Ambleside Lodge is a care home providing accommodation and personal care for up to eight people with learning disabilities, including Autism. There were eight people living in the home at the time of our inspection.

The inspection took place on 20 October 2016 and was unannounced.

The home 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.

We previously carried out an unannounced comprehensive inspection of this service on 25 August 2015. At that inspection six breaches of legal requirements were found in respect of staffing, the provision of person centred support, treating people with dignity, restrictions on freedom and governance. As a result the service was rated Requires Improvement and six requirement actions for the service to improve were set. Following that inspection, the provider sent us an action plan which identified the steps they intended to take to make the required improvements. This inspection found that the provider had taken the action they told us they had in respect of each of these areas and as such each requirement action had been met.

The culture within the service had significantly improved and both people and staff were empowered by how the service was now being managed. Improved monitoring systems had been embedded which had enabled the service to self-develop and operate in accordance with the principles of reflective learning.

Staffing levels had been reviewed and steps taken to ensure the service was appropriately staffed across the 24 hour period. Ongoing care staff vacancies meant that the service regularly used temporary staff. The impact of this had however been mitigated by the use of the same bank and agency staff who were familiar to people and their needs. The feedback was that collectively staff had the skills to support people effectively and that permanent staff knew people and their needs very well. The provider continued to take proactive steps to recruit more permanent staff.

There were systems in place to ensure staff were safely recruited and suitable to work with people whose situation and needs made them vulnerable. Information that demonstrated that appropriate checks on new staff had been undertaken was now readily available to the registered manager.

Staff training had been revised and staff now had better access to both mandatory and specialist training in order to perform their roles effectively. In particular, training and support was provided to staff to ensure they were able to communicate effectively with those people who used non-verbal communication to express their needs and wishes.

Risks to people were identified and managed in a way that balanced their safety and independence. People were safeguarded from the risk of abuse and their legal rights protected because staff understood their roles and responsibilities.

People received person centred care that was responsive to their needs. Each person had a detailed plan of care that was kept under regular review. Staff understood the importance of providing care in a way that protected people’s legal rights and they took steps to ensure people were not unnecessarily restricted.

People were routinely involved in making decisions about their lives and were supported to access a range of activities that were meaningful to them. People had opportunities to engage in activities that both interested and developed them.

People had positive relationships with the staff who supported them. Staff took active steps to promote people’s privacy and dignity and provide support to people in a genuinely caring and empathic way.

People were supported to maintain good health. The service worked in partnership wit

Ambleside Lodge is a care home providing accommodation and personal care for up to eight people with learning disabilities, including Autism. There were seven people living in the home at the time of our inspection.

The inspection took place on 25 August 2015 and was unannounced.

The home 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.

Feedback from relatives and our observations during the day indicated that staffing levels were sufficient to meet people’s needs. We did however identify that on three occasions, night staffing levels went below the home’s own risk assessment for what was safe.

The home lacked a sense of leadership and did not provide adequate direction to staff. Whilst staff felt supported in their roles, their skills had not been effectively appraised and practice issues had not always been identified and addressed.

The provider had a programme of training, but that did not currently include learning about people’s specialist needs. For example most people living at the home did not communicate verbally and yet many staff had not received training in the use of different communication methods, such as Makaton or Picture Exchange Communication System (PECS). We saw that some staff did not interact effectively with people and some people spent large parts of the day without engagement.

Quality monitoring systems had not always been effective in identifying and ensuring improvements were made. For example, gaps in record keeping meant that it was not possible to evidence that new staff had been appropriately employed.

Some measures to keep people safe meant that other people were restricted more than necessary. For example we saw that communal toilets and kitchen cupboards were kept locked. Some people could safely access these areas, but were prevented the freedom to do so due to the needs of others.

Relatives told us that they were impressed with the quality of staff at the home. They said that staff were kind and knew their family members well. We found that staff competencies varied and that some staff were not always respectful in the way they spoke or wrote about people and their needs. We also observed that staff did not always fully protect people’s privacy and dignity. For example we overheard two staff discuss private information about people in a communal area.

Care plans provided useful information about people and their needs, but this was not always reflective of the care provided. People had opportunities to participate in activities, but these were not always linked to their goals or the particular interests and cultural beliefs. For example one person liked going to the local Mosque, but they had not been supported with this activity for several months.

The environment was safely maintained and known risks were mitigated. Each person had a Personal Emergency Evacuation Plan (PEEP) which outlined how they would be supported to live the service in the event of an emergency. The home also had contingency plans to provide support in the event of a fire, flood or outbreak of infection.

People were safeguarded from harm because staff knew and understood their roles and responsibilities. Staff were able to tell us about the different types of abuse and what they would do if they ever had concerns. The culture of the home was open and staff were confident to voice concerns. People were supported effectively with behaviour that challenges and as a result incidents between people were rare.

People had the freedom to follow their own daily routines and their choices were respected. They were supported to maintain a healthy and varied diet. A library of photographs enabled people to make meaningful choices about the meals they ate.

Medicines were managed well and there were systems in place to ensure people received the right medication at the right time. The home had good links with other health care professionals and ensured that people were appropriately referred for external support or treatment when they needed it. Each person had a health action plan and their physical health and medication were reviewed with the doctor each year.

We found a number of breaches of regulations. You can see what action we asked the provider to take at the back of the full version of this report.