This unannounced comprehensive inspection was carried out on 12 and 13 September 2018.

Ambassador House 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 up to 25 people in one adapted building. At the time of the inspection, 21 people were living at the service.

There was a no registered manager in post because they left the service in May 2018. A new manager had started at the service four weeks prior to the inspection and they had not yet registered with the Care Quality Commission. 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.

At the previous inspection in December 2017, we gave the service an overall rating of ‘requires improvement’. However, Well-led had been rated 'inadequate' because there were multiple breaches of regulations, and the provider did not have effective systems to provide consistently good quality care. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. We met with the provider, registered manager and the nominated individual in May 2018. We also attended a meeting arranged by the local authority later that month, during which the provider gave updates on the improvements they had already made.

At this inspection, we found some improvements had been made and people now received caring, respectful and responsive care. However, there were areas that still required improvement in Safe, Effective and Well-led. There were also breaches of Regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We therefore, gave the service an overall rating of 'requires improvement'. This is a third consecutive inspection where the service had an overall rating of 'requires improvements’. You can see what action we told the provider to take at the back of the full version of the report.

People's care plans and individual risk assessments were not always robust enough to help staff mitigate known risks. This had resulted in unsafe care for one person and had the potential to put other people at risk. The provider’s staff recruitment processes were still not robust enough to evidence that gaps in staff employment histories had been explored. References had not always been requested from the most recent, previous employer. Further environmental improvements were necessary to create a dementia friendly service.

The provider systems to assess and monitor the quality of the service had not always been used effectively to ensure that people received consistently safe, effective and good quality care. The management oversight of the service had improved. There was evidence of a coordinated system to support learning across the three services owned by the provider.

Local safeguarding protocols were being followed by staff and people were not concerned about potential abuse. People’s medicines were managed safely. There were systems in place to ensure that people were protected from the risk of acquired infections. The service was clean. The service had improved the amount and quality of activities provided to occupy people during the day. The provider had a system to handle complaints and concerns.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. People had been supported to have enough to eat and drink to maintain th

We inspected this service in October 2016 and rated the home as Requires Improvement overall. When we inspected the service on 12 and 13 December 2017 we rated the service as Requires improvement . This is the second time Ambassador house has been rated as Requires Improvement. This inspection was unannounced.

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.

Ambassador House provides personal care and accommodation for older people. With the exception of one person when we visited most people were living with some form of dementia. Ambassador House is registered to provide care for up to 25 adults. At the time of the inspection 18 people were living at the home. Ambassador house comprises of a building offering accommodation over three floors.

There was a new 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.

When we visited the home we found there were issues with the temperature of some people’s rooms and the communal parts of the home. This issue had not been identified and addressed by the registered manager and staff on the day. The inspection team needed to prompt the registered manager to take action to address this important issue. The provider had not adequately addressed the long term issue of the heating system. We found that parts of the premises were in a state of poor repair. We also identified infection control issues.

One person’s property was not being protected and some staff did not have a good understanding of how to protect people from harm. Staff recruitment checks were not robust.

People were not always being given choices of what they ate and drank. Drinks were not being offered to people on a regular basis. We found short falls in one person’s food and fluid chart. Which meant we could not be certain that their nutrition and fluid levels were always being met. People’s food was not always warm when they ate it. The service had not considered people’s dining experiences or meaningfully asked their views about the food and drinks.

Staff did not always promote people’s dignity and respect. Confidential information was not always stored securely. People told us that staff did not always knock when they entered their rooms or wait to be invited into their rooms. We saw that staff were not always mindful of promoting people’s dignity when applying people’s medical creams in communal areas of the home. We also saw that steps were not taken to protect the dignity of a person who had become in a state of undress in the communal part of the home.

People’s social needs were not being meaningfully explored with them. Lifelong interests were not being promoted by the service. Staff were not chatting and engaging with people.

Quality monitoring checks by the provider had not identified these issues. Therefore plans were not put in place to openly address these issues.

These issues constituted a breach in the legal requirements of the law. There was a breach of Regulation 9, 10, 12, 13, 14, 19 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we asked the provider to take at the back of the full version of the report.

Staff competency was not being monitored to ensure the training staff had was effective and staff were putting it into practice.

The service was responsive when people were unwell or if there was a change in their needs, requiring professional health support.

The registered manager responded to relatives complaints. There was a

This inspection took place on the 11 October 2016 and was unannounced.

Ambassador House is a residential home providing accommodation and personal care for up to 20 older people, some of whom are living with dementia. At the time of our inspection there were 16 people using the service.

