Archived: Ambleside Residential Home

Updated 5 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by information of concern we received in December 2017 about staffing levels, the service having no cook and people not being supported to pursue their hobbies and interests. The information shared with CQC indicated potential harm to people using the service because there was not always sufficient care staff to support them safely. Additionally, the absence of a cook raised concerns about the service’s ability to provide people with nutritionally balanced meals. We shared these concerns with the main local authority that commissioned the service, and this inspection also examined those risks.

The inspection took place on 10 January 2018, and was unannounced. It was carried out by one inspector, an inspection manager and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was in the care of older people. The inspection was completed on 18 January 2018 when we received information we requested from the provider.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed other information we held about the service including the report of our previous inspection and notifications they had sent us. A notification is information about important events which the provider is required to send to us. We also received feedback from the main local authority that commissioned the service.

During the inspection, we spoke with two people using the service, two care staff, the cook and the registered manager, who is also the sole director of the provider organisation. We observed how staff interacted with people and how care was provided within communal areas of the service.

We looked at the care records for six people to review how their care was planned and managed. We looked at three staff files to review the provider’s staff recruitment and supervision processes. We also reviewed training records for all staff employed by the service. We checked how medicines and complaints were being managed. We looked at information on how the quality of the service was assessed and monitored.

Updated 5 July 2018

This unannounced comprehensive inspection was carried out on 10 and 18 January 2018.

Following the inspection in March 2017, the provider was in breach of a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and had an overall rating of Inadequate. We placed the service in ‘Special Measures’ and we asked the provider to complete an action plan. This was to tell us what they would do and by when to improve all key questions to at least good. We met with the provider to further set out the Care Quality Commission’s expectations that they should provide a service that was consistently safe, effective, compassionate and of good quality. We also used our enforcement powers to impose a condition that required the provider to send us monthly reports showing what actions they were taking to make the required improvements.

This inspection was carried out to check if sustained improvements had been made. We found the provider had not made sufficient improvements to all the areas we had previously identified breaches of the Health and Social Care Act of 2008 (Regulated Activities) Regulations 2014. There were continuing breaches of Regulations 9, 10, 17 and 18, and new breaches of Regulations 7 and 8. We were still concerned about the level of the provider’s willingness and ability to drive sustained improvements. This was the second consecutive inspection where the overall rating for the service was 'Inadequate'. This meant that the service remains in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

Ambleside Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 17 people in one adapted building. At the time of this inspection, 11 people were being supported by the service, some of whom were living with dementia.

There was a registered manager in post, who is also the provider of the service. 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 provider now had safe staff recruitment processes in place. However, there was not always sufficient numbers of staff to support people safely. The inconsistent staffing numbers had a wider impact on the overall quality of care people received. Systems in place to safeguard people from

risk of possible harm or abuse had not been used effectively. People's individual risks were assessed to give guidance to staff on how these could be minimised.

There was still limited choice of food for people to maintain their health and wellbeing. People's needs had been assessed and they had care plans in place. People had been supported to access other health services when required. Staff had received training and supervision. Staff understood their roles and responsibilities to seek people's consent prior to care being provided. Staff worked in accordance with the requirements of the Mental Capacity Act 2005.

People were supported by caring, friendly and respectful staff, but inconsistent staffing numbers meant that they did not always have opportunities to have meaningful interactions with staff. The provider had failed to promote a caring and inclusive environment that put people at the core of everything they did. People's privacy and dignity was not always promoted. We have made a recommendation about improving this.

Staff had not been supported to develop care plans that took account of people's individuality, preferences and choices so that they consistently provided care in a person-centred way. People told us they were bored at the service. We were concerned about the continuing failures to adequately support them to pursue their hobbies and interests. People's complaints and concerns were managed appropriately.

The provider's systems to assess and monitor the quality of the service had not been used effectively to drive sustained improvements. There were continuing failures to provide a good quality service. As a result of these serious failures, we took enforcement action to cancel the provider and the registered manager's registrations, and this process was completed in June 2018. The service had already ceased to operate in April 2018 when the local authority supported people to find alternative care providers.