Camelot House is a nursing home which is able to accommodate up to 90 people in two buildings. Camelot House can accommodate up to 62 people and Camelot Lodge can accommodate up to 28 people. The home specialises in providing nursing care to people who have dementia and other mental health needs. At the time of the inspection there were 73 people using the service.

At the last inspection the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

At the inspection of Camelot House in January 2016, we found that risk assessments and risk management plans were not consistently reviewed regularly. The provider wrote to us in May 2016 outlining how they would improve this. During this inspection we found improvements had been made. People at the service felt safe and relatives were mostly positive. There were sufficient staff on duty and recruitment procedures were safe. People received their medicines as prescribed and infection control practice reduced associated risks to people. The equipment and environment was well maintained.

People and their relatives told us they felt that the care received was effective. Care was delivered by staff who had received appropriate training to undertake their role. Staff were also supported through appraisal and supervision. New staff received a comprehensive induction aligned to national standards. The service had appropriate systems to monitor the applications and authorisations for people being lawfully deprived of their liberty. People were supported to eat and drink sufficient amounts and external healthcare professionals were consulted when needed.

People and their relatives said the service was caring and compliments had been received to reflect this. Staff were observed being caring and supportive towards people and knew the needs of the people they cared for. People were supported to have a dignified death in accordance with their wishes.

The service ensured they were responsive through a comprehensive pre-admission procedure. People and their relatives were involved in care reviews and care records were personalised. People were supported with their hobbies and interests and the service gave examples of how they had gone the “Extra mile” to improve the quality of some people’s lives. There was a system to ensure complaints would be listened to.

People, their relatives and staff commented positively on the leadership of the service. There were systems to seek the views of people and staff, and additional systems that ensured key messages were communicated. There were governance systems to monitor the health, safety and welfare of people. The service had received accreditation of their good practice from both local and national organisations.

Further information is in the detailed findings below:

The inspection took place on 18 and 19 January 2016 and was unannounced. We carried out our last comprehensive inspection on 29 April 2014, followed by a focussed inspection on 16 December 2014. We found the service was compliant with the standards inspected and no breaches of regulations were found.

Camelot House is a nursing home which is able to accommodate up to 90 people in two buildings. Camelot House can accommodate up to 62 people and Camelot Lodge can accommodate up to 28 people. The home specialises in providing nursing care to people who have dementia and other mental health needs.

At the time of the inspection there were 52 people living at Camelot House and 26 people living at Camelot Lodge.

The service had a registered manager. 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.

Risk assessments, care plans and reviews were not always up to date, which meant risks related to issues such as nutrition were not being monitored or appropriate action taken to manage them. Care plans did not always tell staff how to recognise when people were becoming agitated or how to support them if they became aggressive. This lack of detail in care plans increased the risks for others and staff, particularly at night time, and for staff less familiar with the person. In addition a member of staff told us they were not trained to deal with the level of aggression shown by some people. The registered manager was aware that staff would benefit from enhanced training and was looking for training that would provide this.

People said they felt safe living at the home, and this view was shared by relatives. One person told us, “I feel safe here, rules and regulations are strictly adhered to and staff watch over us”. Risks of abuse were minimised through the provision of policies, procedures and staff training. The registered manager had initiated a campaign to encourage staff to report concerns. This had led to an increase in safeguarding referrals which had been managed effectively.

There were sufficient staff to meet people’s needs. A dependency tool was used to ensure the right staffing levels across the home, and several people received one to one support. Staff responded effectively when people required assistance. They demonstrated a good knowledge of people’s individual needs. They were patient and caring in their approach, promoting people’s independence and treating them with dignity and respect. People were supported to make choices about their day to day lives, such as what to wear and how they wanted to spend their time.

People were supported to receive ongoing health care support. Staff were knowledgeable about people’s care and treatment needs, and people were referred appropriately to external health professionals. The home worked closely with the community mental health team to assess people’s needs and develop care plans to ensure they were met. We received positive feedback from them about the skills and responsiveness of staff when caring for people with very complex needs.

The home was accredited to the ‘Gold Standards Framework’ (GSF) and had been awarded ‘Beacon’ status. This award is recognition at the highest level for the quality of care provided to people at the end of their lives.

People’s relatives said they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relatives care.

A daily activities programme took into account the needs of people living with dementia. Activities staff worked to involve everybody according to their individual needs and ability to participate.

The registered manager

We carried out this inspection to follow up on the actions we had identified during our inspection in January 2013. The people living in the home and the staff we spoke with about the service spoke positively about the improvements the provider had made over the last few months.

We saw that the provider had improved their hygiene and infection control practices and procedures with the home having a much cleaner and tidier appearance.

The premises were better maintained with all fire exits clear of blockages and equipment. Improved signage alerted staff to the risks of inappropriate storage of equipment.

People’s records had been reviewed and improved information was available to staff about how to support people. There was evidence to show routine reviewing took place monthly and the care plans were updated.

Camelot House provides care and support for older people, with the majority of people being diagnosed with dementia or mental health conditions. We talked with five people who lived in the home, ten staff, the manager and five professionals who had visited the home. We looked at the care records of eight people living in the home and the records of four staff.

