We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Cambian Cedars 37 Broadway Avenue, Bordesley Green, Birmingham, B9 5LY Tel: Date of Inspection: 21 May 2013 Date of Publication: June 2013 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Safeguarding people who use services from abuse Management of medicines Supporting workers Assessing and monitoring the quality of service provision Inspection Report Cambian Cedars June

2 Details about this location Registered Provider Registered Manager Overview of the service Type of services Regulated activities Cambian Learning Disability Midlands Limited Mrs. Lynne Barbara Ngaaseke Cambian Cedars is a hospital that provides a locked rehabilitation service for up to 22 men who have a learning disability and who may be detained under the Mental Health Act Hospital services for people with mental health needs, learning disabilities and problems with substance misuse Rehabilitation services Assessment or medical treatment for persons detained under the Mental Health Act 1983 Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Cambian Cedars June

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Safeguarding people who use services from abuse 8 Management of medicines 10 Supporting workers 12 Assessing and monitoring the quality of service provision 13 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Cambian Cedars June

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 21 May 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff and talked with other authorities. What people told us and what we found There were 15 people using the service on the day of our inspection. We spoke with five people who used the service, seven members of staff and the manager. People who used the service were supported to ensure their physical and mental health needs were met. People told us and we saw that each person had an activity plan. People were offered regular opportunities to develop their independent living skills and take part in leisure activities. People were encouraged to bring their personal possessions with them to personalise their bedrooms. One person said, "I love my room, I have all my own things in it." Systems were in place to ensure that people using the service were safeguarded from harm. One person told us, "It's nice here; the staff are good to me." People had their medicines as prescribed to ensure their health and well being. People who used the service were supported by staff who had the skills and knowledge to meet their individual needs. People were asked for their views about the home and audits of the quality of care that people received were completed. Where needed, improvements to the service were made as a result of these. You can see our judgements on the front page of this report. Inspection Report Cambian Cedars June

5 More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Cambian Cedars June

6 Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement A team of professionals worked at the hospital. These included care staff, nurses, psychologists, psychiatrists, occupational therapists and speech and language therapists. We saw during our inspection and staff spoken with told us how the team worked together to ensure that the needs of people using the service were met. People's needs were assessed and their care and treatment was delivered in line with their individual care plan. When people moved into the hospital an initial care plan was put in place based on the assessment of their needs that was completed before their admission. During the first eight weeks of their stay a more thorough assessment of needs was completed with the person and the team of professionals working at the hospital. From this a more detailed care plan was developed. Staff spoken with told us that advocates were provided and one advocate held a clinic at the hospital each week. Advocates were also involved in ward rounds to help people make their views known and be listened to. Records sampled showed that people were registered with a local GP and saw them when needed. Records sampled showed that people's physical health needs were met and investigations into people's physical ill health were completed. Records sampled showed that people had annual health checks and check ups when needed at the optician and dentist. Some people were reluctant to maintain their personal care due to their mental ill health. Care plans showed how staff were to support people with this whilst respecting their choice and dignity. People were dressed in individual styles that reflected their age, gender and cultural background. Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Records sampled included how risks to the person were to be managed. We saw that people were encouraged to take risks to increase their independence however staff Inspection Report Cambian Cedars June

7 supported people to ensure that this did not impact on their welfare and safety. People told us that they did their own washing with support from staff. We saw one person being supported by staff to do this. A kitchen was provided where people spent time with occupational therapists to cook a meal or do some baking depending on their individual plan. One person said, "I'm going to cook stew this week, I go to the shop with staff and then come back and cook." Records sampled showed and people spoken with told us that they met with the occupational therapists soon after they were admitted. They discussed with them their interests, the daily living skills they had and what they wished to develop. From these meetings, an activity plan was devised for the person. Records showed and people spoken with said that that the person signed to agree to this. One person said, "We have a fixed structured programme but it is reviewed, we then work towards the next step and build up to doing something different." Records sampled showed and people spoken with told us that they had their leave as agreed by the team. We saw that people had regular opportunities to access the community. People told us that they went to the local shops and to shops in the city centre. Two people went out to the cinema in the afternoon. One person told us that they enjoyed learning to play the guitar and had been on a course for this. One person told us that they regularly went with staff to the local gym. A gym was provided in the hospital and a personal trainer was soon to be employed to work there so to give people more opportunities for exercise. Inspection Report Cambian Cedars June

