Cambian Lufton Manor College

Cambian Lufton Manor College is a college for students aged 16 to 25 with learning disabilities or autism and other complex needs. The college is spread across two sites, the main house site and Manor Farm. On each site there are several communal areas plus accommodation buildings. There are also two community houses for students to develop independent living skills. Not everyone who lived in the community received personal care. The Care Quality Commission (CQC) only inspects where students receive personal care. This is help with tasks related to personal hygiene and eating. Where students do receive personal care, we also consider any wider social care provided.

At the time of inspection there were 37 students receiving a regulated activity. There were also day students who attended the college and did not receive either regulated activity. Students were placed by a variety of local authorities. Many of the students had limited verbal communication skills to express their experience.

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

As part of the inspection we reviewed infection and prevention controls in place at the college. We found some improvements were required. The college was working with two sets of government guidance; some for education and some for health and social care. This had caused some confusion. For example, testing of staff and students under the regulated activity was not regularly happening. The registered manager and principal were informed and started to rectify this during the inspection.

Staff were using personal protective equipment (PPE) such as masks, aprons and gloves. One relative said, “When we return to college, we have to fill in a form checking what we have been doing and if anyone has been ill. All staff are wearing PPE.” However, there was some confusion about the best practice sequence for putting PPE on and taking them off. The registered manager shared actions they were going to take to rectify this. Following the inspection, we contacted the local authority to provide additional specialist support to the college around infection and prevention control.

Students were supported by staff who knew how to keep them safe from potential abuse. Positive, comfortable interactions were seen between students and staff throughout the inspection. Systems to manage safeguarding were in place. It was clear the college worked with other professionals to keep students safe.

Staff felt there were enough of them to support students. The only exceptions were when it was a particularly challenging day. They assured us these were infrequent. All students appeared well supported during the inspection.

Rating at last inspection

The last rating for this service was Requires Improvement (published 3 April 2020).

Why we inspected

The targeted inspection was prompted because risks were identified in staffing and safeguarding. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.

We looked at infection prevention and control measures under the ‘Safe’ key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

At the time of inspection there were 40 students receiving a regulated activity. There were also 15 day students who did not receive either regulated activity. Students were placed by 18 different local authorities. Many of the students had limited verbal communication skills to express their experience.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that students who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for anyone with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. Students using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The college was a large service, with many smaller buildings used for accommodation. The main house site and Manor Farm are registered for the support of up to 74 students. Over ten people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the layout and purpose of the college and the fact the accommodation buildings had capacity for up to six students.

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

Students were comfortable in staff presence and those able to tell us were positive about the support and care they received. Relative feedback was equally as positive. One student told us it was “Awesome” living with their friends and staff looked after them to keep them safe.

There had been significant improvements since the last inspection throughout many areas at the college such as staffing, safeguarding, health and safety, and quality assurance systems. However, it was not clear how sustainable these improvements were. Medicine management had improved although we made a recommendation to ensure the best practice was applied consistently.

Students were not always supported to have maximum choice and control of their lives and staff were not always aware how to support them in the least restrictive way possible and in their best interests. The policies and systems in the service were set up to drive improvement in this practice.

Students were still found to have actions taken when restrictions were placed on them to keep them safe by staff not fully understanding the legislation. One condition had been placed on an authorisation to restrict a student’s liberty without it being followed.

Staff were recruited in a way to keep students safe. The management were in control of driving improvements since the last inspection.

The service applied the principles of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion although at times these were not consistent with other legislation. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 inadequate (published 9 November 2019) and there were seven breaches in regulation. Following the inspection, we added conditions to the providers registration. This meant they had to provide a monthly report, so we could monitor the progress of improvements. At this inspection we found significant improvements had been made and the provider was now only in breach of one regulation.

