We carried out an unannounced inspection of Campania on 12 January 2017. Campania is a large Victorian building over four floors in Weston-super-Mare, a short walk from the seafront, town and parks and is one of the provider’s, N.Notaro Homes Limited, 11 services. The home is registered for up to 41 people who are living with alcohol related problems such as Korsakoff's syndrome. This meant that people required support with mental health challenges, memory loss, behaviours which could be challenging for staff and other physical effects of long term alcohol abuse. The service does not provide accommodation for people who are continuing to abuse alcohol and people sign an alcohol /illegal substance agreement before moving into the home. Therefore they knew when support could be withdrawn by the service, for example following persistent alcohol use, aggressive behaviour or engaging in illegal activities. At the time of the inspection 38 people were living at Campania with one person in hospital. People knew they were subject to random breathalyser tests and drug tests before admission. Staff, with the person’s involvement aimed to provide a package of care and support that would enable people to be as independent as possible. Staff encouraged links with peoples’ families, often lost when lives are disrupted by alcohol abuse, to be re-established. Few people at the home were in contact with relatives. Campania staff tried to go beyond just providing a safe home and put rehabilitation at the forefront of what they tried to achieve by celebrating those who were able to move forward into independent community living. For example, in 2016 eight people were enabled to move out to their own flats in the community with support. Staff encouraged former skills and interests to be regained and provided opportunities for new experiences to enrich the lives of people living at the home.
At the last inspection in July 2014 we found the service to be compliant with the standards we looked at. At this inspection we found the service was still meeting all regulatory requirements and did not identify any concerns with the care provided to people living at the home.
The home had a 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 2008 and associated Regulations about how the service is run. At the time of this inspection the registered manager was on leave and the home was being managed by a knowledgeable and competent deputy manager.
People told us they felt safe. People expressed no concerns about their safety and were complementary about the level of support and care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had good knowledge of how to identify and report any safeguarding or whistleblowing concerns. Due to the nature of the service the home worked closely with local police and a community justice partnership to safely manage conflict, or anti-social behaviour, resolve issues between people living at the home and agree future actions. They also worked closely with homeless and addiction charities, community housing support, further education and voluntary work organisations and independent advocates promoting rehabilitation and facilitated a weekly professionals ‘sharing’ group.
There were systems in place for the safe storage, administration and recording of medicines. Each person kept their medication in a locked cabinet in their bedroom and only staff authorised to administer medicines were allowed access. Some people were able to administer their own medication, especially if they were moving towards more independence in the community. All people taking medicines had a medication administration record (MAR) in place, which included a photograph to ensure medicines were given to the correct person. There was a medication computer system which highlighted who was due medication and alerted staff at the appropriate times, which minimised the risk of medication errors. During the inspection all records we observed had been filled out correctly and all medicine amounts tallied and were in date.
All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.
Staff spoke positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were up to date.
Staff confirmed they received supervision and support with their line manager, which along with the completion of team meetings, meant they were supported in their roles and good standards of care were maintained.
Observations of meal times showed these to be a positive experience, with people being supported to eat where they chose or in the dining room canteen. If people were going out or wanted a quieter experience later, this was organised. Staff engaged in conversation with people and encouraged them throughout the meal. We saw nutritional assessments were in place to ensure people were encouraged to maintain a balanced diet, and special dietary needs were catered for. Maintaining good nutrition is an important part of rehabilitation from long term alcohol abuse and people were given clear information about how a good diet could help them with their recovery.
Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be very caring and treated people with kindness, dignity and respect, forging relationships of trust. People who used the service were complimentary about the quality of the staff and the standard of care received.
Care plans contained accurate and detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, along with a range of personalised information which helped ensure their needs were being met and care they received was person centred. There was a focus on managed rehabilitation with external health professional support such as counsellors and community mental health professionals and it was important for people to set achievable goals. People were expected to participate and manage daily living skills such as personal laundry, cleaning and regular cooking.
Boredom is a key factor in alcohol abuse so Campania provided a supportive, structured day in a comfortable and secure atmosphere. People could then build their own day around a core routine to promote orientation of time and place and improve motivation. People were positive about the variety and frequency of activities available, individually or in groups. The activity schedule catered for all interests and abilities and included involvement from external agencies, job opportunities and further education. A large number of activities and events had been the result of suggestions made from people who used the service. The home actively documented activities and displayed photographs of the different events that had taken place around the building.
The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a weekly and monthly basis and covered a wide range of areas including medication, care files, infection control and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.