Care Home: Cameroon

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What the care home does well People who have recently moved in have been given plenty of time, information and opportunities to visit and get to know the home to help them decide if it is the right place for them.The home has taken good care to get to know each person and understand how they want the staff to help and support them every day. They have detailed records about each person that have been regularly checked to make sure the information is up-to-date.Some people have lived in the home for many years, while some have moved in more recently. All of the people we talked to said they were very happy living at Cameroon.We saw and heard about the interesting things people did every day. Each person had a weekly timetable of the things they wanted to do. There is a mini bus to take people out to activities in the community.People told us they enjoyed the meals. They had been helped to choose the things they want to eat. The staff encouraged people to eat foods that helped them stay fit and healthy.It is a comfortable and homely place to live. Each person had their own bedroom that had been decorated and furnished to reflect their choice, personality and interests.There are always enough staff on duty to give people the help they need. The home has taken good care to employ only people who are entirely suitable for the job. Staff have been well trained, supervised and supported.The home was well managed. The registered manager and deputy manager are both suitably qualified and experienced. Everyone was friendly, cheerful and welcoming.We found that the home was clean, safe and hygienic. What has improved since the last inspection? The home told us about some of the things they have improved in the last year and about the plans they have for the next year.They have helped people to gain access to more clubs and groups including the Gateway Club and the Magic Carpet group.They have bought some new furniture and installed a new shower room. These things have made the home even more comfortable.A deputy manager has been appointed and this means that there is now good management cover at all times. What the care home could do better: The care plans files have lots of information in lots of different places about people`s care needs. We suggested that they work with each person to draw up a summary of the tasks they need help with (for example, washing, dressing and cleaning teeth). People should have a copy of this care plan summary in a format they can understand.Staff must be given better instructions about creams and lotions that have been prescribed so that they make sure that any skin conditions get better.At the last inspection we recommended that the home addresses the problem with their sewage treatment plant. They have not done this yet, although they told us they plan to do this in the next 12 months. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cameroon Heath Cross Whitestone Exeter Devon EX4 2HR The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivien Stephens Date: 2 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Cameroon Heath Cross Whitestone Exeter Devon EX4 2HR 0164761540 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : info@alliedcare.co.uk Honeybourne House Limited care home 13 Number of places (if applicable): Under 65 Over 65 13 13 0 0 learning disability physical disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD- maximum of 13 Physical disability- Code PD- maximum of 13 The maximum number of service users who can be accommodated is 13. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Cameroon is a Registered Home for up to 13 younger adults who may have a learning difficulty and/or a physical disability. The home is a large detached single story building in a rural area 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. There is a large lounge, a separate dining area, or some people choose to eat in the large kitchen. All bedrooms are single occupancy. Adaptations have been made where necessary for those people who have mobility problems. Transport is available using the homes mini bus. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home Several weeks before this inspection the home to completed an Annual Quality Assurance Assessment. This gave us some useful information that helped us understand how the home is managed. We asked the home to give out some of our survey forms. We received 8 completed forms from people living in the home, 7 forms from staff and 2 from health professionals. Their answers helped us to understand what it is like to live at Cameroon. During our visit we either talked to, or observed, all of the people living in the home. We also spoke to three members of staff, the manager and the area manager who was visiting the home that day. We looked at some of the records the home is required to keep, including four assessment and care plan files, recruitment, training and supervision records, and health and safety records. Care Homes for Adults (18-65 years) Page 7 of 34 Our inspection began at approximately 11am and finished at approximately 7pm. What the care home does well People who have recently moved in have been given plenty of time, information and opportunities to visit and get to know the home to help them decide if it is the right place for them. The home has taken good care to get to know each person and understand how they want the staff to help and support them every day. They have detailed records about each person that have been regularly checked to make sure the information is up-to-date. Care Homes for Adults (18-65 years) Page 8 of 34 Some people have lived in the home for many years, while some have moved in more recently. All of the people we talked to said they were very happy living at Cameroon. We saw and heard about the interesting things people did every day. Each person had a weekly timetable of the things they wanted to do. There is a mini bus to take people out to activities in the community. People told us they enjoyed the meals. They had been helped to choose the things they want to eat. The staff encouraged people to eat foods that helped them stay fit and healthy. It is a comfortable and homely place to live. Each person had their own bedroom that had been decorated and furnished to reflect their choice, personality and interests. Care