Cambron House

Cambron House is a care home providing personal care and nursing. It can accommodate up to 38 people. There were 20 people using the service at the time of the inspection.

People’s experience of using this service:

Relatives we spoke with told us staff ensured people were safe. From our observations we saw staff responded to people’s needs promoting safety. Staff understood safeguarding and whistleblowing procedures. We found adequate staff were employed to meet people’s needs. There was a safe recruitment process, which ensured only staff suitable to work with vulnerable adults were employed. The registered manager promoted a focus on openness and transparency. Accidents and incidents were effectively monitored, which ensured staff learned when things went wrong. People were protected by the prevention and control of infection. Medication systems were in place and followed by staff to ensure people received their medicines as prescribed. We identified some minor documentation issues which were addressed immediately by the registered manager, systems were improved and implemented at the time of our inspection.

Staff we spoke with were very knowledgeable about people needs. We observed that care provided was person-centred and individualised. Staff had received effective training to ensure their knowledge was up to date. Staff were supervised and supported. 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. People had access to health care professionals, staff worked closely with professionals to ensure people's needs were met. Professionals we spoke with told us the care provided was very good and they had seen very positive improvements over the last few months.

We observed staff were kind and caring. People were treated with dignity and respect. Relatives we spoke with told us the staff were lovely. People received care that was responsive to their needs. Staff understood people’s needs, including social, cultural, values and beliefs.

People were supported at the end of their life. The staff ensured people and their families wishes were explored and plans developed so these were met. The staff culture had changed, they were well led and supported. The registered manager led by example promoting openness and instilling a passion in staff to ensure the highest possible quality of care was provided to improve people’s well-being and quality of life.

There was a robust quality monitoring system in place to ensure continued improvements.

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 inadequate (published 18 January 2021suplementary published 6 February 2021) and there were multiple breaches of regulation. 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.

This service has been in Special Measures since 18 January 202. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

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.

Cambron House is a care home providing personal care and nursing. It can accommodate up to 38 people. There were 19 people using the service at the time of the inspection.

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

There was a new manager appointed who was applying to register with The Care Quality Commission (CQC). They had introduced new quality monitoring systems with the support of the providers. We found the systems being used were effective in identifying areas for improvement to ensure the service improved outcomes for people who used the service. These systems required embedding into practice and sustained to continue to drive improvements.

Staff we spoke with told us the service was much improved, they felt listened to and supported. There was regular communication with relatives and people who used the service and the manager, and the providers were promoting a positive culture that was person centred.

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 inadequate (published January 2021)

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Special measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Cambron House is a care home providing personal care and nursing. It can accommodate up to 38 people. There were 22 people using the service at the time of the inspection.

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

The service had no registered manager and systems and processes used to ensure the service was running safely were not robust or effective.

Risks associated with people’s care were not always identified or managed in a way that kept people safe.

Staff were not always deployed effectively to ensure people’s needs were met. Staff had not consistently received specific training to meet people’s needs. Staff did not receive competency checks on their performance and abilities to ensure they carried out their roles and responsibilities safely.

The provider had a recruitment process in place which showed staff were recruited safely. However, monitoring of poor performance needed improving.

There were systems in place to safeguard people from abuse. However, these were not effective and following our inspection, we referred seven safeguarding concerns to the Local Authority.

We identified shortfalls in the way people’s medicines were managed.

People were not always protected by the risk and spread of infection.

Staff did not support people appropriately; their approach was not always person-centred and at times was task orientated. Staff did not always respect people’s privacy and dignity.

There was a lack of working together with external agencies to deliver effective care and treatment and support people’s access to healthcare services. This meant their needs were not being met and had a negative impact on people’s well-being.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

There was lack of evidence to show that people were involved in decisions about their care, support and treatment. Relatives we spoke with told us there was lack of communication during the pandemic.

People told us the food was nice. However, from observations it was not clear that people had choices. We identified some people had significant weight loss, therefore it was not always clear that people’s nutritional needs were met.

The environment was not appropriate and did not meet best practice in supporting people living with dementia.

Complaints were recorded in line with the provider’s policy. However, not all concerns had been documented and dealt with following the policy, to evidence what actions had been taken to minimise issues reoccurring.

End of life care plans were in place, but they did not always identify people’s preferences and choices.

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 16 November 2018)

Why we inspected

The inspection was prompted due to concerns received from the local authority commissioners and safeguarding referrals. These were regarding, risks not being managed and lack of robust infection prevention and control. There had also been an outbreak of COVID-19 in the home. Initially, we completed a site visit to look at the Safe and Well led key questions. Following the concerns, we identified at this visit, we completed a second site visit to include the key questions of Effective, Caring and Responsive.

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 coronavirus and other infection outbreaks effectively.

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

We have found evidence that the provider needs to make improvement. Please see all sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cambron House 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 safe care and treatment, consent to care and treatment, person centred care, staffing, leadership and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service is a detached building on two floors with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include a lounge on the ground floor, a reminiscence room and a dining room. The service stands in its own grounds with accessible mature garden areas.

There was a registered manager in post who was responsible for the day-to-day running of 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.

This was the first inspection of the service since a change of registered provider.

People told us that they felt safe living at Cambron House. Staff had received safeguarding training and understood how to recognise and report abuse. We observed warm and friendly interactions between staff and people throughout the inspection. Staff knew people well.

People's risks were well documented and care was provided to people in the least restrictive way whilst being aware of people's personal risks. Risks were regularly reviewed.

Medicines were well managed and people received their medicines safely and on time. People received 'as needed' medicines when necessary. There were protocols to guide staff when to administer these medicines.

Staff were aware of infection control and how to keep people safe from the spread of infection. The home provided gloves and aprons for staff when delivering personal care. There were regular maintenance checks and staff were aware of how to report maintenance issues.

Staff received regular supervision, appraisal and training to support them in their role.

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

There were individualised care plans written from the point of view of the people that were supported. Care plans were detailed and provided enough information for staff to support people. Care plans were regularly reviewed and updated immediately if changes occurred.

There was a variety of activities that people could choose to take part in. People were supported and encouraged to engage in activities. People received good quality food and there were always drinks available to ensure hydration. Where people required specialist diets, we saw that this was being provided.

People and relatives were encouraged to help plan end of life care in a tailored way. Staff were compassionate regarding caring for people at the end of their lives.

There was a complaints process in place and people and relatives knew how to make a complaint. Complaints were investigated and followed up.

Visitors told us that they felt welcome within the home and able to visit whenever they wanted.

Audits were carried out across the service on a regular basis on medicines management, health and safety and the quality of care. Surveys were completed with people who use the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

People and relatives felt the registered manager and management team were accessible to people and relatives were confident in the care that was being provided.