Inspection on 25/10/05 for Cambria House

This inspection was carried out on 25th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cambria House 10/07/07

Cambria House 14/11/06

Cambria House 07/06/05

Cambria House 07/01/05

Cambria House 15/06/04

Cambria House 17/02/04

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Hillview Farm

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Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cambria House 24 St Peter`s Street Winchester Hampshire SO23 8BP Lead Inspector John Vaughan Unannounced Inspection 25th October 2005 10:00 Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cambria House Address 24 St Peter`s Street Winchester Hampshire SO23 8BP 01189 581950 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Choice Limited Mr Robert Anscomb Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2005 Brief Description of the Service: Cambria House provides a service to eight younger adults with a learning disability. The home has been developed to work with service users with complex needs including service users who challenge the services provided for them. The home is owned and managed by C.H.O.I.C.E Ltd. Links are established with the community team, specialist services and the support of their own psychologist services. Accommodation is provided on three floors in a large house that has been refurbished and redeveloped to provide this service. The house is situated in the heart of Winchester and is close to all local services. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place seven hours. All of the service users were seen and the inspectors spent time meeting with individuals talking about their experiences of living in the home. The inspector looked around the home, sampled some of the homes records and talked to the person in charge and staff members who were on duty. What the service does well: What has improved since the last inspection? What they could do better: The manager has been asked again to improve the care planning process in the home to make sure information on how people are supported is documented. The manager has been asked to put some more information in place to support service users with taking their medication. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 6 The home must also improve the records kept for staff before they come to work in the home to make sure that people who live in the home have the right staff supporting them. The manager has been asked to do this more than once. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 The lack of improvement in service users plans means that the home cannot demonstrate how service user’s needs are supported and met. EVIDENCE: The inspectors viewed four service user’s files and spoke to these individuals during the inspection. None of the files examined contained an up to date service user plan and there was no evidence of strategies to develop service users skills, explore aspirations and respond to day-to-day support needs. The files contained good information on communication together with positive and reactive strategies to support service users with behaviour that challenges the service. There was no information on how to develop personal and self help skills or plan for the future. The plans do not contain information or evidence that service users have participated in the planning process. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 10 The inspector spoke to service users who confirmed that they have been involved in specific intervention plans to help them manage their own behaviour. One service user is being supported with oral hygiene, as it is an identified health concern. The staff keep his toothbrush and toothpaste in the office and he asks for this each day. This appeared to be a very restrictive approach at first however the inspector spoke to the service users and he confirmed that it was his choice to do this and it was helping him to brush his teeth regularly. The inspector fed back to staff that this is another example a support practice that needs to be documented in a service user’s plan to demonstrate how they are supporting a service user with an identified need. At the last inspection new plans had not been introduced and the inspectors saw no improvement in the information currently available. The senior staff member assisting with the inspection accessed plans held on the computer however they did not provide any additional evidence. The inspector had been made aware of a new format through discussion with senior management of the organisation and the manager of the home but this has not been introduced. One file contained an intervention strategy to respond to a service user wanting to take control of other service users and how to stop this when it occurs however there was no information on supporting the individual to channel these actions into more a positive activity. Another file did contain positive support guidelines for a service user who can be very negative and this demonstrated the positive approach the home was taking to help this person feel more positive about themselves and their life. Records for a service user indicated that they have had a number of incidents where physical intervention has been required however there are no guidelines within the plan to support the type of physical restraint used and this must be put in place. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 The practices of the home demonstrated that service users are respected as individuals. Service users benefit from a good balanced diet that promotes healthy eating and has been developed with service user involvement. EVIDENCE: Staff were observed to knock on doors and ask permission to enter bedrooms. Service user’s files contained information on how to communicate with the service user and their preferred form of address. The inspector observed service users freely moving around the house. Service user’s bedroom doors have an appropriate lock. These can be overridden in an emergency by the use of a master key. Service users have been issued with a key to their door. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 12 The inspectors sat and ate lunch with service users and staff. This consisted of sandwiches and fruit and hot and cold drinks. Service users confirmed that they have a good range of meals offered and personal favourites are included. Service users told the inspector that they have a menu in place to show what is for dinner. The home offers multiple choices and service users are involved in planning and preparing meals. Healthy eating posters and information was available in the home and service users said that staff are helping them to lose weight and keep fit. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Personal support is given in a way that respects the privacy and dignity of the individual. The lack of detailed medication guidelines and records means that the home cannot demonstrate that service users needs are fully met. EVIDENCE: Service users told the inspector that they feel supported by staff and their privacy and dignity is maintained. Staff were seen to knock on service users doors and as permission to come into their room. The inspectors confirmed by talking to and observing service users that they have flexible routines and times for getting up and going to bed are not set by staff. The support plans should indicate the support each person needs with person care and health needs and the way in which they prefer to receive this support. The home has a Monitored Dosage System in place for the administration of medication. Records are well maintained and the inspector spoke to the member of staff with responsibility for this area. They were found to be knowledgeable and clear on their role. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 14 The inspector was informed that the staff are aware that one service user asks for analgesia when he has had a difficult day and they find that supporting him to relax and take some time to reflect on his day has a more beneficial affect. This is not documented and the staff were advised to document this as part of the persons support strategy and ‘when required’ medication protocol. One service user has needed ‘when required’ medication for his behaviour however there are no guidelines for the use of this medication as part of his overall behavioural support plan and the inspector advised that this must be included in his care plan. The cupboard contained a number of over the counter ‘homely remedies’ and the staff member was advised that they must have these clearly documented in each persons plan and insure these medicines are suitable for the individual through consultation with the GP or pharmacist. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home can demonstrate that the systems are in place to protect service users and report allegations of abuse. EVIDENCE: The home has a policy for responding to suspicions and allegations of abuse. The home has a whistle-blowing policy in place. A copy of Hampshire’s protocol for the Protection of Vulnerable Adults policy is available in the home. The staff training records indicate that staff have had input on the protection of service users and reporting allegations of abuse. It would be of benefit to repeat this training for staff to ensure the policies and practices are up to date. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Service users benefit from personalised individual rooms and a large, well maintained home which has adapted to meet their needs. EVIDENCE: The inspectors toured the home supported by staff and service users. The home was found to be clean and generally tidy with and free from unpleasant smells. The courtyard has been improved since the last visit with the installation of a large Pergola along the rear wall. Service users said they were pleased with this but they did not get the new BBQ this year. Air conditioning has been installed in the kitchen and dinning area to improve ventilation and reduce the high temperatures experienced during the summer months. The inspector was invited to see three service users rooms. All the rooms were different in décor and layout. Books, CD, DVD’s, games, posters and audio and video equipment could be seen and each person said they were very happy with their personal spaces. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 17 A damp, mouldy patch in the lower ground floors porch area looked unpleasant and the inspectors were informed it was a leak from a service user’s en-suite and this was being addressed. The home has reviewed the current practice of propping a service users door open and installed a hold open device, which closes when the alarms sound improving the safety arrangements for this person. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 A serious lack of checks on staff as part of the recruitment process has the potential to place service users at risk. Although Service users are supported by an effectively trained staff team this would be further enhanced by systems for regular consultation and communication with staff. EVIDENCE: The inspector has raised concerns about recruitment checks on staff at the last two visits to the home. At the visit in June 2005 the manager was advised on the Protection of Vulnerable Adults (POVAfirst) checks and Criminal Record Bureau (CRB) checks as a staff member has started with suitable checks being carried out. Six staff files were examined at this visit and five of these files were unsatisfactory. Three files had no proof that a CRB check had been completed. The organisations human resources department was contacted during the visit, which established that one of these individuals now had a