staff and said they were treated with respect. One person said "I think the staff do a great job" whilst another person said “the staff are very kind to me.”

People told us that staff treated them as individuals and supported them with their daily activities as needed. One person said “I am quite independent but staff help me when I need it.” People told us that they had good relationships with the staff and said they "felt safe" at the home and were able to talk to staff if they had any worries or concerns.

People who lived at the home said that they would be comfortable to talk with a member of staff if they were unhappy about the care they received. One person said “I can speak to the nurse on duty, there’s no need to worry about things.”

We saw all areas of the home we visited were clean. We found people were not protected from the risk of infection because appropriate guidance had not been followed.

There was no registered manager in post at the time of this inspection.

Inspection carried out on 13 February 2013

During a routine inspection

There were 18 people living in the home at the time of the inspection. During our visit we spoke with ten people who lived at the home and three staff members.

People who lived in the home were very positive about the service and said they were treated with respect. Every person we met spoke well of Ambleside. One person said "I regard this place as my home now"; another person said “the staff are very kind to me and I have observed them being very kind to other people here.”

People told us that staff treated them as individuals and made the changes to their daily routines when they requested it. One person said “staff ask me what I want to do.” We were also told by another person “I’m fine in my room, I have my call bell if I need anything.”

People told us that they had good relationships with the staff and said they "felt safe" at the home and were able to talk to staff if they had any worries or concerns.

The home was accredited to the ‘Gold Standard Framework.’ This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life.

People who lived at the home said they would be comfortable to talk with a member of staff if they were unhappy about the care they received. One person said “I can speak to the manager and she will sort things out.”

We observed that all areas of the home we saw were clean and the home had an atmosphere of care and respect for people who used the service.