8 Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement We saw that information was provided to people using the service about who to contact if they wanted to report abuse. This was provided in a format using pictures, making it easier to understand. Staff spoken with told us and records sampled showed that all staff had received training in safeguarding vulnerable adults and children from abuse. One member of staff told us that this was good training which had ensured they had a good awareness of how to safeguard people from harm. They said that this was regularly updated so their knowledge was refreshed. The provider responded appropriately to any allegation of abuse. Staff had informed us and the local authority when an allegation of abuse had occurred. They had taken action to ensure that people using the service were safeguarded from harm. People who use the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements. Records sampled showed that each person had a plan of how they would be supported with their behaviour. This detailed what the triggers and the early warning signs to their behaviours were. This meant that staff could respond to the person's behaviour so safeguarding the person, the other people using the service and staff from harm. The plan included how staff would support the person to try to reduce these behaviours and reduce any risks to the person and others. Staff spoken with told us that they had received training in the management of violence and aggression. This was initially a three day course that included theory and practical training. Staff said they had a one day refresher every 12 months to ensure their knowledge and skills were updated regularly. Staff spoken with told us that restraint was only used as a last resort. Staff understood that for some people being restrained may cause them to become more distressed. Staff told us that talking with the person usually helped to calm them down and that they did not feel that restraint was a good way to manage people's behaviour. However, they said that restraint would be used where people were in danger of being harmed to reduce the risks. Staff records sampled showed that before a member of staff started working there the Inspection Report Cambian Cedars June

9 required checks were undertaken. This meant that the person was suitable to work with the people who used the service and had not committed a criminal offence that would affect people's safety and well being. Inspection Report Cambian Cedars June

10 Management of medicines People should be given the medicines they need when they need them, and in a safe way Our judgement The provider was meeting this standard. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Reasons for our judgement The trained nurses employed at the hospital gave medicines to the people who used the service. Staff told us that when they first started working there they completed an assessment to ensure they were competent to give medicines safely. Appropriate arrangements were in place in relation to the recording of medicine. Medicine records sampled showed that records were completed. This indicated that medicines had been given to each person as prescribed by their doctor. Medicines were kept safely. We saw that medicines were kept in locked cabinets in rooms that were locked. This meant that people did not have access to medicines that were not prescribed for them that could have harmed their health and well being. Medicines that needed to be kept at cooler temperatures were stored in a locked medicines fridge. Air conditioning units were provided in the rooms where medicines were stored. This ensured that medicines were kept at the required temperatures to ensure they were effective in meeting people's health needs. Medicines were safely administered. Some people were prescribed injections to be given when needed to help them calm down and reduce their agitation. Records sampled showed and staff spoken with told us that if an injection was given they did checks on the person's physical health. This helped to ensure that the person was alert and the injection was not having an adverse effect on their physical well being. Some people had been assessed as being able to self administer their medicines. There were different stages for the person to achieve to ensure that they were having their medicines safely but they also had increased independence. At the first stage the person came to the clinic and took their medicines under the supervision of the nurse. They needed to be able to show they were able to do this safely before progressing to the next stage where they would keep their own medicines locked in their bedroom. Records sampled showed that each person's ability to do this had been assessed and reviewed to ensure their safety and well being. One person regularly refused their medicines. We saw that all the professionals working with the person had agreed that the person should be given their medicines in drinks or Inspection Report Cambian Cedars June

11 food. It was agreed that it was in the person's best interests to be given their medicines in this way to ensure their health and well being. Inspection Report Cambian Cedars June

12 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement Staff records sampled showed and staff spoken with told us that when a member of staff first started working at the hospital they completed an induction. This was detailed and spread over several days so to allow staff the time to develop their skills and knowledge. When staff first started working there they completed a probationary period. The staff who supervised them assessed whether or not they met the required standard to continue to work at the hospital. Records showed and staff spoken with said that staff had completed the training they needed so they knew how to support the people who used the service to meet their needs. Some training was provided face to face and staff completed other training on line. For the on line training staff had to complete modules and were assessed as competent before they could progress to the next module. Staff received appropriate professional development. Staff spoken with told us they were supported by the provider to attend courses that would ensure they had the skills they needed to work with the people who used the service. Staff spoken with told us they had received regular supervision with their manager which they found useful. Staff also said they received clinical supervision where needed to ensure their professional knowledge was kept up to date. Staff spoken with told us that they thought that the knowledge and skills of each member of the staff team was valued. They said this ensured that as a team they had the skills and knowledge to support the people who used the service. Inspection Report Cambian Cedars June

13 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Reasons for our judgement People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Staff and people using the service told us that every Friday a community meeting was held. This gave people who used the service an opportunity to talk about the things that were important to them and how if they had any concerns, these could be resolved. Records sampled showed that decisions about people's care and treatment were discussed with them and their relatives where appropriate. Staff spoken with told us that regular staff meetings were held where they were able to air their views and these were listened to. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. Staff spoken with told us how all the staff working there had discussed the findings of the report on Winterbourne View and the abuse that happened there. They said they had implemented the report recommendations to ensure that the hospital was safe. Staff spoken with told us that reviews of incidents were completed fortnightly with the team of professionals that worked there. Daily handover meetings were also held with the team to review how people were being supported. This helped to ensure that risks to people's safety and well being were managed and reduced. Records looked at showed that regular audits were completed. These included audits of infection control, care records, the environment, medicines and health and safety. Where actions were identified to improve, an action plan was put in place. These were monitored to ensure that actions were taken to improve the hospital for the benefit of people using the service. Inspection Report Cambian Cedars June

14 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Cambian Cedars June

15 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Cambian Cedars June

16 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Cambian Cedars June

17 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Cambian Cedars June

18 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Cambian Cedars June

19 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Cambian Cedars June