CARE HOME ADULTS 18-65
Cameroon Heath Cross Whitestone Exeter Devon EX4 2HR Lead Inspector
James Rose Unannounced Inspection 14 March 2006 09:30
th Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 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.V284266.R01.S.doc Version 5.1 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.V284266.R01.S.doc Version 5.1 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.V284266.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. PD - Physical disability, 13 service users male or 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 6th April 2005 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. The home 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 large 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.V284266.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours on 14th March 2006. An extended discussion took place concerning care records and a complete tour of the premises was undertaken during the inspection. Five residents were consulted about life at the home and four care staff were also interviewed. Two of the interviews with carers were undertaken individually in private and the way care was delivered was observed. Since the last inspection the home has had a new manager registered who has now left the home and a new proposed registered manager is in post. What the service does well: What has improved since the last inspection?
The home has now achieved a complete care staff team and the new proposed registered manager is introducing a new complete recording system. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 6 What they could do better:
Since the time of the last inspection the registered manager has left the home and little recording is now in place and Honeybourne House Limited has not appropriately monitored this situation. A new proposed registered manager is now in post and it has been agreed that new records will be provided within the next twelve weeks. Requirements have been raised in this report that have had the timescales agreed if however more time needs to be negotiated the home should contact the Commission without delay. At the time of this inspection no records were available of the assessments undertaken on residents and this should be rectified as soon as possible. No care plans were in place and a requirement has been raised for a complete set of care plans to be put in place to provide a foundation for the care to be provided. Risk assessments are also missing and should be undertaken without delay to ensure residents are safe. The home has many new members in the care team and training should be given priority to ensure the quality of care can be maintained. A requirement has also been raised to ensure the home undertakes reporting to the Commission all events covered by the legislation (Regulation 37). Some deficits were found in the recording undertaken of the administration of medication and a requirement has been raised to ensure that all carers that administer medication adhere to the homes policy and procedure. The home had at the time of the last inspection a sensory room that was housed in a wooden building, which was a facility much enjoyed by some residents. Since the last inspection this has been removed and a new building provided for an office for the home. It is disappointing that this was undertaken with no record of any consultation taking place with residents and no apparent plans are available where this facility is to be recited. It is recommended in this report that this position should be reviewed without delay and arrangements made to replace this facility for residents. It is further recommended that the laundry facilities at the home should be reviewed to provide a laundry to the national minimum standards and to provide a suitable protocol to ensure there is no contamination between clean and soiled laundry thus ensuring infection control.
Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 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.V284266.R01.S.doc Version 5.1 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.V284266.R01.S.doc Version 5.1 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 No assessments were available of residents needs. EVIDENCE: The assessments that were undertaken by the home of residents’ needs that have been seen at previous inspections were no longer available. This was discussed with the proposed registered manager and it has been agreed that new detailed assessments will be undertaken without delay and a requirement has been raised for this purpose. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 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, 9 Individual care plans were not available at the home. Risk assessments were not in place. EVIDENCE: Since the departure of the last manager the care plans that were in place are no longer available. This serious situation was discussed with the proposed registered manager and this matter is going to be given a priority, a requirement has been raised and the timescale agreed for completion to ensure that an individual care plan is in place for each person receiving a service at the home. At the time of the inspection the home did not have available risk assessments to enable service users to take responsible risks. This matter was also discussed with the management of the home and these are going to be put in place as a matter of priority. A requirement has been raised to ensure this is achieved within an agreed timescale. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 11 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, 14 and 17 Residents have opportunities for personal development and engage is appropriate leisure activities. Well balanced wholesome meals are provided that are to the liking of residents. EVIDENCE: Residents do have opportunities for personal development and leisure activities are provided, however these are not currently coordinated in a comprehensive individual care plan. This matter is being urgently addressed by the home’s proposed registered manager and is the subject of a requirement in this report. A good quality healthy diet is offered at the home, which was much appreciated by the residents who also confirmed that choice was always available. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 12 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): 20 Some deficits were found in the recording undertaken by the home of the administration of medication. EVIDENCE: The recordings of the administration of medications were examined and some deficits were found. This is a serious matter and has the potential to put residents at risk. This matter is being investigated by the home’s proposed registered manager and is also the subject of a requirement in this report. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 13 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 Residents were confident that when they raised an issue with staff it was taken seriously and acted on. Service users are protected from abuse. EVIDENCE: Five residents were consulted during the inspection they presented as being confident and stated that when they raised an issue with the staff the matter was quickly resolved for them. Appropriate interaction was observed between staff and residents, time was given to residents to enable them to express their views and staff clearly had the confidence of service users. One resident said “ I like my home and I can always get help when I need it”. Three members of the care team were interviewed in private and were clear about what constituted abuse and what action needed to be taken if it was discovered in the home. Some basic training is outstanding for some of the new staff and a requirement has been raised to ensure this is addressed. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 14 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 Cameroon is a well maintained, safe and comfortable environment for residents to live in. EVIDENCE: A complete tour of the home’s facilities was undertaken during the inspection. The communal areas were comfortably furnished and the lounge was provided with a large television and sound equipment. Meals were taken in a separate dining area. A large kitchen is available where some residents like to sit around a central table. Resident’s bedrooms are well furnished and decorated to a good standard to the taste of the service user. Reference was made in the last report to the provision of a new large decking area this was advised to the inspector by the then manager of the home it has not been provided and it appears to have been made without foundation. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 15 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 The deployment and number of staff available throughout the day and night is sufficient to meet the needs of the residents. EVIDENCE: The home has a complete care team available and care is taken to ensure that experienced personnel work with new staff. The staffing levels remain at the same level as previously were available and are sufficient to ensure that residents needs can be met 24 hours a day. The five residents consulted during the inspection process were complimentary about the care staff who clearly had their confidence. One resident remarked, “ The staff are my friends and will always help me “. A requirement has been raise din this report for the registered provider to ensure that all the staff at Cameroon have their basic training completed as soon as possible. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 16 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 and 42 Currently the home is between registered managers and there are deficits in recording, however, the quality of the service to residents is being maintained. Health, safety and welfare of residents is given priority. EVIDENCE: Since the departure of the registered manager the home has not had available the individual care plans and assessments and other recording that was in place at the time of the last inspection. The current proposed registered manager is currently fully engaged in replacing these records and requirements have been raised in this report with timescales agreed with the home. The home’s advisor has agreed to provide any additional support to the home to ensure this is completed. Five residents were consulted as part of the inspection process and they were very positive about life at the home and felt they were well cared for in the same manner as in the past. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 17 Health and safety issues are clearly seen as a priority by the management and staff are trained in moving and handling and fire safety. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 18 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 1 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 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 2 X X X X 3 X Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 19 No 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 YA2 Regulation 14 Requirement The registered provider must provide a full assessment for each resident that is undertaken by people competent to do so. The registered provider must provide an individual service user plan for each resident that has been developed and agreed with the individual concerned and or their representative. The registered provider must provide suitable risk assessment to enable service users to be supported and able to take responsible risks as part of an individual lifestyle. The registered provider must ensure that staff adhere to the policy and procedure for the correct administration of medication. The registered provider must ensure that staff receive induction training and foundation training to Sector Skills Council specification. The register provider must give notice to the Commission without delay of the occurrence of –
DS0000063214.V284266.R01.S.doc Timescale for action 06/06/06 2. YA6 15 06/06/06 3. YA9 13 06/06/06 4. YA20 13 15/03/06 5 YA35 18 06/06/06 6 YA42 37 15/03/06 Cameroon Version 5.1 Page 20 (a) the death of any service user including the circumstances of his death. (b) the outbreak in the care home of any infectious disease which in the opinion of any registered medical practitioner attending persons in the care home is sufficiently serious to be so notified. (c) any serious injury to a service user. (d) serious illness of a service user at a home at which nursing is not provided. (e) any event in a care home which adversely affects the well-being or safety of any service user. (f) any theft, burglary or accident in the care home. (g) any allegation of misconduct by the registered person or any person who works at the care home. Any notification made in accordance with this regulation which is given orally shall be confirmed in writing. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Cameroon Refer to Good Practice Recommendations
DS0000063214.V284266.R01.S.doc Version 5.1 Page 21 1. 2. Standard YA8 YA30 3. YA30 The registered provider should review the reprovision of a sensory room and consult with residents on the issue. The registered provider should urgently review the provision of the laundry to ensure the laundry floor finish is impermeable and that the wall finishes are readily cleanable. The registered provider should provide a written protocol to ensure there is no contamination between soiled and clean laundry and staff trained in its use. Cameroon DS0000063214.V284266.R01.S.doc Version 5.1 Page 22 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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