Archived: Cameroon

Updated 27 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This focussed inspection took place on 1 August 2017 and was unannounced. It was carried out by one inspector.

We inspected the service against one of the five questions we ask about services; Is it safe? The purpose of the inspection was to check that actions the provider had told us they would take to address a breach of regulations found at the last inspection had been carried out satisfactorily.

Before our inspection we reviewed the information we held about the service, including notifications received and information from the local authority.

We spoke with the registered manager and four members of staff. We spoke with, or observed care provided to seven people living in the home. We looked at four recruitment records, three care plans and risk assessment records, and the staff rotas. After the inspection we contacted the provider by e mail.

Updated 27 September 2017

This focussed inspection took place on 1 August 2017. Cameroon is registered to provide accommodation and personal care for up to 13 people with learning disabilities. At the time of this inspection there were nine people living there.

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.