The inspection visit took place on 01 and 02 May 2018. The first day of the inspection was unannounced.

Ambassador Care 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 Ambassador Care Home provides accommodation and residential care for up to 31 people. The home is a large detached two storey property situated in the south area of Blackpool. The accommodation comprises of two lounges, a large dining area and a conservatory. The front and rear garden areas provide seating for the residents. The bedrooms are en-suite with aids and adaptations to the communal bathrooms and toilets situated on all floors of the premises. During our inspection 21 people lived at the home.

There was a manager employed at the Ambassador Care Home who was in the process of being registered with the Care Quality Commission. The previous registered manager left their post in March 2017. 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.’

We had previously received concerns in relation to risk management, medicines management and the leadership of the service. As a result, we carried out a focused inspection to look into those concerns on the 17, 18 May and 01 June 2017. We found there was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Safe care and treatment). Medicine administration forms were signed before administering medicines. Documentation in relation to medicines was not robust and did not clearly guide staff about the administration of medicines. The registered provider did not do all that is reasonably practicable to manage risk. They did not ensure there was sufficient equipment to meet people’s needs and ensure their safety.

There was also a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Good governance). Documentation we looked was not consistently completed. The register provider failed to have a system to assess and monitor processes and ensure safe care and treatment was taking place. We asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well – led.

During this inspection we checked to see if there had been improvements at the service. We observed medicines administration and reviewed documentation around the administration and management of medicines. The controlled drugs book had no missed signatures however the drug totals for one person did not match the total recorded on the ‘countdown sheet’. This indicated staff had not followed process and counted current stock after each administration.

We looked at the ‘as and when’ medicines held within the home and noted errors in the documentation related to three people. One person’s medicine records stated ‘no allergies’. The person told us they were allergic to three medicines. This proved to be true and the manager amended all relevant paperwork.

This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Safe care and treatment) at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Although auditing systems were in place, audits had failed to identify the concerns we picked up during the inspection process. We found the registered provider failed to follow systems that enabled them to identify and assess risk to the health, safety and welfare of people being supported. There were no actions

The service was last inspected on 17 November 2015, when we found the provider was meeting legal requirements.

Since our last inspection, we received concerns in relation to risk management, medicines management and the leadership of the service. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Ambassador Care Home) on our website at www.cqc.org.uk.

We carried out an unannounced focused inspection of the service on 17 May with announced visits on 18 May and 01 June 2017.

The Ambassador Care Home provides accommodation and residential care for up to 31 people. The home is a large detached, two-storey property situated in the south shore area of Blackpool. The home has two lounges, a large dining area and a conservatory. The front and rear garden areas provide seating for people. The bedrooms are en-suite, with aids and adaptations to the communal bathrooms and toilets situated on all floors of the premises.

There was a registered manager. However, at the time of our visit, they had recently left their employment. The registered provider and two senior care assistants were managing 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.

During this inspection, we looked at how medicines were managed. We observed medicines being administered and noted the nurses did not follow good practice. They signed medicine administration forms before administering medicines. Documentation in relation to medicines was not robust and did not clearly guide staff about the administration of medicines.

This was a breach of Regulation 12 HSCA (RA) Regulations 2014 (Safe care and treatment).

During this inspection, we looked at risk management. We found the registered provider did not do all that is reasonably practicable to manage risk. They did not ensure there was sufficient equipment to meet people’s needs and ensure their safety.

This was a breach of Regulation 12 HSCA (RA) Regulations 2014 (Safe care and treatment).

Documentation we looked was not consistently completed. The register provider failed to have a system to assess and monitor processes and ensure safe care and treatment was taking place.

This was a breach of Regulation 17 HSCA (RA) Regulations 2014 (Good Governance)

As part of their role to respond to seek and act on feedback, the registered provider did not respond appropriately to concerns raised with them. This had caused one person to seek alternative action.

We have made a recommendation about the introduction of good practice guidance on managing feedback.

During this inspection, we found staff were knowledgeable about the support needs of people in their care. They were aware of what help people needed to manage risks and remain safe.

Records we looked at indicated staff had received training related to the identification and prevention of abusive practices. They understood their responsibilities to report any unsafe care or abusive practices related to safeguarding of adults who could be vulnerable.

Staff received further training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with people who may be vulnerable. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff and records we looked at.

There was a vi

This inspection visit took place on 17 November 2015 and was unannounced.

At the last inspection on 05 August 2014 the service was meeting the requirements of the regulations that were inspected at that time.

The Ambassador Care Home provides accommodation and residential care for up to 31 people. The home is a large detached two storey property situated in the south area of Blackpool. The accommodation comprises of two lounges, a large dining area and a conservatory. The front and rear garden areas provide seating for the residents. The bedrooms are en-suite with aids and adaptations to the communal bathrooms and toilets situated on all floors of the premises. At the time of our inspection visit there were 27 people who lived there.

There was a registered manager in place. 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 registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. People we spoke with told us they felt safe and their rights and dignity were respected.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff spoken with and records seen confirmed they had received induction training when they commenced working at the home. One staff member said, “I found my recruitment very thorough. I had to wait for all checks to be completed before I could start working at the home.”

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We found sufficient staffing levels were in place to provide support people required. We saw the registered manager and staff members on duty could undertake tasks supporting people without feeling rushed. People told us when they requested assistance this was responded to in a timely manner.

