About the service: Cambridge House provides accommodation and support for up to six people who have a learning disability. On the day of our visit, there were five people living in the service. Cambridge House is a detached bungalow in a residential cul-de-sac within the town of Haverhill, Suffolk.

At our last inspection in November 2017 we were concerned because the service was poorly managed in respect of the maintenance of the building. At that time the provider did not have an effective governance system to monitor the quality of the service and identify the risks to people. At that inspection improvements were required to ensure that people were kept safe in the service. Some radiators were not covered and the temperature of hot water to people's rooms and communal areas was not controlled.

At this inspection we found that some environmental concerns had been rectified. Over the past year a number of improvements had been made, however there was still further work needed. The manager had worked hard on implementing the necessary environmental changes but other areas of the service had not been kept up to date.

Cambridge House has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The outcomes for people did not fully reflect the principles and values of Registering the Right Support because people did not live in an environment that valued and underpinned the best practice guidance and were not supported with appropriate staffing levels.

People’s experience of using this service:

¿ People did not always receive a service that provided them with safe, effective and high-quality care.

¿ There were not enough staff deployed to meet people's needs consistently. This meant that for one person they did not always have varied or meaningful activities and their personal care needs were not met when always required. This was because staff were supporting the people they were funded to provide one to one care with.

¿ Safety of the premises was not always a priority for the provider. 10 out of 11 fire doors were being propped or held open due to a failure of the fire door system and this had been the case for at least six months.

¿ The service was not always well led and there was a lack of quality assurance processes in place to identify the issues found during the inspection.

¿ People received support from staff who were kind and treated them with respect.

¿ People were supported to maintain a healthy and balanced diet.

¿ 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.

Rating at last inspection: The service was rated ‘Requires Improvement’ at our last inspection. The report following that inspection was published on 24 January 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Cambridge House is a residential care home that provides accommodation and personal care for up to six people who have a learning disability. There were five people living in the service when we inspected on 1 November 2017. We gave the provider just under 24 hours’ notice that we would be inspecting the service because it is a small service and we needed to be sure that there would be someone at home.

At the last inspection in April 2015 the service was rated as ‘Good’ in all of the key questions we ask and overall. At this inspection we have concerns in a number of key questions and there are a number of breaches of the regulations. The service has been rated ‘Requires Improvement’ in four of the key questions and as a result overall.

Cambridge House 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. Cambridge House accommodates up to six people in one bungalow which was situated in a cul-de-sac in a residential area.

The care service has not 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. People did not live in an environment that valued and underpinned the best practice guidance.

There was not a registered manager in post at the time of our visit. 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. The previous registered manager left the service in June 2017 however the deputy manager had been offered the managers post and had verbally accepted it. They told us that they hadn’t signed their contract yet and hadn’t submitted an application yet to register although they had found out more about it by telephoning CQC for advice. This person has been referred to as the acting manager throughout the report.

The service was poorly managed in respect of the maintenance of the building. The provider did not have an effective governance system to monitor the quality of the service and identify the risks to people. The provider had not picked up issues that were identified in this inspection.

Improvements were required to ensure that people were kept safe in the service. Some radiators were not covered and the temperature of hot water to people’s rooms and communal areas was not controlled. People living at the service required a lot of support and prior to our inspection, neither of these risks had been assessed.

Staff were recruited safely and received an induction when they first started working at the service. People were supported by sufficient staff who knew them well. Staff had received training and supervision and were able to describe how they worked with people to meet their needs.

Staff had an understanding of safeguarding procedures and how they should report any concerns and appropriate procedures were in place for the safe recruitment of staff. People's medicines were managed appropriately and their healthcare needs were understood and met by the service.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people's ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

People's dietary needs and preferences were supported. People chose what they wanted to

The inspection took place on 26 June 2015.

The service provides accommodation, care and support for up to six adults with a learning disability. At the time of our inspection the home had four people living there.

There is a registered manager at the home.

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.

Staff were aware of how to raise concerns if they suspected people using the service to be at risk from harm, and or abuse. A recent safeguarding concern had been appropriately reported to the Local Authority. The home had taken appropriate actions to deal with the concerns. Staff told us they had been reminded of their responsibility to people in their care and were confident of the management of the home and said they felt comfortable to challenge poor practice.

There were systems in place to ensure people received their medicines safety and audits were carried out to check medicines were in stock and prescribed as required. Staff were trained and assessed as competent before they could give medicines.

Staffing levels were deemed to be sufficient on the day of the inspection and the home kept people's needs under review to ensure staffing levels remained appropriate. Funding arrangements to enable more 1-1 activity was still being pursued.

Risks to people’s safety were well documented. Risk assessments clearly showed what actions staff took to keep people safe and reduce risks to them.

Staff had a good understanding of how to communicate with people and give them choices. Their records told us how they were involved in decision making or how they were supported when more complex decisions needed to be made about their care and welfare.  

Staff said they were well supported and confident in the management. Staff received the training they needed for their role and formal support to help them develop.

People were supported to eat and drink enough for their needs. Staff monitored people’s health and supported people to access the health care they needed.

Staff were caring and supported people to have a fulfilled life. Staff promoted people’s independence and worked closely with family and other health care professionals. This helped ensured people’s needs were met as cohesively as possible.

People were consulted and there was a good quality assurance system with sough the views of people using the service, their families, health care professionals and others involved in their support.

The home was well managed. Staff were confident and there were systems in place to measure the effectiveness and quality of the service provided.

Our inspection of 08 May 2013 found that the provider did not have an effective system in place to monitor the quality of the service. We found that people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. This was because the provider had not made suitable arrangements to ensure that the risks associated to fire safety, gas safety, laundry management and water safety were being managed.

At this inspection we found that the provider had taken action to make the required improvements to ensure that people using the service were safe.

This was a follow-up inspection to our recent inspection to consider two outcomes that were non-compliant and we are now satisfied that the action taken now means the service is compliant with those outcomes.

We found that Cambridge House was responsive to peoples needs. There were sufficient care staff employed. Staff who supported people were caring and treated people with respect and dignity. People lead a full life with access to their community and access health services as needed.

The service needed to improve on leadership as no registered manager had been in place for some time. We had concerns for the safety of people as environmental issues such as fire safety, laundry facilities and water safety had not been assessed and risks reduced.

We met two people who lived at the service. We talked to both people and observed their interactions with staff throughout the inspection. The behaviour of people we met indicated that they were happy with the care. We also spoke to the relatives of one person who lived at Cambridge House. The relative told us that they had no concerns and were happy with the care provided to their relative. They also told us told that the service had greatly improved in the last few months and the staff were “Good” and “The atmosphere was friendly and relaxed”.

There were two people living at Cambridge House during our inspection visit. We met and spoke with both people. Both people had limited verbal ability and did not make use of signing. This meant that we could not interview them to obtain their views of the service. However, we were able to observe their mood and how they interacted with staff.

We saw that both people reacted in a positive way to staff, smiling and responding. One person was clearly pleased to see staff and showed spontaneous affection.

The people who live in Cambridge House are not able to communicate verbally, but we were introduced to them and we saw that they were relaxed and did not show any signs of distress.

The people who live in Cambridge House are not able to communicate verbally, but we were introduced to them and we saw that they were relaxed and did not show any signs of distress.

One person’s relative told us that there was not enough staff around during the day to allow people to take part in social activities. Not everyone goes to a day centre, so people rely on the staff to help them get out and about and to take part in new activities.