CARE HOME ADULTS 18-65
Cameroon Heath Cross Whitestone Exeter Devon EX4 2HR Lead Inspector
James Rose Unannounced Inspection 13th June 2006 9:00 Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cameroon Address Heath Cross Whitestone Exeter Devon EX4 2HR 01483 772901 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Honeybourne House Limited Vacant Care Home 13 Category(ies) of Learning disability (13), Old age, not falling registration, with number within any other category (13), Physical of places disability (13) Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. PD - Physical disability, 13 service users male of female LD - Learning disability, 13 service users male of female OP - Old Age, not falling within any other category There will be a maximum of 13 beds Date of last inspection 28th February 2006 Brief Description of the Service: Cameroon is a Registered Home for up to 13 service users with learning difficulties and a physical disability. The home is a large detached single story building with one double bedroom, the remainder are singles, it stands in its own grounds with extensive views over the surrounding countryside. It is situated within walking distance of the village of Whitestone and is four and half miles from Exeter. The communal areas of the home are comfortably furnished, there is a large lounge and meals are taken in a separate dining room, the kitchen is also spacious and has a central table. The home is well maintained and adaptations have been made to meet the needs of the service users. A mini bus is provided to transport service users to appointments and to take them out on excursions. Outside the home there is off road parking and well-tended gardens. A lawn area is also available with seating provided for service users. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 11.5 hours during June 2006. During the inspection a complete tour of the home was undertaken, four residents were consulted and samples of care records were examined. Evidence was also collected from two healthcare professionals. Four comment cards were returned to the Commission by the relatives/visitors of the residents in the home. Two carers were interviewed during the inspection process and the way care was delivered was observed. This inspection was undertaken with the assistance of Mr B.Marlow the homes advisor. What the service does well: What has improved since the last inspection?
Since the last inspection the then proposed manager has left and the company has appointed a new person who will be taking up the post in the near future.
Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 6 A positive response has been made to the last report and extra resources have been used to enable the home to satisfy the requirements raised. Residents have been reassessed and care planning is in place. Risk assessments have been completed and medication is administered in an appropriate way. Some training remains outstanding for carers but this has been booked and incidents covered by the legislation are reported to the Commission as needed. The three recommendations raised have also been actioned; the sensory room is being decorated and will be made operational when the new manager takes up his post. The laundry room has been completely refurbished and a written protocol has been produced to ensure there is no contamination between soiled and clean laundry. It is acknowledged that the home has been through a difficult phase concerning the leadership and management task, it is commendable that a good service has been maintained to the residents throughout. What they could do better:
When the tour of the home was undertaken it was noted that the bath panelling needed to be repaired or replaced in bathroom 1. A requirement has been raised for this purpose and a timescale for completion agreed. Three personnel files of carers were examined and some did not have the required documentation needed to satisfy the legislation. A requirement has been made to ensure this is undertaken without delay. Currently the home does not have a comprehensive quality assurance system in place, a requirement has been raised for this purpose. At the time of the inspection the accident book that has been in place could not be found. A requirement has been raised to ensure a suitable record is maintained of all accidents in the home. A requirement has also been made for the home to contact the local fire authority for information concerning what fire precautions and checks should be undertaken and a record should then be maintained of action taken. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The performance in this group is adequate. Comprehensive assessments were in place for all residents in the home. EVIDENCE: Since the time of the last inspection the home has undertaken appropriate assessments of all the residents needs. Three assessments were examined at random as part of the inspection process; these demonstrated that details were taken of all needs in the areas of health, personal and social needs. Healthcare professionals and families were also consulted if necessary. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6. 7 and 9 The performance in this group is adequate. Appropriately detailed care plans were in place that were discussed with the individual resident and agreed. Residents were supported and assisted to make their own decisions as necessary. Residents undertook appropriate risks after a comprehensive risk assessment had been completed. EVIDENCE: Comprehensive detailed care plans have been produced since the last inspection; these were constructed from the assessments undertaken. These were discussed with the home’s advisor and it was agreed that they will be developed further and presented in the companies tried and tested format. Residents that were consulted individually during the inspection process advised that they were very happy with the care they received and had a good relationship with their carers. One resident explained that he was going on holiday shortly and that his carer had agreed a list with him of the toiletries he would take and was also going to take him to buy new clothes that he was going to choose.
Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 11 Appropriate risk assessments have been undertaken of hazards facing the individual resident. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 The performance in this group is adequate. Residents have opportunities for personal development and are able to take part in appropriate activities. The community facilities are used by residents including leisure activities. Residents are able to have appropriate relationships and their rights and responsibilities are recognised on a daily basis. The meals at the home are healthy, wholesome and varied. EVIDENCE: Residents are consulted about what activities they would like to have, this is done individually and not as a group to ensure the wishes of the individual are considered. Some of the activities undertaken at Cameroon are: Music, where a range of instruments are used, 10-pin bowling, visits out are organised and picnics. Shopping is undertaken with residents who are given the choice of what products they purchase. Residents are also taken out to public houses for meals etc. The management see it as important that a stimulating environment is provided with regular visits out of the home provided. At the time of the inspection preparations were underway for a football party to coincide with the world cup.
Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 13 The individual leisure activities undertaken and how decisions are made with residents are going to feature in the new care plan recording in detail. The home has a visiting policy in place that is unrestricted and friends and family are made welcome. All the residents consulted stated that they were happy with the food provided and used words such as “smashing” and “great”. Fresh produce is delivered to the home on a daily basis and choice is always available to residents. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The performance in this group is adequate. Service users are supported in the way they like and physical and emotional needs are met. Residents that are able can self medicate subject to a risk assessed approach and they are protected by the way the administration of medication is undertaken at the home. EVIDENCE: Care is taken by the management of the home to ensure that residents receive service in the way they like best. Although some of the residents have little speech they are well able to make their needs and preferences known. Residents’ physical condition is always monitored and ready access is provided to the healthcare professionals when required. From observations made during the two-day inspection process it was clear that sensitive care is provided to the residents in the home and when their moods change action is taken to try to ensure that life is made as comfortable as possible and that their needs are met. The recordings undertaken by the home of the administration of medication were examined. Medication was booked in and a complete issue record was
Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 15 available. Unused medication was returned to the pharmacist and a record maintained. All medication was appropriately securely stored with a dedicated facility available for medication that needed to be held at low temperature. This appropriate administration ensures that residents are protected by the home’s procedures. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The performance in this group is adequate. Residents were confident that if they raised an issue it was taken seriously by the care team and resolved for them without delay. Service users are protected from abuse. EVIDENCE: Four residents were consulted individually during the inspection process, they were relaxed and confident and advised that when they raised an issue with staff it was quickly resolved for them. Staff were seen to react quickly to residents requests during observations made of the way care was delivered during the inspection. The interaction between staff and residents was relaxed and residents were confident that their requests would be met. Two carers were interviewed individually in private during the inspection and were clear about the homes adult protection policy and procedure and knew the appropriate action to take if they discovered any kind of abuse taking place. Carers are given training is abuse as part of a comprehensive training programme. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The performance in this group is adequate. Cameroon is in general well maintained and provides a safe and comfortable environment for the residents who live there. EVIDENCE: A tour of the home was undertaken during the inspection process and all the rooms in the home were seen. The lounge and dinning room were comfortably furnished and well decorated. The lounge was equipped with a large televisions and a sound system for residents use. The kitchen at the home has a large central table where many of the residents like to sit. Currently there is a large Aga cooker in the kitchen, however this has many hot surfaces and the management of the home have decided that this represents too big a risk to residents and it is being replaced. A new sensory room is being provided at the home, this has been decorated and will be equipped when the new manager takes up his post, which is imminent. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 18 Residents’ bedrooms are well furnished and decorated to a good standard to the taste of the service user. During the tour of the home it was noticed that the panelling on the side of the bath needed attention and it should be either repaired or replaced. A requirement has been raised in this report to ensure this is achieved, which will improve the environment for residents. The grounds of the home are well tended and a recent addition of a handrail at the front of the lawn has ensured that the area is safe for residents who have constant access. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The performance in this group is adequate. The number and deployment of care staff throughout the day and night is sufficient to meet the needs of the residents in the home. EVIDENCE: The staffing levels in the home remain at the same level as at the last inspection and these are sufficient to meet the needs of the residents 24-hours a day. Two carers were interviewed during the course of the inspection process, this was undertaken individually in private and it was clear that they had benefited from the induction training that they had received and that they enjoyed their job at Cameroon. Employees have a job description and are clear what their responsibilities are. The four residents that were consulted during the inspection advised that they were happy at the home and had a good relationship with the care team. One resident was able to say “ I like it here and I can always get someone to help me when I need it” another remarked, “ We are well looked after here”. It was also clear from observations that carers got on well with the residents and appropriate banter was overheard throughout the inspection. Some of the personnel files examined as part of the inspection had some documentation missing that are required by the legislation. A requirement has
Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 20 been raised to ensure that this matter is pursued and resolved by the management of the home, this will ensure that residents are properly protected. One of the tasks of the new manager will be to ensure that there is a complete training programme in place for all the care team. At the time of the inspection it was understood that all the basic training will have been completed in the home by the 5th July 2006, which will ensure that residents are in competent hands. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The performance in this group is adequate. Cameroon is currently between registered managers and this has caused deficits that are unusual at this home. Some deficits in health and safety standards were found, however, residents are safe and the service to them has been maintained. EVIDENCE: The management of the home have responded well to the last report and have provided senior staff to work on the deficits found at that time. It was understood that a new manager for Cameroon has been appointed and will take up his post in the very near future. Residents advised when asked that they got on very well with the new person in charge who has helped them when they needed it. They also stated that things for them have been the same at the home as they always were. However, a quality assurance system was not in place, a requirement has been raised to ensure this is rectified. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 22 The management and the proprietors are keen to promote health and safety issues and the welfare of residents and staff. Some deficits were apparent at this inspection. The fire precautions undertaken at the home did not appear to have a complete record and a requirement has been made for the home to consult with the local fire authority to ensure all the appropriate precautions and checks are undertaken and recorded. The accident book was not available at the inspection; a requirement has been raised to ensure that all accidents and incidents are appropriately recorded. It is acknowledged that all handling equipment and aids are regularly serviced and the water supply in the home is tested for unwanted bacteria. Electrical equipment is regularly tested and the installation in the home has a current test certificate. All the regulations that refer to the use and storage of harmful chemicals are in place and incident and accidents that need to be reported are dealt with appropriately. These processes ensure that residents are safe at the home. Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 18 Requirement The registered provider must ensure that personnel files include all the documents called for in Schedule 2 of the legislation. The registered provider must ensure that there is a quality assurance system in place based on residents’ views and staff performance. The registered provider must ensure that all accidents in the home are appropriately recorded. The registered provider must after consultation with the fire authority undertake suitable fire precautions in the home. The registered provider must ensure that the panelling in bathroom 1 is repaired or replaced. Timescale for action 18/07/06 2 YA39 12 18/07/06 3 YA42 12 20/06/06 4 YA42 23 18/07/06 5 YA24 23 18/07/06 Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cameroon DS0000063214.V296744.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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