Inspection on 07/06/05 for Cambria House

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Cambria House 10/07/07

Cambria House 14/11/06

Cambria House 25/10/05

Cambria House 07/01/05

Cambria House 15/06/04

Cambria House 17/02/04

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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 Peters Street Winchester Hampshire SO23 8BO Lead Inspector John Vaughan Unannounced 7 June 2005, 10:30 th 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 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 Stationary 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 H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Cambria House Address 24 St Peters Street Winchester Hampshire SO23 8BP 01189 581950 Telephone number Fax number Email 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 H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07/01/2005 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 H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over five and a half hours. All of the service users were seen and the inspector 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 manager 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 to improve the care planning process in the home to make sure information on how people are supported is documented. 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 courtyard lacks any furniture of facilities and needs to be improved and to make it more attractive and useable for service users. The manger was asked Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 6 to discuss the propping open of a bedroom door with the Fire safety Officer to make sure what they do is the safest way of supporting the person. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 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 standard(s) 2 and 4. The home can demonstrate that service users needs are assessed and service users can try out the service before they move in. EVIDENCE: The inspectors met with a new service user who moved into the home a few months ago. They confirmed that they visited the home prior to moving in to get to know the other people living there and see their room. The service user confirmed that they made choices about the colour scheme for their room, how it was going to be furnished and they could bring along their personal possessions. The service user took the opportunity to show one of the inspectors their room and said that they are very pleased with their personal space. The manager stated that he also went to meet the individual and their carers to discuss the move and make arrangements for visits to the service. An initial assessment was seen which documented the individual’s likes and dislikes, needs and wishes. The inspectors were informed that the organisations referral manager undertook the preliminary placement referral work. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 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 standard(s) 6 and 9. A lack of improvement to the care planning system since the last inspection prevent the home from ensuring that service users ongoing needs are being met. EVIDENCE: The inspectors sampled three service user’s plans. At the last visit to the service a new format was in the process of being introduced. These plans have not developed in the way that was discussed at the previous visits. The plans document service users needs however there are no strategies to develop goals and aspirations for service users. The inspectors discussed the lack of intervention and support strategies with staff who said that they have built up an understanding of each persons day to day needs and rely on verbal discussion and communication to support service users. One service user has no care plan and there are no documented strategies for this person. This has the potential to place the individual at risk. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 10 Key-worker meetings take place and the inspectors saw notes of these meetings in which service users discuss their wishes. There was no evidence to demonstrate that the issues discussed have been developed into support strategies. The inspectors saw a wide range of risk assessment strategies for service users covering daily activities, challenging behaviour and the use of physical intervention strategies. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 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 standard(s) 12, 13, 15 The home has a well managed and meaningful activity programme based on service users interests and wishes. Personal relationships are recognised and supported. EVIDENCE: The inspectors spoke to service users about their experiences of activities and the opportunity for personal development. Very positive feedback was received regarding daily activities. Each person has an activity plan, which documents the daily activities. The plans cover the seven days and document activities across the day. These include swimming, bowling, snooker, horse riding and golf. Activities take place in the home including watching movies, relaxation, and household tasks. One service user talked the inspectors through the rota for cleaning and washing in which all service users take part. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 12 On the day of the visit a group of service users had been out playing snooker in the town centre and another group had been bowling. Service users told the inspector that they have access to the local community facilities and enjoy visiting the church, library and shops. During the inspections service users were observed using the homes computer to e-mail family members and receive e-mails from parents. On service user had just received a postcard from their parent confirming a pre arranged visit. Another service user talked to the inspectors about their experiences in the home and confirmed that they are supported to make and develop personal relationships. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 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 standard(s) 19 The home provides support for service users to access health Care professionals to meet their needs. EVIDENCE: The inspector established that each person is registered with a general practitioner and receives support and guidance to access medical appointments. Serviced users confirmed that they have visited their doctor and that staff have helped them to prepare for these visits. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 14 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 standard(s) 22 Complaints procedures are in place demonstrating that the views and concerns of service users, their families and representatives are recorded and responded to. EVIDENCE: The inspector saw evidence of an accessible complaints procedure. A complaints log is in place and the Protection of Vulnerable Adults procedures are in place. There have been no complaints since the last inspection. Service users spoke to the inspector about raising concerns and said they could talk to staff members if they had any problems. Service users knew how to contact their care managers and the inspector. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 15 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 standard(s) 24, 25 and 30 Improvements in the layout of the home since the last inspection ensure that the service provides individual spaces to meet their needs and promote independence. This would be greater enhanced by the development of the courtyard. EVIDENCE: Service users showed the inspectors around the home. The home has undergone a number of changes since the last inspection. This was discussed and planned with all of the service users and the results were observed at this visit. The inspectors confirmed with service users that the changes had had positive outcomes for individuals. People who wanted quieter parts of the home have now moved to these areas. A service user with higher supervision needs has moved to a room, which is less isolated. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 16 As they were shown around the house the inspectors saw individual very personalised bedrooms, which reflected the tastes and interests of the service users. The patio slabs have been replaced in the courtyard however the space is looking very sparse and is in need of work to provide a more inviting outdoor area. Service users wanted to see a shed or summerhouse and a BBQ. The manager stated that a new BBQ is being purchased and the funding of facilities would need to be requested. The manager is looking at air conditioning units as a priority for the home as it can get very hot in the lounge and kitchen. The inspector advised the manager to review the courtyard development with service users and make this a more inviting space. The home was found to be clean and tidy and free from unpleasant odours. A service users bedroom door was observed to be propped open and the manager stated that the service user needs this for reassurance. Staff provide close support and supervision for this individual. The manager was advised to review this practice in conjunction with the Hampshire Fire and Rescue Service’s local Fire Safety Officer and take action based on their advice. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 The lack of a thorough recruitment checks on staff potentially place service users at risk. EVIDENCE: The home has an outstanding requirement related to the provision of proof of identity for staff. The inspectors examined records and confirmed that application forms, two written references were in place however one record did not have proof of identity and no evidence of a Criminal Records Bureau (CRB) was available. The manager and inspector discussed what is required to comply with this requirement. The manager must ensure that all staff have a completed CRB check prior to starting employment. In some circumstances when agreed with the commission a member of staff can start once a satisfactory Protection of Vulnerable Adults (POVA) first check has been completed. Until the full CRB check is returned staff in this position must be under supervision at all times. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 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. However these have not had any impact on the delivery of the service EVIDENCE: The home has service user meetings, staff meetings and one to one service user meetings. Regulation 26 visits are undertaken and a report is sent to the commission. At the last visit the inspector was informed that a service audit had taken place however the report was not available at the time of the inspection. The manager was unable to find this report and staff did not appear to be aware of the audit. The manager made contact with their head office and arranged for the results to be sent via e-mail. The inspectors viewed the Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 19 document, which included evidence of the canvassing of service users and their families, staff members and care managers. There was no further analysis of the results and no action plan on the areas highlighted by individuals. The inspector discussed this with the manager and advised that further work is needed to complete this process and to demonstrate that they are responding to the feedback of the participants of the audit. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 Cambria House Score 2 x x Standard No 24 25 26 27 28 29 30 Score 2 3 x x x x 3 Version 1.20 Page 20 H54 S47346 Cambria House V221659 070605 Stage 4.doc 9 10 LIFESTYLES 3 x Score STAFFING Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 21 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 6 Regulation 15 Timescale for action The registered person must 7th ensure all service users plans are September reviewed and updated.This must 2005 include clear strategies for supporting service users to achieve goals and aspirations. The registered manager must 7th August ensure that they review the 2005 current pratice of propping open a service users bedroom door in consultation with the Fire Safety Officer and take appropriate action to minimise risks. The registered manager must 7th August ensure that all staff have a 2005 completed CRB Check before commencing employment. The registered manager must 7th August ensure that all staff have proof 2005 of identity on file. Previous timescale of 15th April 2005 not met. Requirement 2. 24 23.4 3. 34 19 schedule 2 19 schedule 2 4. 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 22 No. 1. 2. Refer to Standard 24 39 Good Practice Recommendations The manager should review the outdoor spaces with service users and improve the courtyard space based on service user needs and wishes. The manager should complete the analysis of the quality audit and respond to the concerns and compliments made by participants. Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Hampshire Area 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. Extracts may not be used or reproduced without the express permission of CSCI Cambria House H54 S47346 Cambria House V221659 070605 Stage 4.doc Version 1.20 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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