Ambleside Lodge – London

“Care planning and risk management systems were not consistently person centred. Records lacked detailed guidance to support staff in meeting people’s assessed needs and did not consistently describe people’s physical and mental health conditions, early warning signs of deterioration, relapse indicators or actions staff should take in response to increased risks. We found limited evidence of personalised support planning, crisis planning or documentation describing people’s preferences, goals, strengths and aspirations. In addition, records contained inconsistencies and some important documents had not been reviewed for significant periods.”

“Systems for monitoring quality and safety were not fully effective. Concerns in relation to safety were not addressed, and there was no recorded evidence that care records were monitored on a regular basis. Incidents and accidents were recorded, but there was limited evidence of analysis to identify themes, trends or opportunities for learning and improvement.”

“Staff were safely recruited and had received regular supervision and training. They told us the registered manager was supportive, and they received the information and training they required to undertake their roles. Staff spoke positively about the people they supported and demonstrated an understanding of their needs. We observed positive interactions between the registered manager, staff and people living at the home.”

“Overall, improvements were needed to ensure people received safe, personalised and rights-based care, and to strengthen governance and oversight arrangements across the service.”