Camber Lodge 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. Camber Lodge provides accommodation for up to eight people, living with a learning disability, in one adapted building. At the time of the inspection there were seven people living at the home.

We had previously inspected Camber Lodge in October 2016 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not always managed safely, there were not enough staff working at night and the registered manager had not submitted appropriate notifications. We also found that people’s care plans lacked guidance and detail, and shortfalls had not been identified and addressed through the quality assurance system. We inspected the service again in October 2017 to check that improvements had been made. We found the provider had met the regulation in relation to staffing at night and submitting notifications. However, we made a recommendation because Deprivation of Liberty Safeguards (DoLS) notifications had not been submitted. The provider had met the regulation in relation to risks to people however, further improvements were needed to ensure risks to people’s health were fully addressed. We found there was still a breach relating to people’s records, as these were not consistent and did not contain all the information staff needed. This had not been identified through the quality assurance system. We also identified improvements were needed in relation to the staff culture at the home. The provider sent us an action plan to tell us how they would address these issues.

We had received concerns about the service therefore we brought this unannounced comprehensive inspection forward to look at the concerns and all aspects of the service. We wanted to check that the provider had made improvements, and to see if the service now met legal requirements. We found there had been a number of changes at the home and saw some improvements had been made, however Regulation 17 had not been met and we found further breaches of regulations. This is the third time the service has been rated as requires improvement.

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.

There was a registered manager at the service. 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.

At this inspection we found that some DoLS had expired and applications for their review and renewal had not been submitted. Where DoLS authorisations were in place, we had not been notified of this. We found there had been improvements to people’s records and the quality assurance system. However, further time was needed to allow these improvements to continue and be fully embedded into every day practice.

Improvements had been made to the culture of the service. Staff told us they felt supported by the registered manager. The registered manager had good oversight of the improvements needed to further develop the service. Although there was no formal action plan for improvements they shared with us improvements they knew they had to make and ensure all regulations were met.

People received care that was safe. Staff had a good understanding of the risks associated with the people they looked after

We undertook an inspection at Camber Lodge on 20 and 23 October 2017. Camber Lodge provides accommodation, care and support for up to eight adults with a learning disability. At the time of our inspection there were seven people living at the home.

There was a registered manager in post. 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.

We had carried out an inspection in October 2016 where we found the provider was not meeting all the regulations. The provider sent us an action plan and told us they would address these issues by February 2017. At this inspection we found although improvements had been made further improvements were still required. Where people lived with health related conditions some guidance was not in place about how to support people. Some risks identified had not been fully addressed. We made a recommendation about this.

There was an audit system in place however, this had not identified the shortfalls we found in relation to people’s records, which were not always person-centred and did not contain all the information staff needed. This did not impact on people because staff knew them well. They had a clear understanding of the support people needed and how they liked this provided.

There was a system in place which ensured medicines were stored, administered, disposed of and safely managed.

Staff had a clear understanding of the risks associated with the people they supported and how to keep people safe. There were procedures in place to safeguard people from abuse. There were enough staff who worked each shift to meet people’s needs. Staff had been safely recruited.

Staff knew people really well. They treated them with kindness, respect and understanding. Staff worked with people to help develop their confidence and independence. People were involved in making decisions about what they did during the day. Staff understood people’s needs and preferences and communicated with them in a way that met their individual needs.

The manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff received the training they needed to look after people effectively.

People were supported to eat and drink a variety of meals that met their individual needs and preferences. Staff ensured people had access to external healthcare professionals when they needed it.

People received support that was individualised and responsive to their needs because staff had a good understanding of people’s individual needs and choices. People had the opportunity to engage in activities of their choice and staff supported them to participate if they wanted to.

A complaints policy was in place and people approached the manager or staff with any concerns.

We found a breach of the Regulations 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 this report.

This inspection took place on 25 October 2016, was unannounced and was undertaken by one inspector.

Camber Lodge provides accommodation and care for up to eight adults with learning disabilities. At the time of our inspection there were six people living in the home. There was a registered manager in post.

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.

People did not always receive care and support from sufficient numbers of staff. Staffing levels at night were not consistently sufficient to ensure that people received safe care.

People’s did not aways have their risks assessed and care plans were not in place to mitigate known risks. People’s plans of care had not been reviewed appropriately and were not reflective of their current care and support needs. However, staff knew people well and provided the care that they thought people needed.

