Archived: Cambridge House

Although Cambridge House was in the process of closing down we were made aware some people living in the home and some staff were relocating to other homes managed by the same provider.

We planned to look at five standard areas, however on the day of our visit there were only six people residing at the home as people had already moved out. We therefore reduced the scope of our visit to focus on the areas in which there were concerns.

We spoke with two staff members and two people who used the service. We also spoke with the commissioning team from Manchester City Council and Trafford Local Authority.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

The building accommodated people over four floors and had bedrooms, a lounge and kitchen area on each floor. There were keypads on each floor which meant people were kept safe as they were unable to leave the building without staff support if there was an identified risk of them absconding.

Where there was a risk and people were unable to leave the building we found an application had been made under the Deprivation of Liberty Safeguards (DoLS). There was one person subject to a DoLS on the day of our visit. This meant proper regard was being made to the application of the law in line with the requirements set out in the Mental Capacity Act 2005.

However, an application to deprive someone of their liberty can only be made if that person does not have capacity to make a decision, It is in their best interests, and there are no other less restrictive ways of keeping them safe and well and giving them the care and/or treatment they need. We spoke with people using the service who told us they felt safe but would like "more freedom."

We were unable to find a safeguarding policy relating specifically to the service but staff told us what they would do if they felt they needed to raise a safeguarding alert.

The service had a "Protection Policy" in place which was designed to help staff identify what to do to help support people manage their behaviour in a positive way. We found the policy to be "wordy" and would not necessarily support staff to safely manage behaviour which may be perceived as "challenging."

We had been made aware of some concerns people had about the way people were supported to manage their behaviour if they became agitated or upset. We found through looking at care records, speaking with staff and people using the service, the use of some techniques used by staff, such as physical intervention, could have been avoided. This meant people were not always supported in the safest way possible.

Is the service effective?

We saw from care files and by speaking with people who use the service that it held lots of information about each person. We found some of the information was complex and it would not be easy for staff to ascertain the care needs of the people they were supporting. We did however see a health file which one person told us they had completed themselves which had good information on it such as "likes, dislikes, triggers to behaviour, things that scare me and things that make me happy." People using the service told us "I like it here, some staff understand me but don't always listen to me," and "they are helping me to move on."

We saw risk assessments were in place which outlined the level of risk to and vulnerability of people using the service. Whilst it is important to identify and manage risks to keep people safe it is also important to balance this protection with offering support to people to take some positive risks to promote their independence. We did not see any evidence of staff working in this way.

Is the service caring?

We had received information about some staff using physical intervention inappropriately and arguing with people using the service until they retaliated. One person told us "some staff use their power to stop me doing things which is why I get angry, then they have won". This told us some staff did not support people in an appropriate or caring way.

We saw through looking at records and speaking with staff, the acting manager encouraged staff to reflect on their practice where an incident had occurred to see if things could have been done differently. During our visit we observed staff interacting well with people using the service and people using the service told us they had good relationships with most of the staff.

Is the service responsive?

It was difficult to measure this on the day of our visit as most of the people who used the service had already moved out. People using the service told us sometimes they did not feel listened to but staff were helping them to move into their own flat. They told us visits had been arranged so they could settle in better and they were happy to be moving on.

Where serious incidents had occurred, which involved the use of physical intervention, the acting manager had followed the correct procedures to notify the Care Quality Commission. (CQC). Records we looked at showed staff were encouraged to reflect on the incident and look for any possible triggers. This told us the service was looking for ways they could improve to support people more effectively. However this had not always been done and we saw evidence of incidents which could have been prevented if staff had responded appropriately in the first instance.

Is the service well led?

We were told the registered manager in the residential part of the service had left and there was an acting manager responsible for overseeing the running of the service until it closed down. The acting manager was not present on the day of our visit.

We could see through records and through speaking with staff and people using the service the acting manager had played an active role in improving the service since our last inspection. Care plans were up to date and the files were well organised.

Staff told us regular meetings were held with them and they were encouraged to reflect on their practice and learn from incidents. We saw evidence of this on incident sheets which prompted staff to look for any triggers to why behaviours occurred and ways practice could be improved to prevent incidents occurring in the future which may have a negative impact on the person requiring support.

We were unable to see any quality monitoring audits which had been done but had been made aware the acting manager had introduced new systems to ensure things were properly audited. This had been an action point from our last inspection which had been addressed in March 2014.

At this inspection we found that overall improvements had been made in this outcome area.

Regular quality assurance audits were completed in relation to the management of medicines, health and safety and care planning. However, supporting documentation was not always in place to demonstrate this.

The allocation of care staffing hours and senior support staff was now much clearer.

Care plans and support plans had been reviewed and updated.

Staff were provided with on-going training so they could develop in their role and regular team meetings took place to ensure good communication amongst the staff team.

We looked at the staff rota for the week of the visit to check that sufficient staff were on duty to support the people who used the service. There was some confusion over exactly who was working specific shifts and the staffing hours allocated on an individual basis were not identified.

We looked at the daily support provided from senior staff and the out of normal working hours on-call system. We were told that a senior manager was always on the premises during normal working hours and one on-call during out of hours periods. However, it was not possible to identify exactly who this was from the staff rota.

We looked at the on-going monitoring systems that were in place. The most recent audit was very detailed and highlighted areas for improvement. The audit highlighted that behaviour management plans which supported people with challenging behaviours needed to be updated.

We looked at how the use of crisis prevention interventions was monitored. Although trends and patters of behaviours were identified and monitored individually a system of overall monitoring of such incidents was not in place.

Staff were aware of the different types of abuse that could take place and the signs to look out for. They knew to report any signs or the suspicion of abuse to a senior member of staff immediately. One of the people who used the service told us they had never experienced any form of abuse. They said, "All the staff are very good. No one has ever been abusive to me. They are all very kind."

Effective recruitment procedures were in place to ensure the staff employed were of good character and had the necessary skills, qualifications and experience for their role.

A complaint procedure was available to the people who used the service so they knew what to do if they were unhappy with the standard of care they received.