Cambian Dilston College

Cambian Dilston College is a specialist residential college, providing educational services, accommodation and personal care for young people aged 16 to 25 with learning disabilities, autism spectrum disorder and complex needs. Some people attend the college as day students and other people have residential places for up to 52 weeks. There were 9 young people receiving care and accommodation at the college during this inspection.

The accommodation is made up of several flats above the college and cottages in the grounds.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Staff knew people well and knew the most effective ways to communicate with each person. People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.

Right Care: The service provided safe, personalised care. Staff worked well with other agencies to do so. The service had enough appropriately skilled staff to meet people's needs and keep them safe. The provider assessed risks and staff encouraged and enabled people to take positive risks. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture: People received good quality care and support because trained staff could meet their needs and wishes. Staff knew and understood people well. The values and attitudes of leaders ensured people led inclusive and empowered lives. Relatives gave positive feedback about the caring attitudes of staff and the effective management of the service.

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 13 October 2021) and there was a breach 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.

At our last inspection we recommended a more collaborative approach to the assessment process to ensure all people's needs can be met before they move to the college. At this inspection we found the provider had acted on this and the assessment process was more robust.

Why we inspected

We carried out an unannounced focused inspection of this service 11 August 2021. A breach of legal requirements was found relating to good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this 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.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Cambian Dilston College on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cambian Dilston College is a specialist residential college, providing educational services, accommodation and personal care for young people aged 16 to 25 with learning disabilities and/or autism spectrum disorder. Some people attend the college as day students and others stay for 38 to 52 weeks. There were nine young people staying at the college during this inspection.

The accommodation is made up of several flats above the college and cottages in the grounds.

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

The provider’s quality assurance systems had not identified maintenance shortfalls, including those relating to fire safety checks. There were also some premises issues that required attention. Staff said it took a long time to repair even minor defects.

External care professionals had concerns about how the needs of potential students were assessed before their placement at the college. The placement of some people with extremely complex needs had resulted in a high number of safeguarding incidents. We have made a recommendation about this.

Staff were recruited safely but there was a high turnover of staff and significant use of agency staff. Care staff were trained but did not always feel valued or supported by the organisation.

People appeared happy and relaxed with staff. They used pictures to show they liked the staff, the college, the food and the college grounds. They didn’t like the noise from other students but had places to go, such as a sensory room and their own bedrooms if they wanted privacy.

Staff understood their safeguarding responsibilities and built positive and trusting relationships with people. Individual risks to people were assessed and managed.

People received individualised support at the college that promoted their independence. They were supported to access a wide variety of learning and social experiences in the local community during college times. Relatives said people’s independent living skills had improved.

People were supported to keep in contact with their relatives. Relatives said there was good communication with the college, and this had improved since the last inspection.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. The service provides an opportunity for young people to learn practical and independent living skills during their stay, with a view to moving into their own supported living accommodation in the community when they leave.

A new management team was in place and they were keen to work in more cohesive and collaborative way. The provider was committed to improving the service. The provider had identified several areas that required remedial attention and there were action plans in place to achieve these.

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 1 January 2019).

Why we inspected

We received concerns in relation to the appropriateness of placements, restraint, staffing, food stocks, premises and management support. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led.

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 reviewed the information we held about the service. No areas of concern were identified in the key question of caring. We therefore did not inspect it. The rating from previous comprehensive inspections for that key question was 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. 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 Cambian Dilston College 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 monitor the service.

We have identified a breach in relation to governance 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.

accommodation and personal care for young people aged 16 to 25 with learning disabilities and/or autism spectrum disorder. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides an opportunity for up to 40 young people to learn practical and independent living skills during their stay, with a view to moving into their own supported living accommodation in the community when they leave. Some people attend the college as day students and others stayed for 38 to 52 weeks. There were 18 young people staying at the college during this inspection.

The accommodation is made up of a number of flats above the college and cottages in the grounds. As an older building, the college does not conform to the model of care guidance of 2016 which proposed smaller, community-based housing for people with learning disabilities and/or autism spectrum disorder. However, the care service has been developed and designed in line with other values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This inspection was carried out on 5 and 8 November 2018.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support an overall rating of good and there was no evidence or information from our inspection and ongoing 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.

