Campania

About the service

Campania is a residential care home providing accommodation and support to up to 41 people. At the time of our inspection there were 39 people using the service. Campania provides support to people who are living with the effects of Alcohol Related Brain Damage and conditions such as Korsakoff’s syndrome.

People’s experience of using this service and what we found

People were kept safe from avoidable harm because staff knew them, had received training and knew when they should act. The service worked with other agencies to protect people.

People’s care records helped them receive the support they needed. Care plans were all in the process of being updated and language improved, but they showed a good understanding of people’s needs and aspirations. Information was provided about risks and how these should be managed to help keep people safe. Care plans were regularly reviewed, and staff could access relevant information to ensure they continued to provide the support people needed.

We were assured that people were protected by the prevention and control of infection. The environment and equipment were regularly checked, and actions taken when necessary to manage risks.

People were supported by staff who followed systems and processes to prescribe, administer, record and store medicines safely. Staff understood people’s health and wellbeing needs and referrals were made to specialist services as required.

The numbers and skills of staff matched the needs of people using the service. Staff had training which equipped them to provide effective support. Staff recruitment, induction and training processes promoted safety.

Staff members showed warmth and respect when interacting with people. People had opportunities to occupy their time, develop their skills and maintain independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was a positive culture where people’s individuality was promoted and valued. The registered manager and senior staff were visible and led by example. Staff felt supported and valued, and were positive about working for the service.

Governance processes were effective and monitored performance, kept people safe and encouraged the provision of good quality support. Actions were taken when shortfalls were identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 February 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Campania is a care home. The home specialises in the care of people with alcohol related problems such as Korsakoff's syndrome. Campania is a large Victorian building and the accommodation is spread over four floors. The home can accommodate a maximum of 41 people. The top floor was for people who were ready to move on. There were five rooms with en-suite toilet and sink. Currently five rooms on the top floor were occupied. There were kitchen and laundry facilities and two shared bathrooms in the home. At the time of the inspection 40 people were living at Campania.

People’s experience of using this service and what we found

Safe practice was not always followed to ensure people’s medicines were safely administered which placed people at risk. We reviewed the plans in place to support people safely from the building during an evacuation. Guidance for staff was not always clear placing people at risk, for example, in the event of a fire. The environment was not well maintained, we found several health and safety concerns that placed people at risk, including trip hazards and poor management of infection control.

Recruitment processes did not minimise the risk of employing unsuitable staff and there were mixed views as to whether there was always enough staff on duty. Staff and people told us they had appointments cancelled if there was not enough staff to go with them. Staff training was not up to date, this included safeguarding training which meant the provider could not be sure people were being supported by staff who had the skills and knowledge to meet their needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible, or in their best interests; the policies and systems in the service did not support this practice. There were generic care plans in place, people did not always have choice, some decisions did not always involve people or their representatives, and dignity was not always upheld. For example, the provider held people’s cigarettes and asked them to line up in a communal area to receive cigarettes one at a time

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. Care plans did not have communication profiles for people, which meant there was no evidence, that where needed, the service supported people to communicate and understand according to their needs. People told us they were bored; People told us the activities were not based on everyone’s interests.

Governance systems included internal and provider level audits and regular checks of the environment and service to ensure people received good care. We found these systems were not always fully effective in driving improvement. Whilst it was not evident this had any significant impact on people, it did not evidence a fully effective governance system was in operation and placed people at risk.

We saw some positive interactions during the inspection, with most staff being kind and friendly when supporting people. The provider analysed accidents and incidents to look for trends or ways to prevent a recurrence. There was a business continuity plan in place and we found safety checks of fire maintenance, gas, electrical safety, and safe use of water outlets were all up to date. The provider had already identified a lot of the concerns found during the inspection through their provider level audits. These had been added to the provider’s improvement plan.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was good (published 15 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines management, individualised care, staff training and supervision, quality of the environment including the prevention of infection, and the management of the service at this inspection. We have made three recommendations in relation to, staffing and recruitment, assessment of people’s needs and accessing health care agencies.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Campania is a large Victorian building over four floors in Weston-super-Mare, a short walk from the seafront, town and parks and is one of the provider’s, N.Notaro Homes Limited, 11 services. The home is registered for up to 41 people who are living with alcohol related problems such as Korsakoff's syndrome. This meant that people required support with mental health challenges, memory loss, behaviours which could be challenging for staff and other physical effects of long term alcohol abuse. The service does not provide accommodation for people who are continuing to abuse alcohol and people sign an alcohol /illegal substance agreement before moving into the home. Therefore they knew when support could be withdrawn by the service, for example following persistent alcohol use, aggressive behaviour or engaging in illegal activities. At the time of the inspection 38 people were living at Campania with one person in hospital. People knew they were subject to random breathalyser tests and drug tests before admission. Staff, with the person’s involvement aimed to provide a package of care and support that would enable people to be as independent as possible. Staff encouraged links with peoples’ families, often lost when lives are disrupted by alcohol abuse, to be re-established. Few people at the home were in contact with relatives. Campania staff tried to go beyond just providing a safe home and put rehabilitation at the forefront of what they tried to achieve by celebrating those who were able to move forward into independent community living. For example, in 2016 eight people were enabled to move out to their own flats in the community with support. Staff encouraged former skills and interests to be regained and provided opportunities for new experiences to enrich the lives of people living at the home.

At the last inspection in July 2014 we found the service to be compliant with the standards we looked at. At this inspection we found the service was still meeting all regulatory requirements and did not identify any concerns with the care provided to people living at the home.

The home had 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 2008 and associated Regulations about how the service is run. At the time of this inspection the registered manager was on leave and the home was being managed by a knowledgeable and competent deputy manager.

