Cameron Lodge

Cameron Lodge is a ‘care home’ and is registered to provide accommodation and personal care for a maximum of 12 people. The accommodation is a house and two bungalows on the same site, with each one having separate and adapted facilities.

At the time of the inspection, four people lived in the house and three people lived in each bungalow. Although in total 10 people used the service, only seven people received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. People using the service had a range of conditions including learning and physical disabilities, some people also had mental health needs.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured that people who used the service could live as full a life as possible and achieve the best possible outcomes that included control, choice and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service:

People were treated with kindness, respect and compassion. Staff listened to people, answered questions and took interest in what people were saying. People were supported to express their views and, where possible, were actively involved in making decisions about their care and support. People's privacy, dignity and independence were respected and promoted. One person told us, “I am supported well by the staff.”

Medicines were stored and managed safely. There were policies and procedures in place for safe administration of medicines. People received their medicines when they needed them from staff who had been trained and competency checked.

People were protected from abuse. Staff had received regular safeguarding training. They knew how to identify potential signs of abuse and how to report any concerns. Risks associated with people’s care had been identified and full risk assessments were in place. Risks to people and the environment were also assessed and minimised.

Staff were knowledgeable about the Mental Capacity Act 2005. They knew to seek consent for care and knew the process to help those who lacked capacity to make decisions. People’s needs were met by the adaptation and design of the service. The service was clean and staff correctly observed infection control and prevention measures.

People had developed good relationships with staff, they were knowledgeable about people’s support needs, as well as their likes, dislikes and interests. Staff were responsive to changes in people's health needs. People had access to GP’s and specialist healthcare services. Their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

The registered manager recruited staff with relevant experience and aptitude to work with people. New staff were given an induction and all staff received on-going training. There were enough staff to keep people safe and meet their needs.

People felt included in planning their care. People were supported to live the lifestyle of their choice, culture and religion were actively considered and supported. People told us they felt listened to by staff. People’s needs were assessed, and their care was delivered in line with current legislation. Some people were supported by advocates and relevant person representatives. These are independent supporters who ensure people’s wishes are known and accommodated.

People received a service that met individual needs and helped them to achieve their goals and ambitions. People were encouraged to be as independent as possible. One person told us, “I have a job here that I am paid to do.”

People enjoyed the food provided, staff supported people to maintain a balanced diet, monitored their nutritional health and, where needed, supported people to eat safely.

Accidents and incidents were reported by staff in line with the provider’s policy. The registered manager took steps to ensure that lessons were learned when things went wrong, there was a very low accident and incident rate.

People told us they would feel comfortable about raising any complaints with staff and the registered manager. People said the registered manager and staff were approachable and supportive.

The provider, registered manager and staff had a clear vision for the service. The provider and registered manager monitored the service in to ensure they continued to provide a good quality service that maintained people’s safety. People, relatives and visitors were asked for feedback about the service they received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was Requires Improvement (published 13 July 2018), when there were two breaches of regulation. 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 was a planned inspection based on the previous rating.

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.

Cameron Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cameron Lodge accommodates up to 12 people across three separate units, each one having separate adapted facilities. The accommodation is in a house and two bungalows next door. At the time of the inspection four people were living in the house and five people between the two bungalows.

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.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected the service in December 2016. We found two breaches of regulations, the provider had not made sure that all care was person centred, met people’s needs and reflected their preferences. Checks and audits completed at the service had not been effective as shortfalls found at the inspection had not been identified. At this inspection, improvements had been made but there was a continued breach and a new breach of regulation was identified. This is the second consecutive time the service has been rated Requires Improvement.

Checks were completed on the environment and areas which put people at risk had been identified. The registered manager and staff had informed the provider that some of the environment was not safe, including the outside paths and forecourt that people used regularly to leave and enter their home. The house had not had a functioning washing machine since January 2018 and soiled laundry was being transported between the buildings. There was an odour of urine in some bedrooms and communal areas in the house. The provider had not acted to make the environment safe and reduce the risk of infection for people.

Following the inspection, some building work had been undertaken to improve the environment and the provider confirmed they had planning permission for further improvements but there was no date for the work to start.

