Archived: Cameroon

The purpose of this inspection was to check on actions taken by the provider and registered manager to address the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 19; Fit and proper persons employed, which we found at the previous inspection of the service on 3 August 2016. We found that recruitment procedures had not always been carried out in a safe or effective way.

After the last inspection we received a satisfactory action plan from the provider detailing the actions they proposed to take to meet the regulations. They told us they would insist all applicants for jobs must complete an application form giving a minimum of a ten year evidence of work history and any explanations of gaps. Recruitment checks would be completed including gathering references from previous employers and character references. They would also complete a check with the Disclosure and Barring Service (DBS). An interview would be carried out, and if the applicant were found to be suitable, a start date would be agreed. New staff would not begin working in the service until this process had been completed and satisfactory references and checks received.

However, during this inspection we found that the provider had failed to follow the recruitment process set out in their action plan. The service continued to experience a high turnover of staff. They had been unable to recruit new staff locally, and had instead used recruitment agencies to provide staff from other countries. We were unable to see evidence that either the recruitment agencies or the provider had taken care when recruiting new staff to gather evidence of the applicants’ suitability for the job. This placed people at risk of harm, abuse or poor care.

The provider’s failure to ensure the suitability of new staff had impacted on other areas of the service. People could not be confident the provider would be able to maintain safe staffing levels in the future because the home experienced a high turnover of staff. New staff had arrived in this country with an expectation that they would start work immediately. However, the registered manager told us some new staff had arrived with a very poor command of the English language. Most of the new staff had little or no relevant previous experience. Some staff had not started, and had been passed back to the agency immediately, and some had left the job within a few days or weeks of starting. This had affected the morale of the staff team, and they had experienced periods of very high turnover of staff in the last year. New staff were given some basic induction at the start of their employment and a period of ‘shadowing’ more experienced staff for the first two weeks. However, this had meant people received support from staff who did not always have the skills, knowledge or experience to meet their needs safely. It also meant that people could not be confident they would receive a consistent service from staff who knew them well, understood their needs, or could communicate effectively with them.

The provider had been unable to recruit a cook or cleaning staff. This meant the staff team were expected to carry out cooking and cleaning duties in addition to care tasks. While we found most areas appeared clean, and people received support with personal care when they needed it, people told us they would like to do more activities, and go out more often.

At the time of this inspection we found vacant shifts had been covered by staff from other services operated by the provider. This meant there were sufficient staff to meet people’s basic needs, although staff had limited time to support people with activities, outings or social needs. Some people living in the service had limited verbal communication skills and were unable to answer our questions. We spoke with four people who told us they were happy living there and felt safe. We spoke with four staff who told us they enjoyed working in the home and said there was a friendly and positive atmosphere. Comments included “I like it here”, and “We just need a couple more reliable staff we can hold on to.

After the inspection the provider told us they intended to close the home. They had contacted the local authority commissioning team to agree a timescale for the closure.

We found one continued breach and two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In reaching a decision about our regulatory response to the continued breach of regulations we took into consideration the provider’s decision to close the service. After the inspection we sought confirmation from the provider that they will maintain a safe staffing level until the home is closed. In their response they assured us they will enhance their monitoring processes to ensure the home runs smoothly during the closure process. They told us they will maintain safe staffing and management levels to meet the dependency levels of the people living there. They proposed to increase the number of monitoring visits by the area management team and quality monitoring team to ensure people continue to receive the best service possible until the home finally closes.

Cameroon is registered to provide accommodation for 13 people with learning disabilities who require personal care. The property is a bungalow and is situated in a rural area near the village of Whitestone, just outside of Exeter, Devon. At the time of this inspection there were eight people living there. We either spoke with, or observed staff interacting with, each person during our visit.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was poor security of the building which meant people were placed at risk of harm. When we arrived at the home the door was opened by a person living in the home. There were no staff available to answer the doorbell or the greet us and ensure we had authority to enter the home. People were left alone in the communal areas without means of summoning assistance from staff for ten minutes after we arrived. We spoke with the registered manager and area manager about the security of the home and staff deployment and they took prompt action to address these concerns.

Since the last inspection there had been a number of staff changes and new staff recruited. The number of agency staff used had decreased, although the service continued to use some agency staff to fill vacancies. Many of the newly recruited staff had no previous relevant experience, although they had all received thorough induction training that ensured they had the basic skills and knowledge to meet people’s needs. Staff rotas showed there were certain times during the week when staffing numbers appeared low. The registered manager took action immediately to engage additional agency staff to cover busy periods until new permanent staff were recruited.

Safe recruitment procedures had been completed before most new staff began working with people. However, this evidence was incomplete in two files we looked at. This meant people may be placed at risk of harm or abuse because safe recruitment procedures had not always been followed.

People living at Cameroon were confident their needs were met by staff who had received suitable training. All staff had received induction training on a range of relevant topics at the start of their employment. Many of the staff were also in the process of obtaining nationally recognised qualifications such as the Care Certificate, National Vocational Qualifications (NVQs) and diplomas. This meant staff had received training that provided them with a basic level of knowledge on all areas of people’s needs.