This service has been in Special Measures since the last inspection in June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to restricting student’s liberties in line with current legislation at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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

Cambian Lufton Manor College is a college for students aged 16 to 25 with learning disabilities or autism and other complex needs. The college is spread across two sites, the main house site and Manor Farm. On each site there are several communal areas plus accommodation buildings. There are also five community houses for students to develop independent living skills. Not everyone who lived in the community received personal care. The Care Quality Commission (CQC) only inspects where students receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of inspection there were 88 students and 65 students were receiving a regulated activity. 11 students had a 52-week placement, 54 students were at the college for 38 weeks of the year. 23 students attended the college as day students; they did not receive either regulated activity. Students were placed by 22 different local authorities. Many of the students had limited verbal communication skills to express their experience.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that students who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for anyone with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. Students using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The college was a large service, with many smaller buildings used for accommodation. The main house site and Manor Farm registered for the support of up to 74 students. Over ten people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the layout of the college area and the fact some of the accommodation buildings had recently had the number of students reduced.

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

Although students told us they were safe and happy we found the students were not being kept safe from potential harm and abuse. Students were at risk of being inappropriately supported when they were displaying behaviours which could challenge others. Not all systems were adequate to protect them from harm. Risks were not always being assessed. Those that had been identified did not always have ways to mitigate the risks. Some risks had been identified around the management of medicines. Students were placed at risk of potential harm because health and safety systems were not always effective.

Staff told us, and we found, they were working very long hours. There were discrepancies in how the management had identified the required staff levels. Some staff were working with students with specific health conditions. There was no training or guidance for staff to follow. Most staff were not receiving adequate supervision.

The management were not aware of shortfalls found during the inspection and lack strategic oversight. They had incomplete systems in place to resolve issues when concerns had been found by them. Documents which should have been readily available during the inspection were not always easily produced. The management had plans for the future to try to resolve the issues.

Students were supported to have maximum choice and control of their lives. However, it was not always clear if staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Legislation did not appear to have been followed for some students who had significant restrictions in place.

Care plans for students were not always personalised. Sometimes they lacked key guidance for staff to ensure consistent care was provided and their needs were met. There were good links with other health and social care professionals including access to onsite therapists and professionals.

Students were supported by kind and caring staff who knew them well and often went above and beyond to prevent impact on them. Staff respected people’s privacy and dignity throughout the inspection. Strong links had been developed with the community including for work placements.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was outstanding insert (published 8 April 2017).

Why we inspected

The inspection was prompted due to concerns received about medicines management, health and safety checks, staffing and the management of the college. A decision was made for us to complete an aligned inspection with Ofsted who had received some similar concerns and examine those risks.

We have found evidence that the provider needs to make improvements and students were at risk of harm. Please see safe, effective, responsive and well led domains sections of this full report.

The overall rating for the service has changed from outstanding to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cambian Lufton Manor College on our website at www.cqc.org.uk.

Enforcement

We have identified seven breaches in relation to staffing, keeping students safe from potential risks of harm and abuse, personalised care, the management of medicines, use of restrictive practices, students lacking ability to consent, notifying the Care Quality Commission in line with their statutory obligations and the systems in place to manage the college at this inspection.

We have also made a recommendation in relation to training for staff working with children and young people.

Following the inspection, we completed enforcement to the provider's registration so they had to send a monthly report on the actions they were taking to improve the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The residential accommodation is provided in a number of self-contained units across two sites, Lufton Manor and Lufton Manor Farm. People stayed in the residential accommodation for their first two years at the college, developing their independent living skills and building confidence, aiming to move into a supported living placement in the nearby town for their final year. In a supported living service, people’s accommodation is provided by separate housing providers or landlords, usually on a rental or lease arrangement. In this situation the care people receive is regulated by CQC, but the accommodation is not. At the time of the inspection there were 53 people receiving support with personal care in residential accommodation at the Lufton Manor and Lufton Manor Farm sites. Personal care was being provided to 31 people in five supported living houses in Yeovil. An additional 23 people attended the college on a daily basis.

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.

