Ambleside Bank Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is 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 this inspection 36 people were living at the home.

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 m

We carried out an unannounced inspection of Ambleside Bank on 29 June 2016. We returned to complete the inspection on 1 July 2016.

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 c

We considered our inspection findings to answer the questions we always ask;

• 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.”

We received wholly positive comments about the home and staff members from the people living in the home and visitors we spoke with. Comments included; “This place is the Ritz, super, can’t fault it”, “Marvellous, they cannot do enough for you”, “Staff treat my mum like it is their own mum” and “Staff are good, they try and do their best for you.”

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.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

We spoke with ten people living at the home and three visiting relatives. All told us that they were happy with the service they received at the home. Their comments included “I do what I want and they help me”, “I can get around easily and go for a little walk outside when I feel like it” and “the laundry ladies are very good, my clothes are always lovely and clean and freshly ironed. Everything is marked so nothing goes missing.”

People told us that their environment supported their privacy, dignity and independence. Their comments included “I get up when I want or can stay in my room all the time if I want”, “my rooms lovely, I have brought my bits and bobs with me” and “they have made my bed higher so that I can get in and out easier because I like to be independent.” People told us that they could access all areas of the home independently. Comments included “I can get around easily and go for a little walk outside when I feel like it” and “everyone sits in the garden when the weather is nice.” One person told us “me and the maintenance man do the garden between us, we keep it nice.”

One person told us that they were able to maintain their religious beliefs. They told us “I continue with my beliefs and worship” and “I attend services here but sometimes go out with my friends to church.”

People told us positive things about the meals they received. Their comment included “the food is lovely and plenty of it”, “enjoy the food and “there’s always plenty to eat.”

One person told us “I have my meals in my room but go down stairs when I feel like it” and another person told us “we always have biscuits with our cup of tea.”

People also told us that “they will make you tea anytime even in the night, I think they’d get you something to eat too”, “we can take as long as we like. You can come in late and they still give you a good hot meal” and “I get weighed often because I’ve lost some weight.”

Everyone we spoke to felt they could report any problem. People told us “I tell staff what I want, they listen and I speak up to them” and “I can speak up to them.”

One visitor told us that their relative “loves it and has no complaints, we are very happy with his care.” Another relative told us “we are very happy with the care our mum gets, she’s happy and I know if I had any comments I could tell the staff.”

People told us good things about the staff team that supported them. Their comments included “it’s the staff that make this place”, “the staff are lovely and we get on really well” and “lovely staff, they ask you what you want.”