At the last inspection we found there were some areas of medicine storage and administration that were not entirely safe. At this inspection we found our previous concerns had been addressed and safe systems of storage and administration were being followed.

The home was well maintained. At the time of this inspection a process of redecoration of many areas of the home was underway. The lounge and some bedrooms had recently been redecorated. A member of staff sat with one person to help them choose new decorations and furnishings for their room which was due to be redecorated in the near future. We were told all bedrooms would be redecorated. Maintenance checks had been carried out regularly to all gas, electric and fire equipment.

People told us they felt safe living at Cameroon. They knew who to speak with if they had any worries or complaints. Staff had received training on safeguarding adults and knew how to recognise and report any suspicions of abuse.

People told us the staff were caring. Comments included “There are nice people here,” “I think they are caring” and “They are all kind to me.” Staff sought people’s consent before providing any support or care. People were consulted and involved in all aspects of the service.

Each person had a care plan that gave staff information about all aspects of their personal care and support needs. Risks to each person’s health and safety had been assessed and reviewed and staff knew how to support people to reduce the risks where possible. The staff team had a basic understanding of how to reduce risks such as choking and prevention of pressure wounds but would benefit from further training in these areas. People were supported to access treatment and advice on all aspects of their health needs.

People were supported to participate in a range of activities. A vehicle was available to take people out, although there were only two staff who were able to drive the vehicle at the time of this inspection. The registered manager and staff told us they tried to make sure people went out as often as possible, and where this was not possible they had increased the number of in-house activities. This had included visits from musical entertainers, arts and crafts organisers, and therapists. They were hoping to increase the number of staff who can drive the home’s vehicle in the near future.

People told us the home was well-managed. Staff, people living in the home, relatives and professionals told us the registered manager was approachable. There were good systems of communication between the staff, management team, people living in the home and relatives. Staff told us they were well supervised and supported. Supervision sessions were recorded and stored in each of the staff files. Staff morale was good and we saw evidence of good teamwork.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014).You can see what action we told the provider to take at the back of the full version of the report. We have also made one recommendation relating to guidance in respect of determining safe staffing levels.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

At the time of this inspection there were ten people living at Cameroon.

The summary is based on our observations during the inspection which was carried out over two days. We spoke with five people who lived at Cameroon and observed staff supporting and interacting with each of the ten people who lived there. We also spoke with the registered manager, the deputy manager and four support workers.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were safe because there were systems in place to make the premises were well maintained and suitable for the needs of the people living there. We saw evidence to show all equipment was regularly serviced and maintained. Risk assessments had been carried out on all areas inside and outside the home and actions had been taken to address any areas of concern. People and staff told us communication was good in the home and they could raise any concerns at any time with the registered manager and were confident actions would be taken promptly.

The environment was safe, clean and hygienic. There were safe recruitment systems in place. This meant people could be confident all required checks had been carried out before new staff began working in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager told us they had not needed to submit any DoLS applications. They had sought advice appropriately where they considered people may not have capacity to make important decisions about their health and safety.

Is the service effective?

This is an effective service because people's health and care needs were assessed with them, and they were involved with their care plans and monthly reviews. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service caring?

People who lived at the home told us they felt safe and were happy with the support they received. People told us about the staff they liked, and we were satisfied people were able to speak out and their concerns taken seriously if they had any concerns about any member of staff.

We spoke with staff who were able to tell us how they met people's care needs. We observed the support provided and spoke with the people who lived in the home. This gave us evidence that staff knew people well.

People were supported by staff who were understanding and sensitive to their needs. We saw that staff showed patience and gave encouragement when supporting people.

Is the service responsive?

We saw the service had liaised closely with health care professionals where concerns relating to people's health were noted. The home had sought advice and acted on that advice, for example specialist chairs had been provided to individuals when their needs had changed.

Most people completed a range of activities to suit their individual needs. The manager told us about plans to recruit new staff who will be able to provide a greater level of activities in future to meet every person's needs.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. They received regular supervision and staff meetings. They told us they could ask for further supervision or support at any time.

We saw the manager carried out regular checks on all aspects of the care and services to make sure people received a safe service.

We brought forward our planned inspection following a safeguarding meeting a few days earlier. The manager had received concerns about possible poor care and had passed these concerns to the relevant authorities. The manager had begun investigations into the concerns received and they had taken, or planned to take, a range of actions to address these including disciplinary procedures and further staff training. During this inspection we found that people were not always treated with respect.

We found people's care was planned and delivered to meet their personal and health care needs. Advice and treatment from health and social care professionals was sought and followed appropriately.

Medicines were administered safely. Where poor practice had been found by the manager we saw evidence that actions had been taken, or were planned to be taken address these.

There were sufficient trained and competent staff available to meet people's needs. Staff told us they were well supported, had received good training, and enjoyed their jobs.

There were systems in place to seek people's views and to check the quality of the service and make improvements where necessary.