About the service Cambian Lufton Manor College is a college for students aged 16 to 25 with learning disabilities or autism and other complex needs. The college is spread across two sites, the main house site and Manor Farm. On each site there are several communal areas plus accommodation buildings. There are also five community houses for students to develop independent living skills. Not everyone who lived in the community received personal care. The Care Quality Commission (CQC) only inspects where students 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.
At the time of inspection there were 88 students and 65 students were receiving a regulated activity. 11 students had a 52-week placement, 54 students were at the college for 38 weeks of the year. 23 students attended the college as day students; they did not receive either regulated activity. Students were placed by 22 different local authorities. Many of the students had limited verbal communication skills to express their experience.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that students who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for anyone with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. Students using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The college was a large service, with many smaller buildings used for accommodation. The main house site and Manor Farm registered for the support of up to 74 students. Over ten people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the layout of the college area and the fact some of the accommodation buildings had recently had the number of students reduced.
People’s experience of using this service and what we found
Although students told us they were safe and happy we found the students were not being kept safe from potential harm and abuse. Students were at risk of being inappropriately supported when they were displaying behaviours which could challenge others. Not all systems were adequate to protect them from harm. Risks were not always being assessed. Those that had been identified did not always have ways to mitigate the risks. Some risks had been identified around the management of medicines. Students were placed at risk of potential harm because health and safety systems were not always effective.
Staff told us, and we found, they were working very long hours. There were discrepancies in how the management had identified the required staff levels. Some staff were working with students with specific health conditions. There was no training or guidance for staff to follow. Most staff were not receiving adequate supervision.
The management were not aware of shortfalls found during the inspection and lack strategic oversight. They had incomplete systems in place to resolve issues when concerns had been found by them. Documents which should have been readily available during the inspection were not always easily produced. The management had plans for the future to try to resolve the issues.
Students were supported to have maximum choice and control of their lives. However, it was not always clear if staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Legislation did not appear to have been followed for some students who had significant restrictions in place.
Care plans for students were not always personalised. Sometimes they lacked key guidance for staff to ensure consistent care was provided and their needs were met. There were good links with other health and social care professionals including access to onsite therapists and professionals.
Students were supported by kind and caring staff who knew them well and often went above and beyond to prevent impact on them. Staff respected people’s privacy and dignity throughout the inspection. Strong links had been developed with the community including for work placements.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
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.
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 outstanding insert (published 8 April 2017).
Why we inspected
The inspection was prompted due to concerns received about medicines management, health and safety checks, staffing and the management of the college. A decision was made for us to complete an aligned inspection with Ofsted who had received some similar concerns and examine those risks.
We have found evidence that the provider needs to make improvements and students were at risk of harm. Please see safe, effective, responsive and well led domains sections of this full report.
The overall rating for the service has changed from outstanding to inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cambian Lufton Manor College on our website at www.cqc.org.uk.
Enforcement
We have identified seven breaches in relation to staffing, keeping students safe from potential risks of harm and abuse, personalised care, the management of medicines, use of restrictive practices, students lacking ability to consent, notifying the Care Quality Commission in line with their statutory obligations and the systems in place to manage the college at this inspection.
We have also made a recommendation in relation to training for staff working with children and young people.
Following the inspection, we completed enforcement to the provider's registration so they had to send a monthly report on the actions they were taking to improve the service.
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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.