Archived: Camber Lodge

Camber Lodge is a residential care home providing accommodation personal care and support for up to eight people, living with a learning disability, in an adapted house. At the time of the inspection there were five people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Camber Lodge was a large house, that fitted into the local community. There were deliberately no identifying signs, to indicate it was a care home. Staff wore casual clothing and did not wear anything that suggested they were care staff when coming and going with people. It was registered for the support of up to eight people. This is larger than current best practice guidance. However. the size of the service was mitigated as it had large communal spaces and the current occupancy was five people.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Possible environmental risks to people were not always identified or well managed. Areas in the service needed general maintenance and improvement to ensure the safety of people.

Systems to monitor and maintain quality of the service had still not been fully established effectively in all areas. This meant some areas for improvement were not identified and responded to. For example, fire extinguishers were not secured to the wall and could fall on people.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions they should take if they identified concerns. There were enough staff, who had been safely recruited, working to provide the support people needed, at times of their choice. Staff understood how to support people safely and risk assessments provided further guidance about individual risks. People were supported to receive their medicines when they needed them.

Staff had received training to meet people’s specific care needs. Staff were knowledgeable about the people they supported and had built trusting relationships with them. People were listened to and supported to have control and choice over their lives staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. When people did not have capacity any restrictions to their liberty had been authorised by the local authority. People’s nutritional and health needs were met with involvement from health and social care professionals.

People received support from staff who were kind and caring. People were relaxed, comfortable and happy in the company of staff and engaged with them in a relaxed and positive way. Staff knew people well, understood their needs and how to communicate in with each in an individual and meaningful way. People were supported to take part in activities to meet their individual needs and wishes.

The registered manager had good oversight of the home, people and staff. They were able to tell us about people, their needs and interests. They were working to continually develop and improve the service. There was an open and supportive culture in the service, staff felt well supported. There was a strong team spirit and a desire to work together to ensure the best possible care for people.

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 24 September 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, there were still areas that required further improvement and the service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

We had previously inspected Camber Lodge in October 2016 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not always managed safely, there were not enough staff working at night and the registered manager had not submitted appropriate notifications. We also found that people’s care plans lacked guidance and detail, and shortfalls had not been identified and addressed through the quality assurance system. We inspected the service again in October 2017 to check that improvements had been made. We found the provider had met the regulation in relation to staffing at night and submitting notifications. However, we made a recommendation because Deprivation of Liberty Safeguards (DoLS) notifications had not been submitted. The provider had met the regulation in relation to risks to people however, further improvements were needed to ensure risks to people’s health were fully addressed. We found there was still a breach relating to people’s records, as these were not consistent and did not contain all the information staff needed. This had not been identified through the quality assurance system. We also identified improvements were needed in relation to the staff culture at the home. The provider sent us an action plan to tell us how they would address these issues.

We had received concerns about the service therefore we brought this unannounced comprehensive inspection forward to look at the concerns and all aspects of the service. We wanted to check that the provider had made improvements, and to see if the service now met legal requirements. We found there had been a number of changes at the home and saw some improvements had been made, however Regulation 17 had not been met and we found further breaches of regulations. This is the third time the service has been rated as requires improvement.

The care service has been developed and designed in line with the 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.

There was a registered manager at 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.

At this inspection we found that some DoLS had expired and applications for their review and renewal had not been submitted. Where DoLS authorisations were in place, we had not been notified of this. We found there had been improvements to people’s records and the quality assurance system. However, further time was needed to allow these improvements to continue and be fully embedded into every day practice.

Improvements had been made to the culture of the service. Staff told us they felt supported by the registered manager. The registered manager had good oversight of the improvements needed to further develop the service. Although there was no formal action plan for improvements they shared with us improvements they knew they had to make and ensure all regulations were met.

People received care that was safe. Staff had a good understanding of the risks associated with the people they looked after. Risk assessments were in place and provided the guidance staff needed. Staff understood how to safeguard people from the risk of abuse and discrimination. They knew what actions to take if they believed people were at risk. There were systems in place to make sure medicines were ordered, stored, given and disposed of safely. Only staff who had been assessed as competent were able to give medicines. There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the home.

People were given choices, involved in decisions and asked their consent before staff provided support. There was a training programme and this helped ensure staff had the knowledge and skills to support people effectively. There was a system in place to ensure staff received regular supervision. People were supported to eat and drink a choice of food that met their individual needs and preferences. They were supported to have access to healthcare services when they needed them.

Staff treated people with kindness and compassion. They knew people well and understood their needs. Staff also recognised that some people needed additional support to be involved in their care and to make decisions. Therefore, they received the support and assistance of an advocate.

People received support that met their individual needs and choices. Staff knew people well and supported them appropriately. People engaged in a range of activities they enjoyed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post. 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 and associated regulations about how the service is run.

We had carried out an inspection in October 2016 where we found the provider was not meeting all the regulations. The provider sent us an action plan and told us they would address these issues by February 2017. At this inspection we found although improvements had been made further improvements were still required. Where people lived with health related conditions some guidance was not in place about how to support people. Some risks identified had not been fully addressed. We made a recommendation about this.