At the last inspection, the culture within the house was not person centred, people were not leading meaningful lives, enjoying activities and learning new skills. Following the last inspection, the registered manager had supported staff with training and reflecting on their work practices to help their understanding of supporting people to lead meaningful lives. We observed staff supporting people to be as independent as possible and people had learnt new skills since the last inspection. The deputy manager’s office was in the house, so they were available to support people and staff.

The culture within the house had improved, there was an open and inclusive atmosphere, people were comfortable in the company of staff. Staff communication skills had improved, they used both verbal and non verbal communication to support people. The registered manager had a vision for the service, for people to become more independent and be able to go out when they wanted to be part of the community. This was shared by staff and we observed people going out into the community. Accidents and incidents were analysed to identify patterns and trends, action had been taken to mitigate the risk of them happening again and to implement any lessons learnt.

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.

Staff understood their responsibilities in keeping people safe and were confident to report any concerns to the registered manager and that they would be dealt with. People were supported to take risks, staff followed detailed guidance to mitigate the risks and keep people safe. Each person had a detailed care plan that included their cultural, spiritual and sexual needs. Before coming to live at the service, people were supported to spend time at the service to see if they were happy to move in. People’s needs were assessed using recognised assessment tools and in line with current guidance. People’s end of life wishes were recorded when known and supported to plan so that these wishes would be adhered to.

There were sufficient staff on duty to meet people’s needs, staff were recruited safely. New staff completed an induction to learn about people’s choices and preferences. Staff received training appropriate to their needs, they met with the registered manager to discuss their practice and development needs. People received their medicines safely and when they needed them.

People were supported to eat and drink a healthy balanced diet. People were encouraged to eat the fruit and vegetables they enjoyed and prepare their own snacks. Staff supported people to be as active as possible for example encouraging them to go out for walks.

People were supported to attend appointments with healthcare professionals including GP, chiropodist and dentist. Staff worked with social care and health professionals to assess people’s needs and enable them to access the community. Staff followed the advice given by professionals.

People had access to information in a format they understood, there were pictorial displays around the service to help people communicate how they were feeling, if they had any complaints and what the choice of meal was that day. Complaints were investigated following the provider’s policy. The quality assurance survey was available in pictorial form so people were able to express their views.

People’s privacy and dignity was promoted, some people had devices on their doors that enabled them to be independent but alerted staff that they had left their room. Staff understood when people needed privacy and respected this. We observed people being treated with kindness and respect. Staff spoke with people discreetly and listened to them when they were anxious, people were appeared to find this reassuring.

The registered manager and staff completed audits on all areas of the service, any shortfalls identified were rectified or reported to the provider. People, relatives and staff were asked for their views and opinions of the service. The results had been positive when analysed and the registered manager continued to monitor the quality of the service. Staff and resident meetings were held regularly and action had been taken to address any concerns raised.

The registered manager maintained a good working relationship with the local commissioning groups and local safeguarding authority. They had used incidents as a learning process to reduce the risk of them happening again. The registered manager attended meetings with managers from the providers other services and planned to attend local forums to keep up their practice up to date.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The registered manager had informed CQC of important events such as incidents that had been reported to the police, events that may stop the service, serious injuries and allegations of abuse in a timely manner as required.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the registered manager had conspicuously displayed their rating on a notice board in the entrance hall.

At this inspection there is a new breach and a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported by a deputy manager.

The culture in the main house was old fashioned and did not support people’s individual development and preferred lifestyles. In the bungalows the culture was more family orientated with people having more of a say and more meaningful occupation and time with staff.

Staff did not consistently speak with people in a professional, respectful, sensitive and appropriate way. Staff did not have the skills to communicate effectively with everyone placing people at risk of not being heard. People were not consistently supported to express themselves and were not able to raise concerns or complaints. There was a complaints process that was accessible to staff, families and visiting professionals.

Staff knew people’s life histories, likes and dislikes and any preferred routines. Some people were encouraged to maintain their independence but not everyone was supported to be as independent as they could be. In the main house there was less opportunity for people to engage in tasks and routines.

People were not consistently encouraged and supported to keep occupied. People living in the bungalows were occupied throughout the inspection. However, people living in the main house were not always offered the choice of activities.