There was a registered manager in place. 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.

Due to their complex needs not everyone was able to share their views about the service they received. People looked relaxed and comfortable. Staff provided support with patience and kindness. Staff upheld people's human rights and treated them with dignity.

People and relatives felt the service was safe. Staff received training about safeguarding and knew how to respond to any allegation of abuse. Medicines were managed safely. The accommodation was clean and well maintained.

There were enough staff to provide individual care to people. Regular agency staff were being used to cover vacant posts until permanent staff could be appointed. The provider used vetting checks to make sure any new staff were suitable to work with people who needed care and support.

People’s abilities and needs were fully assessed before they were offered a placement at the college. Staff received essential training to support them safely during their placement.

People were 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 supported this practice.

Relatives felt they could raise issues and comments and that these were listened to. However, they felt that any actions were not always sustained as they were not embedded into staff practice. This mainly related to support for people to keep in contact and communication between the college and parents. We discussed this with the registered manager as an area for improvement.

People received very individualised support at the college that promoted their independence. They were supported to access a wide variety of learning and work experience opportunities in the local community during college times.

People and relatives felt there were fewer activities outside of college in evenings and weekends. The registered manager said transport arrangements were being increased which would improve the opportunities for people to go out.

People, relatives and staff made positive comments about the registered manager and their open, approachable management style.

Systems were in place for auditing the quality of the service and for making improvements. Recent changes to the service and staffing structure had been an unsettling period but the registered manager was keen to take improvements forward.

Further information is in the detailed findings below.

This inspection took place on the 12 and 16 May 2016 and was unannounced. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has experience of using this type of service, or of supporting a person who has used this type of service.

A registered manager was in post at the time of our inspection who had been registered with the Care Quality Commission (CQC) to manage the carrying on of the regulated activity since June 2014. A registered manager is a person who has registered with the CQC 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.

Students told us they liked the staff who supported them and felt safe in their presence. Policies and procedures were in place for staff to follow to ensure that they safeguarded students from harm or abuse and we saw that these were followed in practice. Staff had been trained in safeguarding and were aware of their personal responsibility to safeguard students.

Risks that students faced in their daily lives had been appropriately assessed and were regularly reviewed. Environmental risks around the college site were also assessed and mitigated against. Emergency planning had been carried out and accident and incidents were appropriately managed and analysed to see if preventative measures were needed.

Staffing levels were determined by the number of students at the college at any one time and the nature of their care needs. Staff told us that staffing levels were well managed and they felt very supported in their roles. They said they received regular training and were inducted, supervised and appraised in line with the provider's policies. Staff recruitment procedures were robust and staff disciplinary measures were in place and applied appropriately. Medicines were well managed and audits carried out regularly to ensure that staff remained competent to administer medicines safely.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive students of their liberty lawfully, were currently being submitted to the local authority in line with the service's arrangements with them. The provider understood their legal responsibility under this act. They assessed student's capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in student's best interests had been undertaken and records about such decision making were maintained.

Students were supported to eat and drink healthily and in line with any special needs they had. They were involved in menu planning and had lots of choice about the foods they consumed. The ethos of the service was to support students to be as independent as possible and achieve the best possible outcome in line with their own abilities. Staff encouraged students to be independent, they respected their dignity and spoke with them in a professional but respectful manner. Staff and students enjoyed good relations.

Care was person centred and each student had goals and aspirations to work towards. Care was planned and regularly reviewed. Adjustments to students' care packages were made as needed. Social inclusion was promoted throughout the college environment, both in educational classes and out of college hours where students were encouraged and enabled to pursue activities of their own choice such as bowling, shopping and drama. The college had good links with the local community, which students accessed daily.

The culture of the service was positive and open and we received good feedback about the manager and the leadership of the service overall. Good quality assurance systems were in place and these ensured that the provider had a good overview of the service in order to analyse any concerns or issues raised and to drive improvements where necessary. There had been four complaints received within the last 12 months, all of which had been managed and resolved promptly.

Records held within the service were well maintained and confidentially stored.