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Archived: Cambian - The Fields Good

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Inspection carried out on June 15th 2015

During a routine inspection

The Fields is registered to provide accommodation for people who require nursing or personal care. The home can accommodate up to 54 people who have learning and/ or physical disabilities. The home is divided into seven units, one of which provides nursing care. The home is situated in the Woodhouse area of Sheffield and benefits from access to local facilities.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. There was a registered manager in place who was present on the day of our inspection. 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.

Our last inspection was on 7th May 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on June 15th 2015 and was unannounced. This means the people who lived and worked at The Fields didn’t know we were coming. On the day of our inspection there were 54 people living at the home.

People told us they were happy living at the Fields. One person commented, “There are nice friendly people here, especially the staff, they are lovely and caring.”

We saw the staff were caring and compassionate. They clearly all knew the people who lived at the Fields and were able to understand and respond appropriately to their needs.

There were a wide range of activities available to people who lived at the Fields.

A relative told us they were kept informed and they found the registered manager “approachable and staff are fantastic.”

People were protected from abuse and the service followed adequate and effective safeguarding procedures.

There were thorough pre-employment checks completed for new staff to ensure people’s safety was promoted. Staff were supported to undertake training and had regular supervision for development and support.

There were good, regular quality-monitoring systems carried out at the service.

Whilst care plans contained some information on the individual’s needs and how these should be met, gaps in recordings meant full and accurate detail was not recorded or available to staff.

During our inspection, we found one breach of the Health and Social Care Act 2008 (regulated Activities) 2014, Regulation 9 Person Centred Care.

Inspection carried out on 7 May 2014

During a routine inspection

An unannounced inspection was carried out of Cambian -The Fields on Wednesday 7th 2014. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at during the inspection.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People�s needs were assessed and treatment was planned with the help of individuals and their representatives. Care files we checked confirmed that initial assessments had been carried out by experienced staff before people were accepted into the service. This was to ensure the service could meet identified needs, thereby promoting their safety

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The aim was to promote independence and help people become involved in the community and improve their leisure and work opportunities in a safe way. People told us the care workers were their �mates�.

People were looked after and cared for by staff who were suitably qualified, skilled and experienced. We checked staff supervision and training files and found the provider had made arrangements to ensure staff received training and sufficient supervision so that people received care which was safe and appropriate.

Is the service effective?

During our observations we noted that people�s views and experiences were taken into account and their privacy and dignity was respected by staff. Staff listened to people; they explained the choices available to them in the way people found it easy to understand. We saw staff explaining each time when they carried out care tasks.

Although some people have had assessments of their capacity and deemed needing help to make decisions, none of the people at the home had been referred to be deprived of their liberty to safeguard them from harm. The manager told us the assessment of people were ongoing. This meant people�s changing needs were recognised and assessed to meet their needs.

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people�s care and support needs and they knew how to meet them.

Is the service caring?

We were informed by people and care staff that people were able to express their views and be involved in making decisions about their care and treatment each day. They were able to change their mind and not be worried. Care workers appreciated and respected their wishes.

People were supported by staff who were attentive and friendly. We saw care workers showing patience and gave encouragement when supporting people. We observed people were able to take their time, do things at their own pace and were not rushed. During administering medication we observed staff staying with people and making sure they had taken the medicine without rushing them.

People�s care and treatment was planned and delivered in a way that protected them from unlawful discrimination. This is because staff had received training and received supervision to make sure staff followed the correct procedure when caring for people.

Is the service responsive?

People�s views and experiences were taken into account and their privacy and dignity was respected by care workers who looked after them. The manager told us that they were looking into obtaining disabled parking permits for those who were entitled to them, so people could be more independent. We observed staff supporting people and promoting their independence and community involvement. People went out in a mini bus on the day of our inspection. This was because the weather was sunny and staff decided to take people out instead of carrying on with indoor activities. People were very happy to go out.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Appropriate professionals were involved at the correct time to make sure people were in receipt of appropriate care and treatment promptly.

Records confirmed people�s preferences, interests, aspirations and diverse needs had been taken into account when care and support had been provided in accordance with people�s wishes.

Is the service well-led?

People�s views and experiences were taken into account and their privacy and dignity was respected in the way people were cared for. We witnessed this during our inspection. We also saw evidence that people who used the service understood the care and treatment choices available to them. They were explained to by staff and people were happy to take part and get involved.

People�s needs were assessed and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People�s care needs were followed up by risk assessments to make sure the plan of care minimised the risk to people.

There were arrangements in place to deal with foreseeable emergencies. This included during adverse weather condition transporting staff to and from their homes so that people would continue to receive appropriate support and care.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

Staff had a good understanding of the ethos of the home and quality assurance processes which were in place. We saw the outcome of the last customer satisfaction survey. The comments by people and their relatives were positive. Staff told us they were clear about their roles and responsibilities. They said the management had listened to them and had implemented changes. Staff told us they were well supported to do their jobs by the manager and the deputy.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Inspection carried out on 22 May 2013

During a routine inspection

People we spoke with told us their care and support at the home was good. One person spoke very positively about the activities available at the home. Another person told us: �They (the staff) are all very good.�

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. There were also appropriate arrangements in place where people did not have the capacity to consent to their care

People were cared for in a clean, hygienic environment. We carried out a visual inspection of the premises, and found that all areas we checked were cleaned to a high standard.