There was an audit system in place however, this had not identified the shortfalls we found in relation to people’s records, which were not always person-centred and did not contain all the information staff needed. This did not impact on people because staff knew them well. They had a clear understanding of the support people needed and how they liked this provided.

There was a system in place which ensured medicines were stored, administered, disposed of and safely managed.

Staff had a clear understanding of the risks associated with the people they supported and how to keep people safe. There were procedures in place to safeguard people from abuse. There were enough staff who worked each shift to meet people’s needs. Staff had been safely recruited.

Staff knew people really well. They treated them with kindness, respect and understanding. Staff worked with people to help develop their confidence and independence. People were involved in making decisions about what they did during the day. Staff understood people’s needs and preferences and communicated with them in a way that met their individual needs.

The manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff received the training they needed to look after people effectively.

People were supported to eat and drink a variety of meals that met their individual needs and preferences. Staff ensured people had access to external healthcare professionals when they needed it.

People received support that was individualised and responsive to their needs because staff had a good understanding of people’s individual needs and choices. People had the opportunity to engage in activities of their choice and staff supported them to participate if they wanted to.

A complaints policy was in place and people approached the manager or staff with any concerns.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Camber Lodge provides accommodation and care for up to eight adults with learning disabilities. At the time of our inspection there were six people living in the home. There was a registered manager in post.

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.

People did not always receive care and support from sufficient numbers of staff. Staffing levels at night were not consistently sufficient to ensure that people received safe care.

People’s did not aways have their risks assessed and care plans were not in place to mitigate known risks. People’s plans of care had not been reviewed appropriately and were not reflective of their current care and support needs. However, staff knew people well and provided the care that they thought people needed.

Staff had not received all of the training required to equip them with the skills and competencies to provide safe care to people. A formal system of supervision had not been implemented and staff did not always receive the support that they required to work effectively in their role.

The provider had failed to implement an appropriate system of quality assurance audits in order to identify and address short falls in the service. When shortfalls had been identified timely action to rectify these was not always taken by the provider or registered manager.

People received their prescribed medicines safely and staff knew what action to take if they felt people were at risk of harm. Safe recruitment practices had been followed to ensure that the staff employed by the provider were of a suitable character to provide people with care and support.

People’s health and well-being was monitored by staff and they were supported to access relevant health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to help maintain their health and well-being.

People received care and support from staff that knew them well. Staff provided people with dignified care and support in line with their preferences. People were supported to pursue their interests and hobbies and partake in activities of their choice.

The registered manager was a visible role model in the home and motivated staff to provide person centred care and support.

At this inspection we found the service to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 and one regulation of the Care Quality Commission (Registration) Regulations 2009. The actions we have taken are detailed at the end of this report.

Below is a summary of what we found. The summary describes what people using the service and staff told us, our observations during the inspection and the records we looked at. We spoke with most of the people who used the service, three care staff and the manager.

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

Is the service safe?

People were protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights. Staff we spoke with knew about safeguarding of vulnerable adults and what action to take if they needed to. Records showed that all staff had received training about this. People who lived at the service said that they felt safe. One person told us, 'I feel safe and happy."

CQC monitors the operation of the Deprivation of Liberty safeguards (DoLS) which apply to care homes. This is where restrictions may be placed on some people to help keep them safe. While no DoLS applications had needed to be submitted, we found that suitable policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us, or indicated through gestures and facial expressions, that they were happy with the care delivered and their needs had been met. Our observations and speaking with staff showed that they had a good understanding of people's care and support needs and that they knew them well. One person told us 'I am happy with the care I get'. We saw that staff had received training to meet the needs of the people they supported.

Is the service caring?

People told us that the staff were kind and attentive. Care records contained personalised information which helped staff to know the people they supported and how to meet their needs. We saw that staff showed patience, compassion and understood how to support people as individuals. One person told us 'The staff help us and are kind'. Our observation found that staff knew how to communicate effectively with people, we saw that staff sometimes used Makaton signs and symbols to help them do this.

Is the service responsive?

People's needs had been assessed before they moved to Camber Lodge. This meant that the service had the skills and facilities to meet their identified needs. People told us that they met with their key workers once a month to talk about what was important to them. People had access to activities that were important to them and had been supported to maintain relationships with friends and relatives where possible.

Is the service well-led?

The provider had systems in place to monitor and improve the services provided. The registered manager showed a good knowledge and oversight of the running of the home. Throughout the inspection, the manager and staff demonstrated that they placed the needs of the people who lived at Camber Lodge at the heart of the service. Discussion with staff found that they had a good understanding of their responsibilities and of the values of the service.

People we could speak with told us or indicated that they liked living in the home and that the staff were kind to them. People liked the activities they were involved in and we observed others with communication difficulties expressing enjoyment in what they did.

Staff told us that they felt well qualified for their work and that Camber Lodge was, 'homey'. They liked working there and demonstrated a good understanding of people's individual needs. We saw evidence of individualised care. Access to health care was supported when required. People's needs were monitored. Staff told us they had felt 'stretched' due to the recent, although temporary, increased needs of one person.

Appropriate independent support had been provided for one person who used the service. There were safe medication processes in place and a stable work force. The personal folders viewed on the day did not all appear complete, nor was the filing consistent. This was discussed with the manager subsequent to the visit.