Staff had not received all of the training required to equip them with the skills and competencies to provide safe care to people. A formal system of supervision had not been implemented and staff did not always receive the support that they required to work effectively in their role.

The provider had failed to implement an appropriate system of quality assurance audits in order to identify and address short falls in the service. When shortfalls had been identified timely action to rectify these was not always taken by the provider or registered manager.

People received their prescribed medicines safely and staff knew what action to take if they felt people were at risk of harm. Safe recruitment practices had been followed to ensure that the staff employed by the provider were of a suitable character to provide people with care and support.

People’s health and well-being was monitored by staff and they were supported to access relevant health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to help maintain their health and well-being.

People received care and support from staff that knew them well. Staff provided people with dignified care and support in line with their preferences. People were supported to pursue their interests and hobbies and partake in activities of their choice.

The registered manager was a visible role model in the home and motivated staff to provide person centred care and support.

At this inspection we found the service to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 and one regulation of the Care Quality Commission (Registration) Regulations 2009. The actions we have taken are detailed at the end of this report.

Our inspection team was made up of one adult social care inspector. We set out to answer our five key questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service and staff told us, our observations during the inspection and the records we looked at. We spoke with most of the people who used the service, three care staff and the manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights. Staff we spoke with knew about safeguarding of vulnerable adults and what action to take if they needed to. Records showed that all staff had received training about this. People who lived at the service said that they felt safe. One person told us, “I feel safe and happy."

CQC monitors the operation of the Deprivation of Liberty safeguards (DoLS) which apply to care homes. This is where restrictions may be placed on some people to help keep them safe. While no DoLS applications had needed to be submitted, we found that suitable policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us, or indicated through gestures and facial expressions, that they were happy with the care delivered and their needs had been met. Our observations and speaking with staff showed that they had a good understanding of people’s care and support needs and that they knew them well. One person told us “I am happy with the care I get”. We saw that staff had received training to meet the needs of the people they supported.

Is the service caring?

People told us that the staff were kind and attentive. Care records contained personalised information which helped staff to know the people they supported and how to meet their needs. We saw that staff showed patience, compassion and understood how to support people as individuals. One person told us “The staff help us and are kind”. Our observation found that staff knew how to communicate effectively with people, we saw that staff sometimes used Makaton signs and symbols to help them do this.

Is the service responsive?

People’s needs had been assessed before they moved to Camber Lodge. This meant that the service had the skills and facilities to meet their identified needs. People told us that they met with their key workers once a month to talk about what was important to them. People had access to activities that were important to them and had been supported to maintain relationships with friends and relatives where possible.

Is the service well-led?

The provider had systems in place to monitor and improve the services provided. The registered manager showed a good knowledge and oversight of the running of the home. Throughout the inspection, the manager and staff demonstrated that they placed the needs of the people who lived at Camber Lodge at the heart of the service. Discussion with staff found that they had a good understanding of their responsibilities and of the values of the service.

We spoke with four people who used the service and four members of staff at the inspection. The manager was not available on the day of inspection. One of the members of staff was acting manager. Following the inspection we spoke with the manager as well as three external professionals who worked with people who lived in the home.

People we could speak with told us or indicated that they liked living in the home and that the staff were kind to them. People liked the activities they were involved in and we observed others with communication difficulties expressing enjoyment in what they did.

Staff told us that they felt well qualified for their work and that Camber Lodge was, “homey”. They liked working there and demonstrated a good understanding of people’s individual needs. We saw evidence of individualised care. Access to health care was supported when required. People’s needs were monitored. Staff told us they had felt “stretched” due to the recent, although temporary, increased needs of one person.

Appropriate independent support had been provided for one person who used the service. There were safe medication processes in place and a stable work force. The personal folders viewed on the day did not all appear complete, nor was the filing consistent. This was discussed with the manager subsequent to the visit.

We used a number of different methods to help us understand the experiences of people using the service, because most of the people using the service had complex needs which meant they were not able to tell us their experiences.

We were able to speak with one person who said “we do much more here” and told us that they were going to Blackpool in September. We observed another person who demonstrated pleasure in being taken swimming.

The staff we spoke with told us that they liked working at the home and that they received good quality training and support. Staff said that Camber Lodge was a “family home”.

We also reviewed comments and complaints and found that there was one comment from a relative that expressed the “evident love and attention extended to …” their family member. No written complaints had been received in the last 12 months.