Ambleside Nursing Home

Ambleside Nursing Home is a residential care home providing personal and nursing care to up to 20 people. At the time of our inspection there were 17 people using the service. The home has four floors with a communal area and a dining room. People also have access to a garden area.

People’s experience of using this service and what we found

We were assured by the home’s infection and control policies and procedures. However, we did observe a staff member not wearing their mask appropriately on more than one occasion. At the time of our visit one person’s care plan was not available but was shared with us before the end of the inspection process. Care plans contained information about people’s assessed needs and how staff could meet them. Risk assessments were in place for identified risks and guidance included for staff on how to mitigate those risks.

We have made a recommendation regarding the availability of people’s care records.

Systems were in place to protect people from the risk of abuse. Some steps had been taken to help ensure the physical environment was safe. There were enough staff working at the home to meet people's needs. The provider had robust staff recruitment practices in place. Medicines were managed safely. Accidents and incidents were reviewed to see if any lessons could be learnt from them.

Staff had received training to meet the needs of people using the service. They had also received regular supervision and an appraisal of their work performance. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were supported by staff who knew them well. People's dignity and privacy was respected, and staff understood the importance of maintaining people's independence. People, their relatives and staff told us the home was managed well. Staff enjoyed working at the home. The home worked in partnership with other organisations to provide safe, effective and consistent care.

We have made a recommendation regarding the provision of activities at the home. We have also made a recommendation regarding gathering feedback from people who use the service.

The management promoted a positive staff environment that was open and transparent. The registered manager demonstrated good visible leadership and understood their responsibilities. Staff were motivated and reflected pride in their work. They talked about people in a way which demonstrated they wanted to support them as much as possible and provide the best standards of care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was requires improvement (published 18 October 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This was a planned inspection to check whether the provider was meeting legal requirements and

regulations, and to provide a rating for the service as directed by the Care Act 2014.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvements to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ambleside Nursing Home provides accommodation with nursing and personal care. The home is a period style home laid out over four floors. There are 19 single rooms available, all have toilet and handwashing facilities. At the time of this inspection there were 16 people living at the home and the manager told us they were planning to admit three people. The ground floor accommodates a dining room, lounge, kitchen, and bedrooms. There is access to outside space. All floors are accessible via stairs and a lift. Parking is available outside.

People’s experience of using this service and what we found

For this inspection we only looked at one key line of enquiry in the safe domain as we were following up on a specific concern we had about infection prevention and control (IPC).

Risks relating to infection control were not all being managed safely. The environment was not clean, and some pieces of furniture were damaged. One person’s carpet in their bedroom was badly stained and had been patched up with a piece from a different carpet that didn’t fit and had frayed edges.

Staff were observed using personal protective equipment (PPE) and people had individual risk assessments in relation to Coronavirus. At the time of the inspection no one living at the home had tested positive for Coronavirus.

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

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about how infection prevention and control (IPC) procedures were being managed in the home. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to IPC, in particular, with the environment. The provider did not have enough staff to manage the cleanliness of the home. We also found clinical waste bins that did not have foot pedal operation to help minimise the risk of cross-infection. Communal bathrooms and hand washing sinks in people’s bedrooms did not have hand washing soap, or paper towels for staff to wash their hands following providing personal care to people. Furniture and floor coverings were in disrepair or stained. This made them difficult to keep clean.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of IPC. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ambleside Nursing Home provides accommodation with nursing and personal care for up to 20 people. When we visited, 10 people lived there.

People’s experience of using this service and what we found:

During the inspection people spoke positively of the staff that supported them and told us they felt well cared for. Staff understood the needs and preferences of the people they supported well. All the feedback we received from people, a relative we spoke with and a healthcare professional was positive.

Whilst people told us they felt safe, we found improvements were needed to ensure medicines management was fully safe. Records we reviewed relating to the undertaking of fire testing did not evidence testing had been completed as forecast and the emergency evacuation planning record we reviewed at the time of the inspection was not accurate.

Governance systems included audits and regular checks of the environment. These were not consistently effective in identifying the concerns with medicines we identified or the failure to complete the periodic fire alarm testing. We also identified the provider had failed to notify the Care Quality Commission (CQC) of two safeguarding incidents as legally required. Whilst it was not evident this had any impact on people, it did not evidence a fully effective governance system was in operation and placed people at risk.

We found evidence that a safeguarding incident in the days immediately prior to our inspection had not been escalated internally or to external sources. Staff were recruited safely, and the provider used a dependency tool to calculate staffing levels. During the inspection we received mixed feedback about staffing levels and some staff commented that current staffing levels did not promote access to the local community for people.

Health and safety checks, together with checks of the environment were completed. The provider had ensured all lifting equipment was serviced as required and equipment such as weighing scales were calibrated for accuracy. The service was clean, and staff used personal protective equipment when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There were systems in place that ensured people who were deprived of their liberty were done so with the appropriate legal authority. However, we found improvement could be made in relation to the application and recording of the Mental Capacity Act 2005 and we have made a recommendation about this.

People were supported by staff who had the skills and knowledge to meet their needs. Some supervision and appraisal were currently overdue, and the provider was addressing this. Staff understood their role and were confident when performing it through a continual training package. Staff at the service worked together with a range of healthcare professionals to achieve positive outcomes for people.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. There was evidence that where needed the service supported people in accordance with the AIS. People felt their concerns and complaints would be listened to. Accidents, incidents and complaints were reviewed to learn and improve the service where needed.

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

Rating at last inspection:

The last rating for this service was Good (published March 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

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.

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.

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.

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.