Archived: Ambassador Care Home

People's experience of using this service and what we found

Medicines were not managed safely which placed people at risk of harm. Records did not consistently reflect the help people needed or were not always accessible so staff could not always learn about the help people needed.

Recruitment procedures were not consistently followed to ensure staff were suitable to work with people who may be vulnerable. People were not always supported by staff who knew the help they needed, and people’s dignity was not always maintained. Some areas and equipment within the home required cleaning to minimise the risk and spread of infection. Governance systems were ineffective at ensuring people received safe and high-quality care.

People said they were happy at the home and they liked the staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update. The last rating for this service was requires improvement (published 16 July 2021) and there was a breach of regulation. At this inspection we found improvements had not been consistently made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines, infection prevention and control, nutrition, risk and staffing. We also received concerns on how people were supported to maintain their dignity. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We carried out a focused inspection of this service in March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in the areas of good governance. We undertook this focused inspection on 14 October 2021 to check they had followed their action plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to the key questions safe, caring and well-led which contain those requirements.

We have found evidence that the provider needs to make improvements and that people were at risk of avoidable harm. Please see the safe, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for this service is inadequate. This is based on the findings at this inspection.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remains inadequate. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to the safe management of medicines, record keeping and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up information

We took urgent action under Section 31 of the Health and Social Care Act 2008, to impose conditions on the providers registration. The provider has since applied to deregister with the Care Quality Commission.

Ambassador Care Home is a residential care home providing personal care to 22 people aged 65 and over at the time of the inspection. Some people were living with dementia. The service can support up to 31 people. The premises have been adapted from two townhouses near Blackpool Airport and provide people with their own bedrooms, communal lounges and dining room.

People’s experience of using this service and what we found

We found risks were not managed consistently. We found some areas of risk had either not been thoroughly assessed or addressed. Medicines were managed safely. People were protected against the risk of abuse by staff who knew how to recognise and report concerns. The service was staffed sufficiently by workers who had been recruited safely. We found some shortfalls in infection control, which the registered manager addressed during the inspection.

We found breaches of regulation in respect of good governance and record keeping. The provider used a range of systems to assess, monitor and improve the quality of the service, including feedback from people, relatives and staff. However, we found shortfalls in standards which had either not been identified or had not been addressed. The registered manager promptly acted on the issues we highlighted. The management team were clear about their roles and responsibilities and worked with external professionals to ensure people’s needs continued to be met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 08 July 2019).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to unexplained bruising and a delay in seeking medical attention. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to quality assurance and record keeping at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Ambassador Care Home is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The care home can support up to 31 people.

People’s experience of using this service and what we found

We looked at what activities were delivered at Ambassador Care Home. We noted events were planned and entertainers scheduled to visit. However, feedback on daily activities was mixed. We have made a recommendation about this.

Care plans held information on people’s sensory impairments were appropriate. End of life training had been completed to support people should they wish to remain at the home in their final days. There was a complaints procedure, people we spoke with told us they had not made a formal complaint.

Staff told us they had appropriate training, knowledge and support to keep people safe. Staff could tell us how they managed risk while respecting the person and supporting their dignity. Staff files showed the registered manager used same safe recruitment procedures to keep people safe. Medicines were stored and administered in line with good practice guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff told us training was ongoing and they received refresher training to update their knowledge. The service worked in partnership with outside agencies, health and social care professionals to ensure people received timely healthcare support.

People and visitors felt confident in staff, they told us there was a caring culture within the service and staffing levels were appropriate. We observed people were comfortable in the company of staff. We observed staff offering choice and delivering compassionate care that supported people’s independence and dignity.

The management team delivered care and worked alongside staff. This allowed good oversight to ensure people received effective support and the service was well-led. The registered manager used a variety of methods monitor the quality of the service. These included feedback forms to seek their views about the service provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 07 July 2018) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 evidenced to show information collected related to people's fluid intake had been reviewed and actioned where necessary.

This was the second consecutive time the registered provider had failed to meet all the regulatory requirements and were rated requires improvement.

This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Good governance). Systems and processes to ensure compliance with the regulations were not consistently managed effectively. You can see what action we told the provider to take at the back of the full version of the report.

We looked at recruitment procedures to ensure people were supported by suitably qualified and experienced staff. Records we viewed did not have a full employment history included. We have made a recommendation about this.

We spoke with people and staff about the food and drinks offered at Ambassador Care Home. People said the food was good but would like more choice. We have made a recommendation about this.

Staff monitored people’s fluid intake but no oversight of the paperwork was evidenced. We have made a recommendation about this.

The registered manager did not consistently submit notifications as required as part of their regulatory requirements. We have made a recommendation about this.

People who lived at Ambassador Care Home had care plans that reflected their needs and these had been regularly reviewed to ensure they were up to date. The care plans had information related to all areas of a person’s care needs. Staff were knowledgeable of people’s needs and we observed them helping people as directed within their care plans.

Relatives told us staff treated their family members as individuals and delivered personalised care that was centred on them as an individual. Care plans seen and observations during our visit confirmed this.

Staff delivered end of life care that promoted people’s preferred priorities of care.

The registered provider had refurbished the home to ensure people living with dementia were living in an environment that promoted their safety, independence and positive wellbeing.

Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents as required.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner.

Staff we spoke with confirmed they did not start in post until the management team completed relevant checks. We checked staff records and noted employees received induction and ongoing training.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the building and found it had been refurbished, maintained, was clean and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

We observed only positive interactions between staff and people who lived at Ambassador Care Home. There was a culture of promoting dignity and respect towards people. We saw staff took time and chatted with people as they performed moving and handling procedures in communal areas.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they had no complaints.

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 visible management presence throughout the home. Staff were aware of their role and responsibilities. The deployment of staff was organised, directing staff with their allocated tasks.

At the time of our inspection, the registered provider was managing several rapid staff changes. However, we found staffing levels were suitable with an appropriate skill mix to meet the needs of people who lived at the home.

We saw reviews of care plans had taken place and the environment was clean and well maintained.

During this inspection, we became aware of specific incidents at the home. We are considering our response to these incidents separately.

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.

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.

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.