Homes for Adults (18-65 years) Page 9 of 34 There are always enough staff on duty to give people the help they need. The home has taken good care to employ only people who are entirely suitable for the job. Staff have been well trained, supervised and supported. The home was well managed. The registered manager and deputy manager are both suitably qualified and experienced. Everyone was friendly, cheerful and welcoming. We found that the home was clean, safe and hygienic. Care Homes for Adults (18-65 years) Page 10 of 34 What has got better from the last inspection The home told us about some of the things they have improved in the last year and about the plans they have for the next year. They have helped people to gain access to more clubs and groups including the Gateway Club and the Magic Carpet group. They have bought some new furniture and installed a new shower room. These things have made the home even more comfortable. A deputy manager has been appointed and this means that there is now good management cover at all times. Care Homes for Adults (18-65 years) Page 11 of 34 What the care home could do better The care plans files have lots of information in lots of different places about peoples care needs. We suggested that they work with each person to draw up a summary of the tasks they need help with (for example, washing, dressing and cleaning teeth). People should have a copy of this care plan summary in a format they can understand. Staff must be given better instructions about creams and lotions that have been prescribed so that they make sure that any skin conditions get better. At the last inspection we recommended that the home addresses the problem with their sewage treatment plant. They have not done this yet, although they told us they plan to do this in the next 12 months. Care Homes for Adults (18-65 years) Page 12 of 34 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Vivien Stephens 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 13 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People can be confident they will be given plenty of opportunity to visit and get to know the home before they decide to move in permanently. The home follows good assessment procedures so that they can be certain they will be able to meet the persons needs. Evidence: At the last inspection we found that the home had a good system of assessment in place for people who were thinking about moving in. Since the last inspection two new people have been admitted to the home. We looked at the files of these people to find out how much care had been taken by the home to make sure they were able to meet the peoples needs. The home had a wide range of assessment forms in place and these had been completed with lots of detail showing that the home had taken time to find out as much as possible about the person. Each person had also been helped to draw up their own lifestyle plan. This gave the person the opportunity to say what they wanted to achieve in their lives and how they wanted the home to help them reach their aims. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: We also heard that the home had taken plenty of time to help each person get to know the home before they moved in. This included visits to the home for a day, overnight, or for a few days. They had gathered information from other people who knew the person, including social workers, health professionals and relatives. They also had a range of information about the home in both written and picture format to help people know what they could expect from the home. Their service user guide and statement of purpose have been updated to ensure people have information about the home that is correct. Care Homes for Adults (18-65 years) Page 16 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People can be confident that the home will listen to them and help them to plan the support they need to live their lives as they wish, in as safe a manner as possible. Evidence: We looked at four care plan files during our visit, including the files of two people who had moved in since our last inspection. The files contained a very wide range of information about all aspects of each persons personality, health and personal care needs, interests and regular activities, and family and friends. Regular reviews have been carried out to make sure that the information in the files was kept up-to-date. We saw evidence to show that each person had been involved and consulted in the care planning process. Where people had been helped to draw up their own lifestyle plan it was evident that the home had listened to the person and had worked with them to help them achieve their goals. Our main observation of the care plans was that there was a great deal of information contained in a number of different formats. If staff needed to find out how a person Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: wanted to be supported they would have to look in a number of places, and would have to spend time reading many documents in order to gain an overall picture of the persons daily care needs. We suggested that the home considers using the information contained in the files to put together an easy to read summary of the persons daily routines and care needs. This could also be written in a format that the person could read, agree, and hold a copy of. This summary could be used by staff on a daily basis to check that they have given the person the support they need. We saw evidence to show how the home had worked with each person to help them make decisions about all aspects of their daily lives. They had monthly residents meetings. Each person had a key worker who they worked with closely to make choices and decisions about their lives. People had been helped to choose the things they wanted to do each day, the clothes they wore, the food they ate, and the way their rooms have been decorated and furnished. During our visit we observed staff talking to people on an adult-to-adult basis, agreeing with them how they will support them to do the things they wanted to do, and the places they wanted to go. Protocols were in place in the care plans to explain to staff how to help people who may at times become upset or display behaviour that some staff may find challenging. The protocols explained to staff what might cause the person to become upset and how the staff can