The registered manager encouraged people to feedback on the quality of the service and to share their experiences. Quality questionnaires were sent to families, health professionals and staff each year but people were not included since group meetings had been unsuccessful. Regular audits of records were recorded and included what action was needed, who would take the action and by when. However, shortfalls identified during the inspection of the quality of the support had not been picked up by the provider’s audits.

People were protected from the risks of abuse, including financial abuse. Staff knew how to respond to abuse and how to keep people safe. Risks to people, including any accidents or incidents, were assessed, monitored and reviewed.

There were enough staff to meet people’s needs. There were contingency plans for emergencies, such as staff sickness. The registered manager followed the provider’s recruitment process to make sure staff employed were of good character and safe to work with people.

People received their medicines safely and on time from staff trained to administer medicines. Medicines were stored, disposed of and managed safely.

Staff completed training to meet people’s basic needs but knowledge and awareness of best practice was limited. Staff had one to one meetings and an appraisal to discuss their personal development. Staff communicated effectively with each other to meet people’s needs.

People made some day to day choices in their daily life, for example, what to wear and what meals to have. Staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) but did not always put these into practice. Applications for DoLS had been made in line with guidance.

People enjoyed a choice of healthy food and drinks. Staff knew what foods and drinks people preferred and supported them to maintain a healthy diet. People’s health was assessed, monitored and reviewed. People had access to health care professionals when they needed them, such as speech and language therapists and community nurses.

The atmosphere at Cameron Lodge was relaxed and calm. People appeared content in the company of each other and staff. Staff promoted people’s privacy and dignity. People’s confidentiality was respected and their records were stored securely.

People’s choices and preferences for their end of life care were recorded and kept under review. Care plans showed what people’s different beliefs were and how to support them.

The registered manager completed a pre-assessment when people were thinking of moving to the service to check they could meet their needs. People and their relatives were involved in planning and reviewing their care and support. Each person had a care plan which centred on them and their preferences and these were regularly reviewed.

There was an open communication between staff and the management team. Staff told us they were able to give honest views and had regular staff meetings to discuss any concerns.

Notifications had been submitted to CQC in line with guidance.

We last inspected Cameron Lodge in October 2013 when no concerns were identified. At this inspection breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified

The inspection of April 2013 found that the provider needed to take action to make sure people were living in an environment that was adequately maintained and hygienically clean to prevent the risks of infection.

The main house were six people lived was now adequately maintained. Hallways, bedrooms, bathrooms and landing areas had been redecorated. Furnishings and equipment had been replaced. Areas in the home like the kitchen and bathrooms were hygienically clean. The home smelt clean and fresh.

Staff were properly supported to provide care and treatment to people who used the service. Staff had received the necessary training and were supervised to make sure they could carry out their role effectively and safely.

Most of people living in the home were unable to verbalise to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

People who use the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond to their needs. Staff knew the people well were able to communicate with them using a range of methods. If people were unhappy about something the staff were able to recognise the signs and take the appropriate action to resolve any issues. Staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported

The main house were six people lived was not adequately maintained. Areas needed redecorating and some furnishings and equipment needed replacing as they were old, ripped and dirty. Areas in the home like the kitchen and bathrooms were not hygienically clean. There was a strong odour in parts of the main house.

Staff were not properly supported to provide care and treatment to people who used the service. Staff had not received the necessary training and were not supervised or appraised to make sure they could carry out their role effectively and safely.

At the time of the inspection, there were 12 people living at Cameron Lodge.

Some of the people living in the home were unable to verbalise to tell us about their experiences so we spent time with people and observed interactions between the people and the staff.

We saw that staff listened to people and took their views seriously and always answered their questions in a way that they could understand. We saw that the staff were friendly and people seemed relaxed in the home.

People told us and indicated that they received the care and support that they needed at Cameron Lodge. They indicated that they were happy at the home. Some people were participating in activities which they seemed to enjoy.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

Some staff told us that they would like to do different activities with people. They said this was sometimes difficult due to not having enough drivers to take people out. Specialists who visited the service said that the opportunities for community involvement for people could be more varied and improved.