The environment was well maintained, clean and hygienic when we visited. No offensive odours were observed by any members of the inspection team. People who lived at the home said they were happy with the standard of hygiene in place. One person we spoke with said, “I think the cleaners do a very good job keeping the home so clean.”

The service had an ongoing redecoration and refurbishment programme in place. Communal areas and people’s personal accommodation had been redecorated and recarpeted when we undertook our inspection visit. People who lived at the home told us they were happy with the improvements being made.

We found medication procedures in place at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.

People told us they were happy with the activities arranged to keep them entertained. These were arranged both individually and in groups. Activities organised on the day of our inspection visit were well attended.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were comfortable with complaining to staff or management when necessary.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included staff and resident meetings and care reviews. We found people were satisfied with the service they were receiving.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We also spoke with Blackpool council’s contracts monitoring team and Healthwatch Blackpool who are an independent consumer champion for health and social care.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe and their rights and dignity was respected. They told us they were receiving safe and appropriate care which was meeting their needs. Safeguarding procedures were in place and staff understood how to safeguard people they supported. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff understood when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment had been maintained and serviced regularly ensuring people were not put at unnecessary risk. We found staffing levels were adequate with an appropriate skill mix to meet the needs of people using the service. People we spoke with told us staff were responsive when they needed their help. One person said, “I find the staff are all friendly and approachable. They are always available if you need them.” A visiting relative said, “Good staff who are always quick to act on requests for assistance.”

Is the service effective?

People’s health and care needs had been assessed with them and they were involved in writing their plans of care. Specialist dietary needs had been identified where required. Care plans had risk assessments completed to identify the potential risk of accidents and harm. Staff members we spoke with confirmed guidance was provided to ensure they provided safe and appropriate care. We found care plans were flexible, regularly reviewed for their effectiveness and changed in recognition of the changing needs of the person. People spoken with said their care plans were up to date and reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People we spoke with were happy with the care being provided. One person said, “It’s a lovely place to live. The food is absolutely wonderful and the staff are lovely caring people who will do anything for you.” Another person said, “I get on really well with the staff. They are so patient and kind. I am so grateful my family found this place for me. They know I am well and don’t have to worry about me.” A visiting relative said, “I have been really impressed with the level of care given to mum. She looks really well and tells me how happy she is.”

Care plans had been maintained recording the care and support people were receiving. Good care practices were observed and people told us they were happy with the support they were receiving.

Is the service responsive?

People spoken with said they were happy with their care and had no complaints. They told us there was always adequate numbers of staff on duty and they were available when needed. Records showed admissions to the home were well planned. Information about people’s care and dietary needs had been recorded. We also saw potential risks to people’s health and welfare had been identified. Guidance had been provided for staff to ensure they provided safe and appropriate care.

Is the service well-led?

The service had quality assurance systems in place. Records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff had a good understanding of their roles and responsibilities. People we spoke with said they received a good quality service at all times.

At this inspection we followed up on issues we raised at previous inspections. These included concerns regarding the safe handling of medication, the propping open of designated fire doors, the ways people were supported to move around the home independently. We used the opportunity to look at the systems that were in place to support the staff team following receipt of a number of anonymous concerns regarding people's employment entitlements. The intelligence we had received gave us concerns that people may be dissatisfied with the care they received if the staff team felt unsupported and unclear about their role. We did not get the opportunity to speak directly to people living at home as many were resting after lunch. Our observations were that people looked happy, well cared for and comfortable. The provider had systems in place to regularly assess the quality of service that people received. Audits were undertaken, risk assessments completed and care plans put together. Improvements to the door release and fire safety systems had been made, and people at the home were satisfied with this. Improvements to the way medicines were managed had been made, and some of the “out of date” practice we observed at pervious inspections was now not taking place.

Work had been carried out with the staff team to clarify their employment rights and entitlements so that they now felt better supported by the management team.

The home's pre admission assessment procedures were detailed and thorough. This meant that care and support needs were known so that a decision could be taken to determine if the level of care required could be provided. The care practices we observed during our visit confirmed that on the whole, people were being encouraged to maintain their independence and undertake tasks by themselves where able.

Individual records were kept for each person with a personalised plan of care setting out the action to be taken by the staff team in order to address assessed needs. This ensured that all aspects of health, personal and social care needs of people were known and met. Risk assessments had been completed to identify the potential risk of accidents or harm to the people being support. These were regularly reviewed and updated when necessary.

We noted that a number of bedroom doors were propped open with door wedges. The manager explained that some people wanted their doors open all the time. We explained that propping doors open with wedges was seen as a potential fire hazard, and that more appropriate devices such as door guards linked to the fore alarm system were safer. Again, she said she said she would seek advice from the local fire officer, and stop using wedges until a more appropriate and safer system was found.

We spoke with three residents about their medicines and the care they received.

None of them raised any concerns about the way their medicines were handled.

We spoke with seven people about their medicines and the care they received. Nobody raised any concerns about their medicines.

People who use the service told us the staff were very kind and treated them well. They told us they felt safe and liked living at the home. People told us they had been given plenty of information about the service being provided to make an informed choice about whether the home was the right place to meet their needs. They told us they felt safe and liked living at the home. We were told that staff were very attentive and knew their needs and care requirements.

“the staff are brilliant. They are always so kind.”

“the staff are very attentive, they always come very quickly when I need assistance”

“I like to stay in my room and watch TV”

“I like to stay in my room but go to the dining room for my meals”

“It's like one big happy family here”

“I am looked after really well”

“I am really comfortable here”