There was a very high level of confidence in the leadership and management of the service expressed by people, relatives and staff. Managers had a ‘hands on’ approach, and were always available to offer support and guidance. One person told us, “[Manager’s name] is amazing!” A senior member of staff said, “This is one of the best places I’ve worked. [Manager’s name] is so effective and supportive. They are always available even on this multi-site facility. They are so approachable”. The provider had comprehensive and effective quality assurance systems in place to monitor safety and the quality of care. Managers actively sought feedback from people using the service, staff and their families, and we saw this information was used to improve the quality and safety of the support provided.

The registered manager worked holistically with the principal of the college and staff team, supporting people to increase their level of independence and confidence. This required a highly personalised and responsive approach, so that people could progress and attain their individual goals. People’s individual goals were reviewed frequently, including an annual review with the person, their family and key members of their staff team, where a new action plan was developed to support them as they moved forward. This approach allowed people to develop confidence and skills, making a dramatic difference to their lives. For example, a person living in the residential accommodation, who did not interact at all with others when they first came to the college were now happy and confident enough to attend all day group lessons and to socialise with other people. Other people had learned new independent-living skills, being able to cook, do their laundry or travel by public transport. People enjoyed participating in a wide range of activities and were pursuing their vocational interests, like washing cars or working in a hospital. One person, who lived in a supported living house, said, “I love doing this, being independent from staff”.

The service placed a strong emphasis on a ‘person centred approach’, and ensured people, and their advocates where appropriate, were fully consulted and involved in all decisions about their lives and support. This meant people’s legal rights were protected. People’s individual communication needs were understood and all information provided in a format appropriate for them, which meant they could participate fully. People told us the staff were kind and caring and treated them with dignity and respect. Staff spoke passionately and positively about people and their achievements. One member of staff told us, “I enjoy seeing students’ progress and seeing how far people have come. What amazing young people they have developed into. So much more confident and able”.

The service was extremely proactive in ensuring support was planned in partnership with people and their families. This began before the person moved to the service which allowed time for staff to be appropriately trained and the residential placements to be planned. A social care professional told us how people placed together and sharing a flat had a similar kind of temperament. They told us, “They are skilful the way they link people. It enables living arrangements to be really beneficial. It’s really huge for people with autism and autistic spectrum disorder to have peers and a social network”. Care and support plans were in ‘easy read’ format so they were accessible to people. They were comprehensive and contained the guidance staff needed to provide effective and safe care. Each person was involved in reviewing their support plan regularly and we were satisfied people had given their consent to the support being provided as set out in their support plan.

People were kept safe and free from harm. They were encouraged to become more aware of safety issues and to learn strategies to protect themselves, for example the people living in the supported living accommodation opened their front doors with a chain and asked for ID when we visited them during the inspection. Comprehensive risk assessments identified individual risks to people’s health and safety and there was information in each person’s support plan showing how they should be supported to manage these risks. Risk assessments also supported people to take positive risks. This enabled staff to promote their independence and meant people could do what they wanted to do in a safe way, for example enabling a person with a history of self-harm to safely use a needle and scissors for sewing. Systems were in place to ensure people received their prescribed medicines safely as they moved towards greater independence in managing their own medicines.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Four staff ‘leads’, with responsibility for safeguarding, covered the campus sites and community houses. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. Staff were recruited carefully and appropriate checks had been completed to ensure they were safe to work with vulnerable people.

There had been a lot of staff turnover in the last 12 months, but a successful recruitment campaign meant all posts would be filled in the next few weeks. Staffing levels had been maintained in the meantime with regular agency staff who were supervised by permanent staff, and had an understanding of people’s needs and could provide consistency.

A comprehensive induction and regular training meant staff were knowledgeable about their roles and responsibilities, and people’s individual needs. Annual ‘refresher training’, maintained their knowledge and skills in key areas like safeguarding and infection prevention. ‘Bespoke’ training was arranged as required on topics like diabetes, and administering emergency medication. In addition, training days and workshops organised during the college holidays, supported staff to better understand their role and the needs of the people supported by the service. Good staff practice was recognised and valued, which improved the quality of care provided to people. The majority of staff told us they felt really well supported through supervision, appraisal, and team meetings. One member of staff said, “I genuinely love my job. It’s fantastic…I feel the most valued I have done in years”.