support them to remain calm and safe. We also heard how some people have chosen to attend church regularly. The staff have provided the support necessary to help people follow their chosen religion. The care plan files contained detailed risk assessments about all areas of potential risk. The risk assessments showed that the home has supported people to take risks while at the same time helping them to reduce or eliminate those risks. An example of this was one person who enjoys walking in the surrounding lanes every day. The home has given the person advice on road safety and provided a reflective jacket. They have regularly monitored the situation to ensure the person continues to be as safe as possible. During our visit we either talked to, or observed, all of the people living in the home. People told us about the way they have been supported to live their lives they way they wanted. They were all happy living at Cameroon. All information about individuals was held in a confidential manner in the office, which was kept locked when not in use. Care Homes for Adults (18-65 years) Page 18 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported to lead interesting and stimulating lives following a plan of the regular things they want to do, with plenty of opportunities for leisure activities. People are offered a nutritious and varied range of meals to suit all individual tastes and preferences and dietary needs. Evidence: During our visit we saw plenty of evidence to show that people lead interesting and varied lives. Each person had an individual weekly timetable of the things they do on a regular basis. During the day some of the people were out and about doing planned activities. The home has a minibus that is used to take people to the groups and activity sessions they regularly attend, many of these are in Exeter, a few miles away. In the last year the home has helped people to join new groups including the Gateway Club and the Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Magic Carpet group. Cameroon is situated in the country approximately one mile from the village of Whitestone. During our visit we discussed the way the home has maintained good links with the village and local community. On the day of our visit a reflexologist was visiting to provide reflexology sessions for some of the people living in the home. In the afternoon we saw some of the women living in the home having beauty treatments. Around the home there were many examples of artwork created by people living in the home. We also heard how people enjoyed the garden and helped to maintain it. We heard about outings, shopping trips, and many leisure activities they enjoy. People told us about some of the holidays they have had, and the holidays they are planning to take this year. The home has created a sensory room with a range of sensory equipment. We heard that some people enjoy using this room regularly. People have been supported to keep in touch with family and friends. Visits to, and from, family and friends have been encouraged and supported. During our visit we saw people having their evening meal. The meal was attractively presented and looked tasty and nutritious. We heard how the home helps each person plan and choose what they want to eat. The staff we talked to had a good knowledge of each persons likes and dislikes, and any special dietary needs. The people we talked to said they always enjoyed the meals and confirmed they could choose something different if they did not like the main meal on offer. Care Homes for Adults (18-65 years) Page 20 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported by competent staff who have sufficient knowledge and information about each persons needs to ensure all health and personal care needs are met. Evidence: We case tracked the personal and healthcare support given to four people living in the home by reading their care plan files and checking all documents relating to their care, including medication administration records. We also met each person and talked to them about the care they had received. We found that the care plans contained a great deal of information about all aspects of each persons care needs but the information was presented in so many places, and in such detail, that it was possible to miss some important basis areas of personal care (see also section 2 Lifestyle). An example of this was one person who needed support from staff to help them look after their teeth. We heard that the person had visited the dentist at some time in the past but had been very upset by the experience and therefore the dentist was unable to check their teeth or carry out ony treatment. There was no guidance in the care plan files to inform staff how they should support the person to keep their teeth clean. There was no plan to help the person overcome their Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: fear of visiting the dentist, and no evidence of consultation with a dentist about the best way of maintaining good oral hygiene. Despite a few omissions, including the above example, we found the care plan files also contained some good information about daily routines and personal care needs. We could see some information about normal daily routines including the persons preferred times of getting up and going to bed, and information about washing and bathing. Some of the care plans had been signed by the person concerned, but others had not yet been signed. We heard that these were mainly those people who were unable to read, and who relied on a relative or advocate to check the care plans and sign on their behalf. Chris Summers assured us that they intended to complete this task in the near future. We talked to Chris Summers about ways the information in the care plan files could be presented to give staff an easy to follow guide on how each person wants to lead their daily lives, and the tasks they want care workers to help them with. The files contained detailed information about peoples health care needs. We saw copies of letters from health care specialists that showed how the home had sought their guidance and treatment appropriately. Peoples weight had been recorded regularly and we could see that the home had considered peoples nutrition needs and how individuals should be supported to maintain a healthy lifestyle. People had received regular health checks on all