Archived: Cambian - Trent Valley Road

Updated 18 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23 and 24 November 2016 and was unannounced. The inspection team consisted of one inspector.

Before the inspection we checked the information we held about the service and provider. This included the notifications that the provider had sent to us about incidents at the service and information we had received from the public. We used this information to formulate our inspection plan.

We spoke with the three people who used the service, five members of care staff, the deputy manager, the home manager and the provider’s senior homes manager. We did this to check that good standards of care were being met.

We spent time observing how people received care and support in communal areas and we looked at the care records of the three people who used the service to see if their records were accurate and up to date. We also looked at records relating to the management of the service. These included audits, staff rotas and training records.

Updated 18 January 2017

We inspected this service on 23 and 24 November 2016. This was an unannounced inspection. Our last inspection took place in October 2015. At that time we found the provider was in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This meant they were not meeting the required Regulatory requirements. As a result of this the service was rated at the time as ‘requires improvement’.

The service is registered to provide accommodation and personal care for up to six people. People who use the service have complex needs which may include a mental health condition and/or a learning disability. At the time of our inspection three people were using the service.

The service did not have a registered manager. 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 and associated Regulations about how the service is run. The home manager had however applied to register with us and the process for this registration was in progress.

At this inspection, we identified a number of Regulatory breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At this inspection, we found that the provider did not have effective systems in place to effectively assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

The provider did not always notify us of reportable incidents and events as required and the CQC rating from our last inspection was not being displayed in accordance with the law.

Risks to people’s health, safety and wellbeing were not consistently identified and planned for on admission, and people did not always receive their planned care in a manner that promoted their safety.

Medicines were not always managed safely and people were not always protected from the risk of abuse as local and national reporting guidance was not consistently followed. This meant that people’s safety, health and wellbeing was not consistently promoted.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

Staff received training to provide them with the knowledge and skills needed to meet people’s needs. However, unsafe and inconsistent staffing levels meant there was a risk that physical intervention (restraint) may not always be used effectively and safely.

Independence was promoted, but some people felt that some of the restrictions placed on them at the home limited their independence at times. Some people felt they were not treated equally with the other people who used the service. This was because they felt they did not have equal access to the home’s vehicle to enable them to participate in community activities in line with their individual preferences.

People knew how to complain and complaints were investigated. However improvements were needed to ensure meetings about complaints were held at people's preferred locations.

Safe recruitment systems were in place to ensure staff were suitable to work at the home. People spoke fondly about the staff. However, some people felt that recent changes at the service had resulted in staff having less time to interact with them.

Staff understood the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant if people could not make decisions about their care, the staff knew how to support them to ensure decisions were made in their best interests. Consent to care was sought before staff provided people with care and support.

People could access enough food and drink that met their individual preferences.

People were involved in the planning and review of their care.