Ambleside is a two storey residential and nursing home which provides care to older people including people who are living with dementia. Ambleside is registered to provide care for 60 people. At the time of our inspection visit there were 53 people living at Ambleside. Nursing and residential care is provided on the ground floor across two units, and the first floor supports people across two units living with dementia and who need residential care.

People in care homes receive accommodation and nursing and/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.

At our last inspection we rated the service Good overall. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good. This was because:

People felt safe living with other people in the home who were supported by a consistent and caring staff team. There were sufficient staff to meet people's needs. Staff had time to spend with people and to get to know them and what hobbies and interests they enjoyed.

Risk assessments enabled people to continue to live their lives as they wanted and people continued to receive effective care from staff who had the skills and knowledge to support them to meet their needs. Trained and competent staff ensured people received their medicines safely.

People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. People were treated with respect by staff who addressed them by their preferred names and who supported them in line with their personal preferences and wishes. End of life care was sensitively discussed and people’s wishes were recorded so staff knew what and how to support people in their last days at the home.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported best practice.

People's nutritional needs were met and most of the people told us they enjoyed the food. Where people had specific dietary needs, such as vegetarian, soft and pureed foods, these needs were met.

The environment was clean and well maintained. Staff understood how to limit the risk of cross infection and followed safe infection control practices.

The service continued to be responsive to people's needs and had improved the activities and lifestyle choices available to people. Staff continually sought information from relatives and friends so they could get to know people better.

Since the last inspection a new management team were in place, including a new registered manager. The changes they introduced had a positive impact on the home. All of the staff team felt changes were made for the better although some staff raised concerns that communication could be improved. The registered manager and provider continued to work with the staff team to keep staff fully involved when changes were made.

The service was led by a registered manager who promoted a service that put people first.

Further information is in the detailed findings below.

This inspection was completed by two inspectors. During our visit we spoke with the Regional Director, a business administrator, two nursing staff, a team leader, six care staff and one housekeeper.

We also spoke with five people who lived in the home and two visiting relatives.

We carried out observations of care throughout the home. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and visiting relatives told us.

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

Is the service safe?

People were cared for in an environment that was well maintained and suitable for the needs of the people.

People and relatives told us they felt they and their relatives were well looked after. We were told: “It’s absolutely brilliant” and “It’s like a hotel.”

We found concerns during our visit with regards to the number of staff available and how those staff were deployed in the home to meet people’s individual care needs.

We found appropriate arrangements were not in place to ensure staff managed the

risks associated with the use and management of medicines. The management and

administration of medicines was not safe. We have asked the provider to tell us how they will make improvements to ensure medicines are managed and administered effectively.

We spoke with staff who told us they had not read or accessed people’s care records for some time which had the potential to place people at risk of receiving inappropriate care and support. Staff we spoke with also raised concerns with us about the numbers of staff available and the impact it was having on people's care and welfare. Staff told us people’s care needs were not always met. One staff member said: “It’s very stressful; staff morale is incredibly low because there are not enough staff.”

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We spoke with the registered manager after the inspection. The registered manager understood their responsibilities in relation to this legislation.

Is the service effective?

People and relatives we spoke with told us they were happy with the care provided. One relative said: "You can’t fault it. They phone me if there is a problem.”

We found that some of the care plans and risk assessments we looked at were not reflective of people's needs.

We saw care plans were evaluated monthly, but were not always updated with any

changes to care needs.

Is the service caring?

People were supported by staff who were kind and attentive. We saw and heard people being giving choices throughout the day about where what they wanted to eat or drink, where they wanted to sit. We also saw staff spent time with people and cared for people at their preferred pace.

Some staff we spoke with told us they felt they were not always able to provide the care they wanted to because of the numbers of staff available. One staff member told us: “The residents get very agitated. We can’t do everything because there is not enough staff. It’s not safe.”

Is the service responsive?

Systems and processes were in place to monitor and manage complaints, accidents and incidents. We found the provider monitored incidents and complaints to ensure similar concerns were reduced from happening again.

Is the service well led?

There were processes and systems in place to monitor the service provided. The manager used the information gathered through these processes to assess and improve the quality of service for people.

This inspection took place on 27 October 2015 and was unannounced. A further visit was made on 3 November 2015 so we could speak with more people about their experiences of living at Ambleside.

Ambleside is a two storey residential and nursing home which provides care to older people including people who are living with dementia. Ambleside is registered to provide care for 60 people. At the time of our inspection there were 50 people living at Ambleside.

At our last inspection in November 2014 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a lack of effective systems to monitor and assess the quality of service people received and people were not always supported by staff who were competent to complete certain care procedures. The provider sent us an action plan telling us the improvements they were going to make by May 2015. At this inspection we found improvements had been made.

There was a registered manager in post at the time of our inspection. 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.

All of the people we spoke with told us they felt well cared for and felt safe living at Ambleside. People told us staff were respectful and kind towards them and staff were caring to people throughout our visit. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent, before any care was given.

Care plans contained information for staff to help them provide the individual care and treatment people required, however not all records supported people’s changing needs. The provider had recognised this was an area for improvement and was taking action to address this. Examples of care records we saw reflected people’s wishes in how they wanted their care delivered. We found people received care and support from staff who had the clinical knowledge and expertise to care for them.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained, qualified and experienced staff. Where medicines errors had been identified, swift action and advice was taken to ensure people received their medicines safely.

Staff understood they needed to respect people’s choice and decisions. Assessments had been made and reviewed to determine people’s capacity to make certain decisions. Where people did not have capacity, decisions had been taken in ‘their best interest’ with the involvement of family and appropriate health care professionals.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, three applications had been authorised under DoLS for people’s freedoms and liberties to be restricted. The registered manager had contacted the local authority and completed applications for other people living at Ambleside to ensure their freedoms were not restricted unnecessarily.

Regular checks were completed by the registered manager and provider to identify and improve the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People told us they were pleased with the service they received however people, relatives and staff did not have confidence that issues they referred would be resolved to their satisfaction.