We inspected this service on the 14 and 15 November 2018 and it was unannounced. At our last comprehensive inspection in August 2017, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to complete an action plan to show what they would do and by when to improve. We returned to complete a focused inspection in April 2018 to look at two key questions of Safe and Well-led. At that inspection we found the provider had taken the action needed to make the required improvement. At this inspection we found that improvement had been sustained, therefore we have rated the service as ‘Good’ overall.

Camelot Care Homes Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates 57 people in two adapted buildings. At the time of our inspection there were 53 people living at the service. Five of the rooms at the home were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery.

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.

People had individual care plans which were personalised. We found that information was not always current to give staff guidance to provide responsive care. We have made a recommendation about updating care records.

Medicines were managed safely; we observed medicines administration and observed that staff practice was safe. Medicines administration records contained the information required to make sure people had their medicines as prescribed.

Pre-employment checks had been completed before staff started work. There were sufficient staff available to meet people’s needs. Staff understood their role in keeping people safe and had received training on safeguarding people from harm.

Staff were well trained and had opportunity for regular supervision. They told us they felt well supported and could approach the registered manager at any time. New staff received an effective induction.

People had a choice of meal and were supported by staff to eat where needed. Mealtimes were inclusive and relaxed. There were drinks available throughout the service.

Premises were kept clean and staff followed effective infection prevention and control practices. There was a programme of planned maintenance and decoration in place.

People were supported by a staff team that knew their needs well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had been given the opportunity to record their end of life wishes. The service had supported people at the end of their lives with assistance from healthcare professionals.

Activities were varied and provided daily. People had the option to be involved but could also choose to spend time doing their own activity. Visitors were welcomed without restrictions.

There were regular meetings for people, relatives and staff and minutes were kept. People, relatives and healthcare professionals all stated they thought the service was caring, responsive and well-led.

There had been no formal complaints since our last inspection, however there was a policy in place to manage any complaints. There were suggestion boxes in the receptions of both building so people, relatives

We undertook an unannounced focused inspection of Camelot Care Homes Ltd on 19 April 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in August 2017 had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and safe? This is because the service was not meeting some legal requirements.

No risks or concerns were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Camelot Care Homes Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Camelot Care Homes Ltd provides accommodation with nursing and personal care for up to 57 older people, some of whom have dementia. At the time of our inspection, 52 people were resident at the home. Five of the beds were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery.

The service is housed in two separate buildings on one site. One building is called Comilla and one is called Countess. There are landscaped gardens, which both buildings share. Accommodation was arranged over the ground and first floors and there were lifts for access. There are a range of communal areas that people can access such as dining rooms, lounges and a conservatory. Parking was available.

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.

People we spoke with felt safe living at the service, there were sufficient numbers of staff to meet people’s needs. Staff understood their responsibility to safeguarding people from harm and what to do if they were concerned.

Medicines were managed safely, registered nurses were responsible for the administration of medicines and we observed their practice was safe.

The environment had been decorated in some communal areas such as corridors, toilets and bathrooms. The environment was clean with no evidence of odours in any part of both buildings. Flooring in some areas had been replaced and there was a plan in place to make further improvement to areas such as flooring, painting and decorating.

Maintenance checks were completed and where needed external contractors were used to service equipment and check for safety. Staff were observed to use safe infection prevention and control practices such as use of gloves and aprons.

Risks had been assessed and measures put in place to support safe practices. Clinical staff regularly reviewed risks and they shared good practice with care staff. Accidents and incidents were analysed for trends or any lessons that could be learned.

People, relatives and staff were complimentary about the management of the service and thought the home was well managed. The service worked in partnership with other agencies to make sure people got the care and support they needed.

Quality monitoring had improved and was used to produce action plans. The provider was involved in monitoring at the service and reviewed action plans with the registered manager at their visits.

Camelot Care Homes Ltd provides accommodation with nursing and personal care for up to 57 older people, some of whom have dementia. At the time of our inspection 48 people were resident in the home. Five of the beds were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery.

This inspection took place on 17 August 2017 and was unannounced. We returned on 18 August 2017 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

At the last inspection in May 2016 we found medicines were not always managed in ways that protected people or were safe. At this inspection we found the registered manager had taken action to address these concerns and ensure medicines were managed safely. People received support to take the medicines they had been prescribed and staff kept good records of medicines they supported people to take. Medicines were stored securely.

