Ambleside Lodge - Redhill

Updated 9 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

Ambleside Lodge - Redhill is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ambleside Lodge - Redhill is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post for almost a month and had begun the process of applying to register with the Care Quality Commission.

Notice of inspection

This inspection was unannounced. Whilst the service were aware we would return for a second day of inspection they were not informed of the date or time.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed people and their interactions with staff and each other throughout the inspection visits. We spoke with 1 person and 2 relatives about their experience of Ambleside Lodge. We also spoke with 9 members of staff including 7 care staff, the manager and regional manager. We viewed a range of records held within the service, this included 4 care plans and medicines records. We looked at 3 staff files in relation to recruitment. A variety of records relating to the management and oversight of the service, including staff training records, risk assessments, policies and procedures were reviewed. After the inspection we continued to receive information relating to the running of the service.

Updated 9 August 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Ambleside Lodge is a residential care home providing personal care to up to 8 people with learning disabilities and autism. The home comprises the main house and a self-contained flat on the top floor. At the time of the inspection 6 people lived in the home.

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

Right Support: People did not always have the opportunity to do things they enjoyed. Records showed that people were unable to go out and pursue their leisure interests on a regular basis. Where people had set goals, these were not always known to staff and people were not always supported to achieve them. People’s communication plans were not followed, and their sensory needs were not always acknowledged by staff. This meant people were not always able to fully express themselves.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act 2005 were not always followed to ensure people’s rights were upheld.

Risks to people’s safety were not always mitigated and plans to support people safely were not always known or followed by staff. This included areas such as supporting people to eat safely, minimising people’s anxieties and ensuring robust infection prevention and control measures were in place. People received their medicines in line with their prescriptions although some improvements in medicines processes were needed. Staff were not effectively deployed to meet people’s needs and preferences.

Right Care: People were not always treated with dignity and respect. We observed some staff were not attentive to people and used disrespectful language when referring to people. Staff had not always responded to concerns to ensure people felt safe in their home. Staff told us they had concerns regarding how people were feeling or how they were responding to others although they had not raised this with the management team in line with safeguarding processes.

People did not always have the opportunity to contribute to their care. Monthly reviews were not completed regularly, and relatives did not feel fully involved in their loved one’s care. Health records were not completed to ensure they were tracked although there was evidence people were supported to attend health appointments.

We observed some staff taking a positive and respectful approach with people. They supported people with kindness and took an interest in what they were doing and their well-being. People had a choice of what they wanted to eat and drink, and individual preferences were known to staff.

Right Culture: The culture at Ambleside Lodge did not support people living fulfilled and empowered lives. Staff were unable to fully demonstrate their understanding of 'Right support, right care, right culture' guidance and how this should influence the support people received. The views of people and staff were not routinely sought in a meaningful way to ensure they could contribute to the running of the service.

Quality assurance systems were not effective in ensuring continuous improvement within the service. Whilst audits had identified some shortfalls in the management systems, these had not brought improvements to people’s quality of life. People’s experience of the care they received was not central to the management monitoring systems. Contemporaneous records of people’s support were not always securely stored.

Staff and relatives told us that since the new manager had joined the service, they felt things were starting to improve and that people, relatives and staff were being listened to more.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 March 2022)

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 the provider remained in breach of regulations.

At our last inspection we recommended the provider review people's plans for activities and allocation of staff to support these. At this inspection we found continued concerns and that people were not consistently provided with the opportunities to do things they enjoyed.

Why we inspected

The inspection was prompted in part due to concerns received in relation to people’s safe care and the provider oversight of the service. A decision was made for us to inspect and examine those

risks. We found improvements needed to be made in these areas and identified multiple breaches of regulations.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding systems, safe care and treatment and staff deployment and skills. We have also found people's care was not person-centred, people were not always treated in a caring way, people were not supported to do things they enjoyed and there was a lack of management oversight at this inspection. We issued warning notices in relation to people’s safe care and treatment, person-centred care and good governance.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.