CRB and the other two had been applied for. In all three cases these staff had started working in the home without the POVAfirst check. One record did not contain proof of identity or references and another record had only one reference. The inspectors again emphasized the importance of Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 19 these checks as the current poor practice has the potential to place service users at risk. The training records for the home were examined and found to contain evidence of mandatory training in areas such as food hygiene, moving & handling, First Aid and Health & Safety. Staff have also been on courses to cover autism, epilepsy, managing challenging behaviour and supervision training. Further training has also been on anti-discriminatory practices, effective communication, values and attitudes and Adult protection. Training in physical intervention practices has been provided and proact scip is used in the home. The home has an established induction and foundation training course and staff are undertaking their NVQ awards. The inspectors spoke to six staff during the inspection. Staff asked about the support they receive confirmed that they have had supervision and feel supported by the homes management team. Team meetings have not been taking place for some time and some staff commented on this. The inspectors saw evidence that meetings have restarted and given the complexity of the service it is important that the staff team have regular meetings to ensure consistency and support is maintained. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 An experienced and suitably qualified individual manages the home. Systems for monitoring the quality and development of the service are in place supporting service users and their representatives to raise concerns and comment on the running of the home. The response of the manager now demonstrates that this will have an impact on the service. The lack of consistent checks of the Fire alarm system has the potential to place service users and staff at risk. EVIDENCE: The manager has suitable qualifications and experience to manage a care home. The manager has demonstrated a clear understanding of the needs and issues related to the service user group he provides support to. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 21 The current practice in the home does not demonstrate that staff recruitment and the development of service users support strategies are being effectively managed. The quality assurance audit that was seen at the last inspection has been responded to by the manager and the inspectors saw evidence of development objectives in service user holidays, involvement of service users in recruitment, meeting health care needs, improving communication systems with families and care managers, cleaning, Staff health and safety, assessible information and induction. The homes fire records were examined during this inspection. The system was serviced in September 2005. The last fire drill was carried out in September and concerns were raised about the lack of weekly checks on the system. The records seen indicated that the system has only been checked six times since February 2005 and the last check was five weeks ago. The person in charge made arrangements for the alarm to be tested on the day of the inspection. The haphazard monitoring of the alarm system has the potential to place all people in the build at risk and must be improved. The environmental Health Officer attended the home during the inspection to carry out their own Health & Safety inspection and feedback indicated that the home did not present any serious concerns. Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cambria House Score 3 X 2 x Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 X DS0000047346.V261093.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The registered person must ensure all service users plans are reviewed and updated. This must include clear strategies for supporting service users to achieve goals and aspirations. Repeated requirement, previous timescale of 7th September 2005 not met. The registered person must ensure that all physical intervention strategies are supported by clear guidelines. The manager must ensure that clear guidelines are in place within the service user’s plan for ‘when required’ medication and homely remedy agreements must also be in place. The registered person must ensure that any medication used when required as part of a service users behavioural support plan is documented within this plan. The registered person must ensure a record is kept for each member of staff, which includes proof of identity and two written DS0000047346.V261093.R01.S.doc Timescale for action 25/01/06 2. YA6 15 25/12/05 3. YA20 13 25/12/05 4. YA20 13 25/12/05 5. YA34 19 schedule 2 25/11/05 Cambria House Version 5.0 Page 24 references (which includes a reference from the last post where they worked with vulnerable adults or children). A statutory requirement notice has been issued in respect of this requirement The registered person must provide evidence to confirm that a CRB check has been completed for each member of staff that includes a check on the Protection of Vulnerable Adults list. A statutory requirement notice has been issued in respect of this requirement 7. YA34 19 schedule 2 The registered person must ensure that any staff member starting work prior to the return of their CRB application has had a Povafirst check and that all other information set out in schedule 2 of the Care Homes Regulations 2001 is in place. A statutory requirement notice has been issued in respect of this requirement 25/11/05 6. YA34 19 schedule 2 25/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cambria House DS0000047346.V261093.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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