aspects of their health. The people we talked to during our inspection spoke highly of the staff team and told us the staff give them the support they wanted with all personal and health care needs. We also talked to four members of staff. They told us they had received good training on all areas of personal and health care needs. They also said there are good systems of support and communication in place to ensure they always have good information about any changes in personal or health care needs. The home uses a monitored dosage system of medicine administration supplied by their pharmacy. All staff have received basic training on the system and good administration practice by the pharmacy. Some staff have also had in-depth training on the safe administration of medicines, and this has included a test to check their competency and knowledge. At the time of this inspection none of the people living in the home were able to self medicate. The care plans included detailed assessments on all aspects of each persons medication where there was a potential risk. Medicines were stored in the rear kitchen area. While the storage arrangements were safe the manager and staff had found the kitchen was often very busy and there was a Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: possibility that staff may be distracted when working with medications. They have been considering moving the medicines to a quieter area where the staff are less likely to be distracted. We found that the medicine stocks were stored tidily and regular checks have been carried out to make sure all stocks were current. Unwanted medicines have been returned to the pharmacy. The medicine administration records had been well maintained and there were good accounting procedures in place to ensure the stocks held were correct. The medicine administration charts included relevant information about particular medications where there may be specific risks, side effects, or important administration instructions. One area where better information should be provided was on the administration of creams. We advised that there should be clear instructions on where and how each prescribed cream should be applied. There should be a method of monitoring the skin condition and instructions on what to do if the condition improves or worsens. Care Homes for Adults (18-65 years) Page 23 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People can be confident that the staff will listen and take the right actions to help them resolve any concerns or complaints. People are protected from harm or abuse by well trained staff and robust policies and procedures. Evidence: Since the last inspection there has been 1 complaint received by the Commission. At the time of this inspection the home had investigated the complaint and taken action to reduce the risk of a similar incident happening again, but they had not responded to the complainant. A few days after this inspection the home provided evidence to show they had responded to the complainant and assured us they would follow this up to check that the complainant was satisfied with the outcome. The home told us they have received 2 complaints that they have investigated and resolved quickly. The people we talked to during our visit, and the comments we received from people who completed a survey form before this inspection showed that each person felt confident that they could speak to someone if they were unhappy about anything, and they felt confident that it would be sorted out satisfactorily. Comments included I would tell any of the staff, I can speak to the manager or my key workers. A health professional who completed a survey form said they were Impressed by manager and member of staff when there was a concern with my client when out and about and meeting someone who knew them from the past. A Vulnerable Adult Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: meeting was called, member of staff involved even had the foresight to take a picture of the possible abuser on his mobile phone! which proved invaluable evidence for the police. The complaints procedure has been given to each person living in the home. It has also been produced in an easy read format and explained to each person to help them understand how to speak out if they have a complaint. We also heard that the home holds regular key worker meetings and residents meetings where people are encouraged to speak out if they have any complaints or concerns. We also talked to some of the staff about their confidence in the way the home is managed, and asked if they felt they could raise any concerns and feel confident that they would be listened to and acted upon. They told us they felt there was an open atmosphere where they felt able to speak out. They said that there are regular visits to the home by senior managers of Allied Care (at least once a month) and they felt confident they could always speak to a senior manager if they had serious concerns. All staff have received training on the protection of vulnerable adults. The home has a range of policies and procedures in place covering all aspects of protection. We looked at the way the home looks after peoples money, savings and valuables. We found that the home had safe systems in place and the money was regularly checked to make sure it was correct. Care Homes for Adults (18-65 years) Page 25 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a comfortable, safe and well maintained home that has been decorated, furnished and equipped to suit each persons individual needs. Evidence: During this inspection we carried out a tour of the home. We found that all areas of the home and garden had been well maintained. They have a yearly maintenance planner and there was an ongoing plan of redecoration and improvement of the environment. The home is situated approximately 1 mile from the village of Whitestone. The gardens have been well maintained and attractively laid out. At the back of the bungalow there are lovely views over the countryside reaching to Exmoor. Although the home is a bungalow the main lounge is on a lower level reached either by steps or a ramp. Access around other areas of the bungalow is level. Where necessary hoists, grab rails and other equipment has been provided to help people move around safely. Meals can be eaten in the dining area situated between the main lounge and kitchen, or