Cambridge House

Cambridge House is a residential care home providing personal care and support to 5 people who have a learning disability and/or who are autistic. The service can support up to 6 people.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were kept safe by staff who had been appropriately trained and who were familiar with people's care plans.

There were sufficient staff deployed to meet people's needs.

At this inspection we found there were greater opportunities for people to pursue leisure and social interests outside of the home.

Improvements had been made to the safety of the building with new fire doors fitted throughout.

People were supported to access specialist health care support and were in the process of attending dental appointments.

Individual risk assessments around the locked kitchen were more person centred and in place to keep people safe.

Staff supported people to take their medicines safely. The registered manager continued to understand the importance of people not being over medicated, particularly when managing people's increased anxiety.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

Staff understood and responded to people's individual needs.

Care plans were person-centred and provided clear information for staff about how to support people.

Staff had completed training in a range of areas that were specific to the people they supported and responded to situations such as managing complex seizures or gastrostomy tubes according to people's care plans and risk assessments.

Staff understood and responded to people's individual needs.

Right Culture

The registered manager worked very closely with the staff and people who lived at Cambridge House.

We received positive feedback about the leadership of the service. Most of the relatives we had contact with were complimentary and positive about the service and the care and support their loved ones received.

The stable management and staff team supported people to receive consistent care from staff who knew them well.

We received a few negative comments regarding communication which the registered manager was made aware of to address.

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 28 June 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cambridge House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Cambridge House is a residential care home providing personal care and support to five people with a learning disability and, or autistic spectrum disorder at the time of the inspection. The service can support up to six people.

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

The service provided by staff did not always fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

¿ Staff supported people to pursue their interests within the home and achieve their day to day goals of developing life skills.

¿ There were limited opportunities for people to pursue leisure and social interests outside of the home. These opportunities needed to be planned to ensure staff were available.

¿ Following a recent external fire safety assessment, work was needed to make sure fire doors were compliant to fire safety. The registered manager had updated us with their progress; however, the work had not been scheduled or completed at the time of writing this report.

¿ People were supported to access specialist health care support. Some people had access to dentists and had attended dental appointments. However, a combination of COVID-19 and a local dentist closing, meant some people struggled to access an NHS dentist.

¿ Staff worked with people using distraction techniques when they experienced periods of anxiety. In the main people’s freedoms were not restricted by staff unless it had been risk assessed as being a safety concern. However, the kitchen was always locked when staff were not present. A kitchen safety risk assessment reviewed was not as person-centred around each person’s individual known risks when the kitchen was unlocked, as it could be.

¿ Staff supported people to take their medicines safely. The registered manager understood the importance of people not being over medicated particularly when managing people’s increased anxiety. People were supported to live healthy lifestyles and staff members promoted healthy choices in areas such as eating and drinking.

¿ People had been supported to personalise their rooms.

Right Care

¿ There were enough appropriately skilled staff to meet individual people’s needs when at home.

¿ Staff knew the people they supported well. Staff understood and encouraged the individualised way people communicated their wishes and choices. People used body language, facial expressions, sounds, or pictures to make their wishes known to staff.

¿ Staff respected and encouraged people to make a choice, although records did not always evidence this in enough detail.

¿ People’s individual care, treatment and support plans and risk assessments reflected their range of person-centred support and care needs.

¿ Staff supported people with kind and compassionate care. However, staff did not always promote opportunities for people to experience growth or new skills.

¿ Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff had supported people living at the home for a long time in some cases.

¿ Staff understood how to protect people from poor care and harm. Staff had training and knew how to recognise and report poor care or harm when required.

Right Culture

¿ Staff supported people to learn day to day life skills wherever possible. However, people’s opportunities were mainly limited to known preferences. People were not always encouraged to explore new interests or pursuits.

¿ Staff felt supported by the registered manager who they found approachable.

¿ The registered manager understood the key principles of guidance such as Right support, right care, right culture. However further development was required to ensure people led inclusive and empowered lives.

¿ Audits were completed at the home to monitor the service provided and make any improvements needed.

¿ Relatives of people were involved in their family members care decisions and were happy with the care provided. Decisions were made in people’s best interests.

¿ Staff knew and understood people well and were responsive to their needs.

¿ Improvements had been made since the last inspection, but there was still work to do to sustain improvements and fully embed the principles of Right support, right care, right culture.

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 27 October 2020).

The service remains rated requires improvement. This service has been rated requires improvement for the previous three inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. A number of improvements had been made since the last inspection, however there was still further work needed to make, sustain, and embed these improvements.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cambridge House provides accommodation and support for up to six people who have a learning disability. On the day of our visit, there were five people living in the service. Cambridge House is a detached bungalow in a residential cul-de-sac within the town of Haverhill, Suffolk.

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.

At our last inspection we had concerns that people did not always receive a service that provided them with safe, effective and high-quality care. At that inspection there were not enough staff deployed to meet people's needs consistently. At that inspection we were also concerned that the safety of the premises was not always a priority for the provider. 10 out of 11 fire doors were being propped or held open due to a failure of the fire door system and this had not been addressed in a timely manner. At that inspection we found the service was not always well led and there was a lack of quality assurance processes in place to identify concerns. These failings resulted in breaches of three of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found progress and some improvements had been made. The service was no longer in breach of any of the Regulations however challenges around the staffing levels remained.