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.

People were kept safe and protected from avoidable risk of harm, and staff understood the procedure to follow in order to safeguard people. People’s care plans and risk assessments were robust, person-centred and detailed enough to allow staff to support them effectively. People were supported to share views and experiences through residents meetings and a key worker system. The service adhered to the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

While people had their on-going healthcare needs met by the service we found that pressure relieving equipment was not always used correctly. The systems in place for the management of medicines were suitable, but we observed some poor practice during observations of the medicine round.

There was enough to eat and drink and people enjoyed the choice of food available. There was a programme of activities and events available and the environment was kept person-centred and stimulating.

Staff received a full induction and on-going training that enabled them to carry out their duties effectively. They were supported through supervision, appraisal and observation and had opportunities to contribute to the development of the service through team meetings. Staff demonstrated a kind, caring and committed attitude to supporting people. They treated people with dignity and respect and understood their needs and wishes. Staff recruited to the service had the correct knowledge, skills and experience to carry out their duties safely.

While there were enough staff to keep people safe, there were occasions during our inspection where people had to wait for care and support and did not have access to equipment to assist them with this.

The management and culture of the service was positive, and improvements had been made through robust quality monitoring systems. People, their relatives and the staff team were asked to contribute to the overall development of the service through meetings and surveys.

When we inspected Ambassador House on 27 November 2013, we found that the home was generally clean and hygienic. However, we also found that people were not always fully protected from the risk of infection. This was because some systems designed to control the spread of infection were lacking. We judged this to have a minor impact on people using the service.

We inspected the service again, to check that improvements had been made. We found that all areas of the home appeared clean. There were appropriate hand washing facilities available throughout the home.

We saw that systems were in place to manage waste (including clinical waste) and these were adhered to by staff. We looked at items of equipment such as commodes and saw that all items appeared clean. Training records that we looked at showed all staff had completed, or were in the process of completing infection control training.

This meant that people were protected from the risk of infection because appropriate systems had been put in place and guidance had been followed.

During our inspection on 27 November 2013 we spoke with five people using the service and four staff working at the home. People told us they were happy with the care and support they received from staff. People experienced effective, safe and appropriate care. Care plans were well documented to promote continuity of care.

People told us the food was very good and they always had enough to eat and drink. We found that people received food that met their cultural needs.

We looked at the systems in place for the cleanliness and infection control. We found that some areas required improvements to reduce the risk and spread of infection. Overall we found the premises where the service was provided to be suitable and well maintained. However we observed three bedroom doors wedged open with chairs. This practice does not ensure the safety of people living in the home if there was a fire.

There was an effective complaints system in place. Comments and complaints people made were responded to appropriately and in a timely manner.

The people who were living at Ambassador House care home when we visited on 21 June 2012, had varied levels of verbal communication, however they were demonstrated through speech, facial expressions and gestures that they were satisfied with the care and support they received. One person said ‘’they look after me well’’.

One relative told us that they were pleased with the care their relative was receiving and the activities they participated in. They also commented that the staff were responsive to individual requests from relatives, ensuring people had good, personalised care.

One relative told us that they were pleased with the care their relative was receiving and the activities they participated in. They also commented that the staff were responsive to individual requests from relatives, ensuring people had good, personalised care.

This unannounced inspection was carried out on 29 June 2015 and 01 July 2015.

Ambassador House is a registered care home which provides accommodation for up to 25 people who require nursing and personal care; some of whom may be living with dementia. The home offers accommodation over two floors. There were 25 people living at the home when we inspected it.

At the time of our inspection, there was a manager in place who was in the process of registering with the Care Quality Commission as the registered manager. 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 and associated Regulations about how the service is run.

People were assisted by staff in a way that supported their safety and they were treated with respect. People had care plans in place which took account of their needs and individual choices.

People’s medication was administered by staff who had received training to ensure that the medication was administered safely and in a timely manner.

Staff cared for people in a warm and caring manner.

Staff were trained to provide effective and safe care which met people’s individual needs and wishes. Staff were supported to maintain and develop their skills and knowledge by way of regular supervision, appraisals and training.

There were enough skilled, qualified staff to provide for people’s needs. The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home.

People were supported to have a healthy and nutritious diet and to access healthcare professionals when required.

People were able to raise any suggestions or concerns they might have with the manager and were listened to as communication with the manager was good.

Arrangements were in place to ensure the quality of the service provided to people was regularly monitored.

People were involved in meaningful activities in the home.