People told us they felt safe. People expressed no concerns about their safety and were complementary about the level of support and care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had good knowledge of how to identify and report any safeguarding or whistleblowing concerns. Due to the nature of the service the home worked closely with local police and a community justice partnership to safely manage conflict, or anti-social behaviour, resolve issues between people living at the home and agree future actions. They also worked closely with homeless and addiction charities, community housing support, further education and voluntary work organisations and independent advocates promoting rehabilitation and facilitated a weekly professionals ‘sharing’ group.

There were systems in place for the safe storage, administration and recording of medicines. Each person kept their medication in a locked cabinet in their bedroom and only staff authorised to administer medicines were allowed access. Some people were able to administer their own medication, especially if they were moving towards more independence in the community. All people taking medicines had a medication administration record (MAR) in place, which included a photograph to ensure medicines were given to the correct person. There was a medication computer system which highlighted who was due medication and alerted staff at the appropriate times, which minimised the risk of medication errors. During the inspection all records we observed had been filled out correctly and all medicine amounts tallied and were in date.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff spoke positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were up to date.

Staff confirmed they received supervision and support with their line manager, which along with the completion of team meetings, meant they were supported in their roles and good standards of care were maintained.

Observations of meal times showed these to be a positive experience, with people being supported to eat where they chose or in the dining room canteen. If people were going out or wanted a quieter experience later, this was organised. Staff engaged in conversation with people and encouraged them throughout the meal. We saw nutritional assessments were in place to ensure people were encouraged to maintain a balanced diet, and special dietary needs were catered for. Maintaining good nutrition is an important part of rehabilitation from long term alcohol abuse and people were given clear information about how a good diet could help them with their recovery.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be very caring and treated people with kindness, dignity and respect, forging relationships of trust. People who used the service were complimentary about the quality of the staff and the standard of care received.

Care plans contained accurate and detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, along with a range of personalised information which helped ensure their needs were being met and care they received was person centred. There was a focus on managed rehabilitation with external health professional support such as counsellors and community mental health professionals and it was important for people to set achievable goals. People were expected to participate and manage daily living skills such as personal laundry, cleaning and regular cooking.

Boredom is a key factor in alcohol abuse so Campania provided a supportive, structured day in a comfortable and secure atmosphere. People could then build their own day around a core routine to promote orientation of time and place and improve motivation. People were positive about the variety and frequency of activities available, individually or in groups. The activity schedule catered for all interests and abilities and included involvement from external agencies, job opportunities and further education. A large number of activities and events had been the result of suggestions made from people who used the service. The home actively documented activities and displayed photographs of the different events that had taken place around the building.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a weekly and monthly basis and covered a wide range of areas including medication, care files, infection control and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.

If you wish to look at our findings in detail please see the full report.

Is the service safe?

The environment was clean. People told us they felt safe. Staff personnel records contained all information required. This meant the provider could demonstrate that the staff employed had the skills and experience needed to support people who used the service. Staff were confident to raise concerns to the manager and able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Is the service effective?

People can be reassured their needs will be met. Each person had a care plan that detailed their care needs. Staff had a good understanding of people's care and support needs and they knew people in the service well. Care records were accurate and complete. All risks had been assessed, and safeguards put in place where necessary.

Is the service caring?

People were supported by patient and respectful staff. People told us they were treated with respect and were involved in decisions about the care they received. One person told us, "Oh yes, the staff are all very good." Throughout our visit, we saw that people were not rushed. One person told us, 'They don't hurry you here.'

Is the service responsive?

There were systems in place to monitor and audit the quality of the service. For example, people's views were sought in surveys. People's support needs were assessed before they came to the service. Care records reflected people's needs and ensured that care and support was provided in accordance with people's wishes. People had access to activities that were important to them, and were supported to maintain relationships with friends and relatives where possible.

Is the service well-led?

Clear quality assurance processes were in place, including regular audits, monitoring of complaints and surveys. All care records we viewed were accurate, current and complete. The service had a robust system in place to respond to complaints and concerns. Staff had a good understanding of the ethos of the service and there were quality assurance processes in place. Staff were regularly supervised by senior staff.

Comprehensive assessments were completed so the service could meet people's needs effectively. People, where able, were supported to move to independent accommodation. The service provided meaningful activities suited to people's needs. People were not given opportunities to discuss issues associated with living in the service and moving to independent accommodation.

We saw there were appropriate arrangements for the management and administration of medicines. People were enabled to self- administer and manage their medicines as part of achieving maximum independence.

There were appropriate systems in place for the recruitment and selection of staff. The required legal checks had been made to establish the suitability of people who applied to work in the service.

There were systems in place to monitor and audit the quality and safety of the service. Improvements had been made where shortfalls in practice had been identified. People's views were sought about the service they received.

Residents were involved in planning the support they need from the service. The records showed that residents were involved in arranging their care. Although a few residents said they could not remember planning their care, the care records showed they had written and signed some of the care documentation. One resident said' I can't remember planning my care, but I've a bad memory." Whilst another resident said 'staff and I did it together.'

Residents had a mixed view of the service. There were a variety of views about the food which varied between "not good" to 'food is good' onto 'The food is very good.' Residents we spoke with told us that they had good relationships with staff and their views ranged from 'they are alright' to "staff are pretty good.'

Residents told us that they felt safe in the home and were able to talk to staff if they had concerns. One resident said "If I wanted to complain, I would talk to the manager and get a written response.'

Residents told us they felt involved in the decision making in the home. Residents told us they participated in the home's community meetings and the minutes were available in public areas.