People’s relatives told us their family member was safe living at Cambridge House however there continued to be challenges associated with sufficient staff and recruitment of new staff. Improvements were needed to reduce the number of hours the registered manager was working ‘on the floor’ to enable them to undertake their registered manager duties and working hours.

People were supported by staff who had a good understanding of how to recognise and report potential harm or abuse and were confident in local safeguarding procedures.

The service had systems to identify when people had not received their medicines when required and addressing it.

Good hygiene standards were maintained within the service and the environment was clean. Infection control processes were in place and issues were addressed when required.

Management plans and adequate personal protective equipment (PPE) was in place to help reduce the risk and impact of the COVID-19 pandemic.

Relatives were happy with the care and support their family member received and spoke positively about staff and the difference the service made on their family members life. People's care and support needs were met by staff who knew them well and enjoyed working at the service

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Rating at last inspection

The last rating for this service was requires improvement (published 18 April 2019).

Why we inspected

This was a planned inspection based on the rating at the last inspection. In addition, we had received some information from stakeholders that there were staffing and recruitment challenges at the service. As a result, a decision was made to undertake a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement and is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link Cambridge House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in November 2017 we were concerned because the service was poorly managed in respect of the maintenance of the building. At that time the provider did not have an effective governance system to monitor the quality of the service and identify the risks to people. At that inspection improvements were required to ensure that people were kept safe in the service. Some radiators were not covered and the temperature of hot water to people's rooms and communal areas was not controlled.

At this inspection we found that some environmental concerns had been rectified. Over the past year a number of improvements had been made, however there was still further work needed. The manager had worked hard on implementing the necessary environmental changes but other areas of the service had not been kept up to date.

Cambridge House has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The outcomes for people did not fully reflect the principles and values of Registering the Right Support because people did not live in an environment that valued and underpinned the best practice guidance and were not supported with appropriate staffing levels.

People’s experience of using this service:

¿ People did not always receive a service that provided them with safe, effective and high-quality care.

¿ There were not enough staff deployed to meet people's needs consistently. This meant that for one person they did not always have varied or meaningful activities and their personal care needs were not met when always required. This was because staff were supporting the people they were funded to provide one to one care with.

¿ Safety of the premises was not always a priority for the provider. 10 out of 11 fire doors were being propped or held open due to a failure of the fire door system and this had been the case for at least six months.

¿ The service was not always well led and there was a lack of quality assurance processes in place to identify the issues found during the inspection.

¿ People received support from staff who were kind and treated them with respect.

¿ People were supported to maintain a healthy and balanced diet.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Rating at last inspection: The service was rated ‘Requires Improvement’ at our last inspection. The report following that inspection was published on 24 January 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At the last inspection in April 2015 the service was rated as ‘Good’ in all of the key questions we ask and overall. At this inspection we have concerns in a number of key questions and there are a number of breaches of the regulations. The service has been rated ‘Requires Improvement’ in four of the key questions and as a result overall.

Cambridge House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cambridge House accommodates up to six people in one bungalow which was situated in a cul-de-sac in a residential area.

The care service has not 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. People did not live in an environment that valued and underpinned the best practice guidance.

There was not a registered manager in post at the time of our visit. 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. The previous registered manager left the service in June 2017 however the deputy manager had been offered the managers post and had verbally accepted it. They told us that they hadn’t signed their contract yet and hadn’t submitted an application yet to register although they had found out more about it by telephoning CQC for advice. This person has been referred to as the acting manager throughout the report.

The service was poorly managed in respect of the maintenance of the building. The provider did not have an effective governance system to monitor the quality of the service and identify the risks to people. The provider had not picked up issues that were identified in this inspection.

Improvements were required to ensure that people were kept safe in the service. Some radiators were not covered and the temperature of hot water to people’s rooms and communal areas was not controlled. People living at the service required a lot of support and prior to our inspection, neither of these risks had been assessed.

Staff were recruited safely and received an induction when they first started working at the service. People were supported by sufficient staff who knew them well. Staff had received training and supervision and were able to describe how they worked with people to meet their needs.

Staff had an understanding of safeguarding procedures and how they should report any concerns and appropriate procedures were in place for the safe recruitment of staff. People's medicines were managed appropriately and their healthcare needs were understood and met by the service.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people's ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

People's dietary needs and preferences were supported. People chose what they wanted to eat and drink. People's support plans were personalised however they were also lengthy and out of date in places. Improvements were required to make them clear and to ensure that the information within them was current and relevant to the person.

People participated in a range of activities and received the support they needed to help them do this. Staff respected people's privacy and dignity and understood the importance of maintaining and supporting confidentiality. People were provided with the support they needed to maintain links with their family and friends.

We found a number of breaches 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 the report.

At this inspection we found that the provider had taken action to make the required improvements to ensure that people using the service were safe.

This was a follow-up inspection to our recent inspection to consider two outcomes that were non-compliant and we are now satisfied that the action taken now means the service is compliant with those outcomes.

The service needed to improve on leadership as no registered manager had been in place for some time. We had concerns for the safety of people as environmental issues such as fire safety, laundry facilities and water safety had not been assessed and risks reduced.