This inspection took place on 21 May 2018 and was unannounced.

Cameron Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cameron Lodge accommodates up to 12 people across three separate units, each one having separate adapted facilities. The accommodation is in a house and two bungalows next door. At the time of the inspection four people were living in the house and five people between the two bungalows.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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

We last inspected the service in December 2016. We found two breaches of regulations, the provider had not made sure that all care was person centred, met people’s needs and reflected their preferences. Checks and audits completed at the service had not been effective as shortfalls found at the inspection had not been identified. At this inspection, improvements had been made but there was a continued breach and a new breach of regulation was identified. This is the second consecutive time the service has been rated Requires Improvement.

Checks were completed on the environment and areas which put people at risk had been identified. The registered manager and staff had informed the provider that some of the environment was not safe, including the outside paths and forecourt that people used regularly to leave and enter their home. The house had not had a functioning washing machine since January 2018 and soiled laundry was being transported between the buildings. There was an odour of urine in some bedrooms and communal areas in the house. The provider had not acted to make the environment safe and reduce the risk of infection for people.

Following the inspection, some building work had been undertaken to improve the environment and the provider confirmed they had planning permission for further improvements but there was no date for the work to start.

At the last inspection, the culture within the house was not person centred, people were not leading meaningful lives, enjoying activities and learning new skills. Following the last inspection, the registered manager had supported staff with training and reflecting on their work practices to help their understanding of supporting people to lead meaningful lives. We observed staff supporting people to be as independent as possible and people had learnt new skills since the last inspection. The deputy manager’s office was in the house, so they were available to support people and staff.

The culture within the house had improved, there was an open and inclusive atmosphere, people were comfortable in the company of staff. Staff communication skills had improved, they used both verbal and non verbal communication to support people. The registered manager had a vision for the service, for people to become more independent and be able to go out when they wanted to be part of the community. This was shared by staff and we observed people going out into the community. Accidents and incidents were analysed to identify patterns and trends, action had been taken to mitigate the risk of them happening again and to implement any lessons learnt.

People were supported to have maximum choice and control of the

Cameron Lodge is a privately owned care home, in Deal, for people needing residential care. It provides care for up to 12 people with learning disabilities. The accommodation is in a house and two bungalows next door. At the time of the inspection there were ten people living at the service. (Four people were living in the house and three people were living in each bungalow).

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

The culture in the main house was old fashioned and did not support people’s individual development and preferred lifestyles. In the bungalows the culture was more family orientated with people having more of a say and more meaningful occupation and time with staff.

Staff did not consistently speak with people in a professional, respectful, sensitive and appropriate way. Staff did not have the skills to communicate effectively with everyone placing people at risk of not being heard. People were not consistently supported to express themselves and were not able to raise concerns or complaints. There was a complaints process that was accessible to staff, families and visiting professionals.

Staff knew people’s life histories, likes and dislikes and any preferred routines. Some people were encouraged to maintain their independence but not everyone was supported to be as independent as they could be. In the main house there was less opportunity for people to engage in tasks and routines.

People were not consistently encouraged and supported to keep occupied. People living in the bungalows were occupied throughout the inspection. However, people living in the main house were not always offered the choice of activities.

The registered manager encouraged people to feedback on the quality of the service and to share their experiences. Quality questionnaires were sent to families, health professionals and staff each year but people were not included since group meetings had been unsuccessful. Regular audits of records were recorded and included what action was needed, who would take the action and by when. However, shortfalls identified during the inspection of the quality of the support had not been picked up by the provider’s audits.

People were protected from the risks of abuse, including financial abuse. Staff knew how to respond to abuse and how to keep people safe. Risks to people, including any accidents or incidents, were assessed, monitored and reviewed.

There were enough staff to meet people’s needs. There were contingency plans for emergencies, such as staff sickness. The registered manager followed the provider’s recruitment process to make sure staff employed were of good character and safe to work with people.

People received their medicines safely and on time from staff trained to administer medicines. Medicines were stored, disposed of and managed safely.

Staff completed training to meet people’s basic needs but knowledge and awareness of best practice was limited. Staff had one to one meetings and an appraisal to discuss their personal development. Staff communicated effectively with each other to meet people’s needs.

People made some day to day choices in their daily life, for example, what to wear and what meals to have. Staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) but did not always put these into practice. Applications for DoLS had been made in line with guidance.

People enjoyed a choice of healthy food and drinks. Staff knew what foods and drinks people preferred and supported them to maintain a healthy diet. People’s health was

The service was divided into a main house which accommodated six people and two bungalows on the grounds which each accommodate three people. At this inspection we returned to the main house.

The inspection of April 2013 found that the provider needed to take action to make sure people were living in an environment that was adequately maintained and hygienically clean to prevent the risks of infection.

The main house were six people lived was now adequately maintained. Hallways, bedrooms, bathrooms and landing areas had been redecorated. Furnishings and equipment had been replaced. Areas in the home like the kitchen and bathrooms were hygienically clean. The home smelt clean and fresh.

People who use the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond to their needs. Staff knew the people well and were able to communicate with them using a range of methods. If people were unhappy about something the staff were able to recognise the signs and take the appropriate action to resolve any issues. Staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported

Staff were properly supported to provide care and treatment to people who used the service. Staff had received the necessary training and were supervised to make sure they could carry out their role effectively and safely.

The service was divided into a main house which accommodated six people and two bungalows on the grounds which each accommodate three people.

Most of people living in the home were unable to verbalise to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

People who use the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond to their needs. Staff knew the people well were able to communicate with them using a range of methods. If people were unhappy about something the staff were able to recognise the signs and take the appropriate action to resolve any issues. Staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported

The main house were six people lived was not adequately maintained. Areas needed redecorating and some furnishings and equipment needed replacing as they were old, ripped and dirty. Areas in the home like the kitchen and bathrooms were not hygienically clean. There was a strong odour in parts of the main house.

Staff were not properly supported to provide care and treatment to people who used the service. Staff had not received the necessary training and were not supervised or appraised to make sure they could carry out their role effectively and safely.

We made an unannounced visit to the service and spoke to people who use the service, specialist community services, the manager and to staff members.

At the time of the inspection, there were 12 people living at Cameron Lodge.

Some of the people living in the home were unable to verbalise to tell us about their experiences so we spent time with people and observed interactions between the people and the staff.

We saw that staff listened to people and took their views seriously and always answered their questions in a way that they could understand. We saw that the staff were friendly and people seemed relaxed in the home.

People told us and indicated that they received the care and support that they needed at Cameron Lodge. They indicated that they were happy at the home. Some people were participating in activities which they seemed to enjoy.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

Some staff told us that they would like to do different activities with people. They said this was sometimes difficult due to not having enough drivers to take people out. Specialists who visited the service said that the opportunities for community involvement for people could be more varied and improved.