in the kitchen. Both areas were comfortably laid out and furnished. Each person had a bedroom of their own that had been decorated and furnished in the Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: colours and style of their own choice. Each room had been personalised with pictures, lighting, and personal effects that reflected the persons interests. The bathrooms have been attractively decorated and the fittings were of a domestic and homely style, with suitable equipment for those people who may need assistance. The shower room had been refurbished in the last year. The laundry was well equipped and in good working order. All areas of the home were found to be clean and hygienic. At the last inspection there was an unpleasant odour from the homes sewage treatment system and we recommended the home should address this problem. There was no odour problem on the day of this inspection, although the home told us they are planning to install a new sewage treatment plant in the next 12 months. Care Homes for Adults (18-65 years) Page 27 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported by sufficient well trained and competent staff to ensure their needs are fully met. Good recruitment procedures have been followed to make sure people are protected from the risk of harm or abuse. Evidence: On the day of this inspection there was a manager, deputy manager and three care workers on duty. The staff were relaxed and cheerful and we saw people going out and doing a range of activities either on a one-to-one basis or in small groups. We talked to most of the people living in the home and three members of staff about staffing levels, and we were satisfied that there were sufficient staff to meet the needs of the people living in the home. We looked at the recruitment files of four staff employed since the last inspection. We found that the home had taken up criminal records bureau (CRB) checks, at least 2 satisfactory references, and they have checked the Protection of Vulnerable began work, but we were assured by the manager that he had taken up a verbal reference on the person. We recommended that the records should provide clear evidence of the dates of references and the content of any telephone discussions and verbal references. Since the last inspection the Commission was made aware that the home had Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: employed at least one person without taking up a reference from their most recent employer. We were given firm assurances at this inspection that it is now the homes policy to obtain at least two satisfactory references, one of which must be from the most recent employer. We looked at the records of induction and training and found that all staff had received a good range of training. The home uses a Devon based training organisation to provide all mandatory training for the staff. The home has followed a comprehensive induction programme for new staff covering all important areas of knowledge. The manager has also provided some in-house training on a range of topics. We asked the staff on duty if they felt they had received sufficient induction and ongoing training to cover all of the work they were expected to carry out. They told us that training has been given a high priority by the organisation and they have received lots of training covering a wide range of topics. Evidence of this could be seen in their recruitment and training records. We saw records of supervision showing that all staff have received regular monthly supervision sessions. They also attend regular staff meetings. Staff told us they have good communication and support systems. Care Homes for Adults (18-65 years) Page 29 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a safe, comfortable and well run home and they can feel confident that they will be consulted on all aspects of daily life and their views will be listened to and acted upon. Evidence: The home manager and deputy manager both have relevant qualifications and experience. The people we talked to during this inspection, including staff, told us the home ran smoothly and was well managed. A health professional who completed a survey form said It feels as though management have worked hard to improve standards at the home and create a nice homely environment. Staff I have met have a nice attitude with the clients. We found there was an open and friendly atmosphere, and the manager and deputy manager demonstrated a commitment to listening to people, and working alongside them to help everyone receive the best possible service. The company have a range of internal audit systems in place to make sure that all aspects of the management of the home are checked regularly. They also carry out a monthly health and safety audit. During our visit we met the Area Manager who visits Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: the home on a regular basis, usually unannounced, and at different times of the day to check that the home is running smoothly at all times. The company have a wide range of policies and procedures in place that are regularly updated. This means that staff can be confident that they can easily access information about good practice and check that they are following safe procedures. The home sends out regular satisfaction surveys to relatives and professionals to check that everyone is happy with the way the home is run. People living in the home are consulted and involved in a variety of ways including residents meetings, care plan reviews and key worker meetings. Care Homes for Adults (18-65 years) Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The home should consider providing a summary of the information in the care plan files to give each person and the care staff team an overview of the support they need on a daily basis. The summary should be written in a straightforward and easy to read style so that staff know exactly how they should support the person throughout the day. A copy should be given to the person concerned in a format they can read and understand. There should be clear instructions on where and how each prescribed cream should be applied. There should be a method of monitoring the skin condition and instructions on what to do if the condition improves or worsens 2 20 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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