About the service:

Ambleside Residential Care Home provides personal care and support for up to 20 older people living with dementia, who may have behaviours that are challenging. At the time of the inspection there were 20 people living in the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service

¿ Management processes were in place to monitor and improve the quality of the services offered and the provider promoted an open and empowering culture, which ensured people were at the centre of the service.

¿ People told us they were comfortable and relatives said people received the care and support they needed, from a committed team who respected people’s privacy and dignity. This included the provider, registered manager and staff; who showed a good understanding of people’s preferences and assisted them to make safe decisions and choices about their day to day lives.

¿ Staff had completed relevant training and demonstrated the skills and knowledge to understand people’s individual needs. There were systems in place to manage medicines and protect people from harm and abuse.

¿ Staff had developed positive relationships with people, relatives and friends and there was a community atmosphere in the home. This reflected the ‘open door’ management style and showed how involved people were in decisions about their care.

¿ Conversations about how the service should move forward were encouraged for the benefit of people and feedback showed changes had been made. For example, the introduction of pets for people to enjoy spending time with and caring for.

Rating at last inspection:

Good. (Report published 19 August 2016)

At this inspection we found the service remained Good.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Ambleside Care Home is a care home for up to 20 older people that require support with personal care and who live with dementia and those who live with behaviours that are challenging. At the time of the inspection there were 18 people living in the home. The service is a large detached house and is owned by Grace Care Homes Limited and is located in Bexhill on Sea, East Sussex.

At a comprehensive inspection in November 2014 the overall rating was requires improvement. Breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found there were risks to people due to the management of nutrition. People in the service had not received care and support that was individualised to their needs and people had not been protected against unsafe treatment by the quality assurance systems in place.

During our inspection on 01 July 2016, we looked to see if improvements had been made. We found that many improvements had taken place and the breaches of regulations had been met.

There was 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.

Not everyone could tell us of their experiences, but those that could spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. People had confidence in the staff to support them and we observed positive interactions throughout our inspection.

At this inspection, we found that people were safe. Care plans and risk assessments were reason specific and included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe here. It’s nice here.” A visitor said “Lovely staff and it’s a real home here.”

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. Staff retention was good and most staff we spoke with had worked at Ambleside for many years.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes and dementia. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. One p

This inspection took place on the 25 November 2014 and was unannounced.

Ambleside Residential Care Home provides accommodation and care for up to older 20 people living with a dementia type illness and behaviour of concern, which may impact on their safety and that of others, and who require assistance with daily living. There were 17 people living at the home on the day of the inspection.

The home was run by a registered manager who was present during the inspection. 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.

Risk assessments had been completed as part of the care planning process. However, we found they had not all been reviewed on a regular basis or updated when people’s needs changed.

We found there were not always enough staff to meet people’s needs and a system to determine appropriate staffing levels was not in place. This meant people had to wait for staff to assist them.

There were systems in place for the management of medicines, but records had not been updated when prescriptions had been changed.

Not all staff had attended essential training, such as supporting people living with dementia, infection control and moving and handling.

The majority of staff had not attended training, and did not have a clear understanding of, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Gates on the bottom and top of stairs meant people were unable to move around the home freely and the main doors to the home were locked. There was no information in the care plans to show the restrictions were appropriate for everybody.

People were encouraged to make their own decisions about the food they wanted. However, food and fluid charts had not been completed when required, and a process to ensure that people had an adequate diet of their choice was not in place.

People said they felt safe living in the home and relatives had no concerns about people’s safety in the home, or when people went out for a walk. Not all staff had attended or updated training in safeguarding people, although they demonstrated a good understanding of procedures, and the action they would take if they had any concerns. Appropriate policies and procedures were in place.

Pre-employment checks were completed, including references and full employment history. This ensured only suitable staff were employed.

Mobility aids were available for staff to assist people to move around the home safely, and we observed staff using these. The home was well maintained; to ensure that people could move around using walking aids, and visitors and staff were safe.

The culture in the home was open and relaxed, and staff felt they all worked together as a team and supported each other. They had an understanding of people’s needs and assisted them with all aspects of their daily lives. People told us the staff were lovely and the food was very good. Relatives said there was no restriction on visiting and they were always made to feel very welcome.

There was a complaints policy and procedure in place. People said they would talk to staff if they had any concerns, although they did not have any at the time of the inspection.

There were breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

We used a number of different methods to help us understand the experiences of people who used the service. People had complex needs, which meant they were not able to tell us their experiences. However, those that spoke to us, said they had enjoyed their breakfast and reading their paper.

Staff said they asked people for their consent before they provided support. We found evidence that people were encouraged to make choices and observed staff treated people with respect and dignity.

We examined three care plans and found that they were based on people’s individual support needs. The care workers we spoke with demonstrated a good understanding of people's needs and how these were met.

Safeguarding procedures and policies were in place and the home used them as required to ensure people’s safety.

By observing the care and support offered, we saw there were enough qualified, skilled and experienced staff to meet people’s needs.

People’s personal records including medical records were accurate and fit for purpose. Records were kept securely and could be located promptly when needed.

Some people living at the home had complex needs and were not always able to tell us about their experiences. We observed the interaction between staff and people closely. We saw that staff knew people well and treated them with care and respect. Staff asked people’s consent before they provided any care or treatment.

People, who were able to, told us they were happy living at the home. One person told us, “We couldn’t wish for a better place, it’s the carers that make it home.” Another person told us, “I was dreading moving here, but I am very happy.”

We spoke with three visitors to the home. They all told us they were happy with the care provided to their relative. One visitor told us, “the home meets all their (relative’s) needs.” Another visitor said, “I don’t worry about them now they are living here.” All visitors we spoke with told us they were kept informed about their relative. This included changes in health or new care needs.

We looked at medication records and saw that the home had systems and processes in place that ensured people were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.

We saw there were enough appropriately trained staff in place to meet the needs of the people living at the home. There was a complaints policy in place and there were clear processes to deal with complaints correctly.

Not all the people living in the home were able to tell us about their experiences, so we also observed the interactions between the people living in the home and the staff.

Staff spoke respectfully to the people living in the home. They talked in an encouraging and cheerful way to people. They were responsive when people needed support and reassurance.

Some people talked about their life and were able to say a little about the home. People said the staff asked them what they wanted to do. They said that they were given choices with meals and drinks and when they wanted a shower. They also said they were listened to if they wanted to do something or sit somewhere different. One person said: "I prefer to sit in this lounge because the music is loud in the other one."

People said they thought the home was fine. They said that the staff were helpful and kind.

We saw people being supported by the staff with patience and encouragement.

People talked about their families and said they visited often. Some people talked about their health and said they saw the nurse.

People said the staff were good and they were friendly. They said if they were in their bedroom they could call the staff on the buzzer and they came quite quickly.

People said that the staff talked to them about what they thought of the home.

People looked relaxed and comfortable. They chatted to each other and the staff. People were reassured when they looked anxious and staff spent time to find out if there was a problem.