At the last inspection in May 2016 we found people did not always have a care plan in place and people received personal care at times that did not suit them. At this inspection we found the provider had taken action to address these concerns. The provider had reviewed the care plans in place for people. People had a care plan which was personal to them. The plans included information on maintaining health, daily routines and goals to maintain skills and maximise independence. Care plans set out what people’s needs were and how they wanted them to be met.

Although the provider had taken action to address the issues we found at the last inspection, we found further shortfalls at this inspection.

The home was not clean and action was needed to control the risk of cross infection. Bathrooms, shower rooms and toilets in both wings of the home had not been effectively cleaned. Equipment had not been maintained in a good state of repair, which increased the risk of cross infection.

During the inspection we found an area of the home that was unsafe. A window on the first floor of the home had a broken pane of glass. This had left the window with exposed sharp edged glass, which was accessible to people using the service. Staff were not able to tell us when the window had been broken. Action had been taken to board up the broken window by the second day of the inspection.

The service had audit and quality assurance systems in place. However, these systems were not effective and had not ensured shortfalls in the home were identified quickly and action taken to resolve them. This is the third inspection we have completed since the service was registered. At each of these three inspections we have identified breaches in the regulations and told the provider improvements were needed. The provider had taken action to address the specific issues we have raised on the two previous occasions. However, on each subsequent inspection we have identified different breaches of regulations. The provider did not have effective systems to assess, monitor and improve the quality and safety of the service being provided.

We received mixed feedback from people about the quality of food. Some people were very complimentary about the choice and quality of meals. However, some people did not receive support to meet their dietary needs or preferences.

People told us staff treated them well and they felt safe living at Camelot. People said there were usually enough staff available to provide care for them when they needed it and most staff understood their needs. Comments included, “They have

Camelot Care Homes Ltd provides accommodation with nursing and personal care for up to 57 older people, some of whom have dementia. At the time of our inspection 52 people were resident in the home. 20 of the beds were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery. A multi-disciplinary team of a physiotherapist, rehabilitation assistant and occupational therapist was based at the home to provide support for people with their recovery.

This inspection took place on 5 May 2016 and was unannounced. We returned on 11 May 2016 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

At the last inspection we found the systems for assessing and managing risks did not always ensure there was clear information for staff on the action that was needed to keep people safe. At this inspection we found the registered manager had taken action to address this concern. Risks people faced were assessed and plans were in place showing staff how to manage them.

Medicines were not always managed in ways that protected people or were safe. There was a lack of information about when people should be supported to take ‘as required’ medicines. Medicines were not always stored securely and the records did not always match medicines held in the home.

People were not always able to choose when they received care and support. Comments from people included, “We just do as we’re told” and “You’ve got to follow and fit in with everyone else”. Care plans contained information about what people’s needs were, but not always how those needs should be met. Staff provided the care people needed, but sometimes this was task focussd, and not focussed on the person and their wishes.

People said they felt safe living at Camelot. Comments included ‘‘I do feel safe here” and “I feel safe and well looked after”. A relative told us “I’m confident (my relative) is safe and happy here”.

Systems were in place to protect people from abuse and harm and staff knew how to use them. Staff understood the needs of the people they were supporting. We saw that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They received a thorough induction when they started work at the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

People were confident that they could raise concerns or complaints and they would be listened to.

The provider and registered manager assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements. We received positive feedback from health and social care professionals about the registered manager and their ability to resolve concerns or shortfalls in the service.

We found breaches 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 this report.

Camelot Care Homes Ltd provides accommodation with nursing and personal care for up to 57 older people, some of whom have dementia. At the time of our inspection 49 people were resident in the home. 20 of the beds were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery. A multi-disciplinary team of a physiotherapist, rehabilitation assistant and occupational therapist was based at the home to provide support for people with their recovery.

This inspection took place on 6 July 2015 and was unannounced. We returned on 9 July 2015 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

The systems for assessing and managing risks did not always ensure there was clear information for staff on the action that was needed to keep people safe. Although information in the assessments was not clear and could be confusing, we saw staff were taking steps to keep people safe.

People were positive about the care they received and praised the quality of the staff and management. Comments included, “ Everything is 100%, I’ve never had any concerns ”; and “ I have no concerns about anything”. A relative told us “I do feel that (my relative) is safe and I think the care has improved over the last year or so”.

Systems were in place to protect people from abuse and harm and staff knew how to use them. Staff understood the needs of the people they were supporting. We saw that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They received a thorough induction when they started work at the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. We saw that people’s needs were set out in clear, individual plans. These were developed with input from the person and people who knew them well. People were confident that they could raise concerns or complaints and they would be listened to.

The provider and registered manager assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.

We found a 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 this report.