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 complimentary about the food provided. The home offered a wide choice of meals and catered for individual wishes, including those made on the day. We saw that people’s likes, dislikes, allergies or specialist diets were accounted for, with systems in place to ensure this was recorded.
Staff we spoke to had a clear knowledge and understanding of the mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone who does not have capacity needs to be deprived of their liberty in their own best interest. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the provider had followed the requirements in the DoLS. Related assessments and decisions had been properly taken.
Staff also told us that they felt supported and listened to through the completion of supervision meetings and yearly appraisals. They also told us that team meetings were held and they were encouraged to attend and have input with the agenda.
Throughout the inspection we saw evidence of positive and caring interactions between staff and people who lived at the home. Staff were observed treating people with kindness, dignity and respect. The people we spoke to told us how much they enjoyed living at Ambleside Bank and how well the staff looked after everyone.
We saw that the home had a comprehensive activities programme, which was supported by a spacious and well equipped activities room. We saw lots of activities being completed throughout the day and people we spoke to were complimentary about the choice and amount available.
People we spoke with told us that the home was well-led and managed and they would recommend living there. Staff stated that they enjoyed working at the home and felt supported.