Archived: Ambleside Residential Home

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.

When we inspected the service in August 2016, the provider was not meeting some of the fundamental standards of care. We found people were put at risk of acquired infections because the service and equipment were not sufficiently cleaned. There were not sufficient numbers of skilled staff to support people safely and staff had not received regular supervision. People had not been adequately supported to pursue their hobbies and interests. Also, the provider did not have effective systems in place to assess and monitor the quality of the service. We found these were breaches of regulations.

At this inspection, we found the provider was still not meeting these standards. In addition to this, the provider did not follow safe staff recruitment processes and was not adequately meeting people’s nutritional needs.

Ambleside Residential Home provides care and support for up to 17 people with a range of care needs including those living with chronic health conditions, physical disabilities, and dementia. At the time of this inspection, 11 people were being supported by the service.

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 service was still not always adequately cleaned and this put people at risk of acquired infections. The provider did not have safe staff recruitment processes in place, and there were not always sufficient numbers of staff to support people safely. However, there were systems in place to safeguard people from risk of possible harm, including individual risk assessments that gave guidance to staff on how risks to people could be minimised.

Staff had received training, but this had not always been appropriately applied to ensure that people were not at risk of acquired infections. However, staff now received regular supervision and were supported when they required it. Staff also understood their roles and responsibilities to seek people’s consent prior to care being provided and they worked in accordance with the requirements of the Mental Capacity Act 2005 (MCA).

Although people were supported by caring, friendly and respectful staff, inadequate staffing numbers meant that they did not always have opportunities to chat with staff. People were not always sufficiently supported to make choices. Although people had enough food and drinks, the food provided did not appropriately provide the nutrition they required to maintain their health and wellbeing. However, people had been supported to access other health services when required.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices about how they wanted to be supported. However, people told us they were bored at the service and had not been adequately supported to pursue their hobbies and interests. The provider had a formal process for handling complaints and concerns, and people were mainly happy with how their care was managed.

The provider did not have effective processes to assess and monitor the quality of the service. They had failed to make sustained improvements to areas where shortfalls had been previously identified. Where improvements had been made, the provider had failed to show that they had put systems in place to enable them to sustain the improvements they had previously made. Although the provider encouraged feedback from people who used the service, relatives, staff and external professionals, they did not always act on the feedback received to improve the quality of the service.

During this inspection we identified that there were breaches of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Furthermore, the service has been rated Inadequate in Well-led for two consecutive inspections because the provider had not taken appropriate steps to ensure that they provided safe, effective and compassionate care that met people's needs and expectations. They had failed to sustain improvements they had previously made and they did not have effective systems to continually improve the quality of the service. This meant that at this inspection, the overall rating became Inadequate. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

As the overall rating for this service is 'Inadequate', the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service provides care and support for up to 17 people with a range of care needs including those living with chronic health conditions, physical disabilities, and dementia. There were 10 people being supported by the service, including a person who had returned from hospital during our inspection. Another person was in hospital, but we were told that they were unlikely to return to the home.

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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm. The provider had effective recruitment processes in place, but there was not sufficient numbers of staff to support people safely. The lack of staff required to carry out domestic duties meant that the care staff did not always have enough time to support people appropriately. The home was not always clean and equipment was not always properly maintained. This put people at risk of unsafe care.

Staff had been trained for their job roles, but they did not receive regular formal support and performance reviews in the form of supervision and appraisals. They understood their roles and responsibilities to seek people’s consent prior to care being provided and they worked in accordance with the requirements of the Mental Capacity Act 2005 (MCA).

Although people were supported by caring, friendly and respectful staff, inadequate staffing numbers meant that they did not always have opportunities to chat with staff. They were supported to make choices about their care. People had adequate food and drinks to maintain their health and wellbeing. People had been supported to access other health services when required to maintain their health and wellbeing.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. They were involved in reviewing their care plans. However, they were not always supported to pursue their hobbies and interests.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service, their relatives, staff and other professionals, but it was not always evident if they acted on the comments received to improve the quality of the service.

The provider’s quality monitoring processes were not being used effectively to drive continuous improvements. Although they had been some positive changes to the quality of the service, the provider had failed to show that they could sustain the improvements they had previously made.

The provider was not meeting some of the fundamental standards. You can see what action we told the provider to take at the back of the full version of this report.