Appropriate checks were undertaken before staff began work. We checked staff files and saw that before commencing employment, the provider carried out checks in relation to staff�s identity, their past employment history, their right to work in the UK and a Disclosure and Barring Service (DBS) check

The provider had a comprehensive complaints system in place, and information was provided to people who use services, their relatives and representatives so that they understood how to make a complaint.

Inspection carried out on 19 September 2012

During an inspection looking at part of the service

We checked records and spoke with staff. We saw that the provider had robust arrangements in place for monitoring staff availability and staffing numbers, so that people's changing needs could be met.

Inspection carried out on 11 May 2012

During a routine inspection

Some of the people who were receiving a service were unable to tell us about their experience due to their complex needs. However, the people we spoke with were extremely positive about their experience of Cambian The Fields. One person told us �I like my room�, and also that the staff �are nice.� Two people told us that they enjoy gardening at the home and spoke enthusiastically about the range of activities they were able to participate in at the home.

Inspection carried out on 20 January 2012

During an inspection looking at part of the service

People told us they had attended residents meetings and someone from Mencap visits the home.

People told us they were given choices and staff respected their wishes. They also told us they were able to access the community and visited the local shops. People also told us they liked living at the service, they said staff were very good and looked after them.

Inspection carried out on 17 August 2011

During an inspection looking at part of the service

During this inspection we focussed our visit on The Hollies unit.

We found that overall, people living in this unit, were now receiving more appropriate care, treatment and support to meet their complex needs.

People had been given some opportunities to have involvement in making decisions about the way their care and support was delivered. They told us they had more opportunities to access the community and were going on a day trip to the coast on the day of our visit.

People also told us they were being supported to choose the d�cor, furnishings and furniture for their bedrooms to make them more personalised and comfortable.

The staff who were supporting people told us they were now able, to better meet people's needs in ways, which, protected their dignity and rights. This was because there were now more staff on duty on each shift and the Nurses were offering more support to them and individuals who lived there.

The four people who lived there all had updated care plans, however, these plans will need further development including supporting people to have more meaningful input in to their support plans.

Daily medication was being administered and recorded appropriately for people However, there was no recorded evidence of when (PRN) medication should be administered to individuals and this could lead to inconsistencies, which could place people's health and welfare at risk. We have asked the provider to address this as a priority.

Overall, the environment within the unit had improved. People were living in accessible, clean and safe accommodation. Some areas of the unit had been redecorated and refurnished. These improvements promoted people's wellbeing protected their dignity. However, more needs to be done to ensure that communal areas provide comfortable and homely communal accommodation. People's bedrooms still needed to be redecorated and personalised to ensure that people have appropriate bedroom facilities.

The staffing levels in the unit, had improved and the increases were now adequate to meet people's complex care and support needs. However, the 1-1 funding,which people are supposed to be receiving is not yet clearly agreed by the funding authorities and the provider and this will need to be clarified. To ensure that people are offered appropriate levels of staff support in order to meet their assessed care and support needs.

Inspection carried out on 5 July 2011

During a routine inspection

Since the last time we inspected the service a new provider had taken over the running of the home last year, we found that they had made improvements to the service including;

People in the main appeared to be well supported and they told us they were involved in making decisions about their lives.

The provider has ensured that some people were more involved in devising their care and support plans.

There had been some improvements within the environment for example redecoration and refurbishment of some areas.

The staff recruitment and training practices had been developed in line with good practice.

The provider had introduced other quality and safety practices.

Some people had opportunities to be involved in making everyday decisions and new policies and practices had been introduced to protect people's rights.

Overall, staff had good relationships with people. This meant that most people living at The Fields were offered an appropriate level of care and support to meet their needs.

The provider has been co-operative and transparent with us about the areas they thought the service needed to develop.

However, we observed some areas of concern relating to a small four bedded unit, The

Hollies. Where four people, who had complex needs and presented challenges to the

service were living. We found that these people were not receiving an adequate level of care and support.

On the day of our inspection we found the staffing levels were inadequate to meet some people's complex needs and there was evidence that the staff were not being adequately supported by their line managers.

There were also concerns that medication administration was not being recorded accurately. These findings meant that we could not be satisfied that the quality monitoring systems in place were effective. This meant people living in this unit may not benefit from safe, quality care, treatment and support.

As a result of this we made a safeguarding alert to the local safeguarding adult's team. A strategy meeting was held on 11 July 2011 and it was agreed that each person's health and social services care managers would reassess people's needs within two weeks. A separate investigation of our findings will also be carried out by the Sheffield local area safeguarding adult's team.

We sent the provider a compliance action report letter on 7 July 2011 because the failures to comply with the outcomes in this report were too serious to wait for the publication of the full report about our review of compliance. They responded to us by 15 July and advised us they had taken action to address our most serious concerns.

We will continue to closely monitor this service and will carry out another inspection to

ensure that people are safe and are receiving safe care, treatment and support.