There were 53 people living in the home at the time of our inspection. People were able to move freely about the public areas of the home and were comfortable in each others company and with the staff who supported them. We spent time watching what was going on in a service, how people spent their time, how they respond to other people living in the home and staff providing the service.

We saw improvements in the provider’s quality assurance processes, identified as weak in our last inspection report of November 2012. We saw a letter of notification that the provider had recently been awarded beacon status for the national gold standard framework in end of life care.

People were treated with respect by staff and we saw they were involved in decisions about their care and daily living. We saw and heard that staff were committed to supporting people and they demonstrated a good knowledge of the people they supported.

Some aspects of the provider’s services would benefit from improvement particularly in relation to hygiene & infection control, fire safety and record keeping.

Camelot House provides care and support for frail older people, with the majority of people being diagnosed with dementia or mental health conditions. We talked with eight people who lived at the home, 11 staff, five relatives and three visiting professionals. Some people had communication difficulties; this meant they could not specifically tell us what it was like to live at Camelot House. We used the Short Observational Framework for Inspection (SOFI) to help us understand people’s experiences on the home.

People’s privacy, dignity and independence were respected by the staff that supported them.

People experienced care, treatment and support that met their needs and protected their rights.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Generally we found that people were cared for in a clean, hygienic environment.

There were enough qualified, skilled and experienced staff to meet people’s needs.

The provider did not always have effective systems to regularly assess and monitor the quality of service that people receive.

We carried out a comprehensive inspection of this service on 29 April 2014. After that inspection we received information about concerns in relation to the service. As a result we undertook a focused inspection on 16 December 2014 to look into those concerns.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 29 April 2014

Camelot House is a care home which is able to accommodate up to 62 people. The home specialises in providing care to people who have dementia and other mental health needs.

At the time of this inspection there were 52 people living at the home.

There was a warm and friendly atmosphere in the home. We saw that relationships between people who lived there and staff were respectful and polite. One health and social care professional told us: “There is always good feedback concerning the friendly atmosphere within the home and the activities that take place.”

There was a registered manager in post who created a positive, person centred culture. One member of staff said about the manager: “She’s very friendly and you can always talk with her about anything. She cares about the people who live here and treats everyone as an individual.”

People were cared for in the least restrictive manner to keep them safe. Some people who lived at the home had been assessed by outside professionals using the Deprivation of Liberty Safeguards as set out in the Mental Capacity Act 2005. We saw the records relating to these authorisations and were confident that people were receiving care in line with the conditions set out in the authorisations.

We saw acts of kindness and consideration throughout the day. One person was sat quietly doing a word puzzle. Staff noticed they were having difficulty with the pen they were using and quickly provided them with another. We saw that another person had become upset and staff sat with them offering reassurance and comfort.

People who lived at the home looked very relaxed and comfortable with the staff who supported them. One person told us: “I feel safe with all the staff. Being cared for by nice people makes all the difference.”

People were able to make choices about all aspects of their day to day lives. Throughout our visit we saw that people made choices about how they spent their time. People were offered opportunities to take part in variety of activities in groups and on a one to one basis. We saw there were a number of pictures about the building to assist people to move around independently and make choices. Some people chose to spend time in their rooms whilst others spent time in communal areas. One person said: “I like my room and my TV so I’m happy up here.”

People received effective care at the end of their life. The home was accredited to the ‘National Gold Standard Framework.’ This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life. The home had been awarded ‘Beacon’ status, which is the highest level of this award.

There was a wide and varied programme of activities which ensured that everyone was involved in activities and occupation throughout the day. We saw that activities were arranged in line with people’s needs and wishes. The home employed two activity workers who made sure activities were available every day.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. People’s rights were therefore properly recognised, respected and promoted.

The 16 December 2014 Focused Inspection into Concerns

Following our inspection of 29 April 2014 we undertook a focused inspection to look into concerns about the service. The inspection took place on 16 December 2014 and looked into concerns about staffing levels, moving and handling procedures, the management and administration of people’s medicines and the quality and choice of food. We also received concerns about the management of pressure sores and the standard of personal care people received.

We spoke with 10 people who lived at the home and eight visitors. We also spoke with five members of staff and the registered manager. We also met with the provider.

Since the last inspection the home has been extended and is now able to accommodate up to 90 people. The home consists of two buildings. Camelot House can accommodate up to 62 people and Camelot Lodge can accommodate up to 28 people. The home specialises in providing nursing care to people who have dementia and other mental health needs.

At the time of this inspection there were 60 people living at Camelot House and 12 people lived at Camelot Lodge.

There were sufficient staff to meet people’s needs. Nobody raised any concerns about staffing levels during our inspection. We saw staff responded quickly to any requests for assistance and they were able to spend quality time with people. The registered manager told they used a recognised dependency tool to determine the number of staff required to meet the needs and numbers of the people at the home. We saw staffing levels had been adjusted where required.

Designated activity staff were employed over seven days. This meant that nursing and care staff were able to focus on the care needs of the people they supported.

People received their medicines when they needed them. We saw staff followed appropriate and safe procedures when administering medicines to people. We checked a sample of people’s medicine administration records against the stock of medicines held and found these to be correct.

We asked people about the quality and quantity of the food provided. One person said “The food is very nice here.” Another person told us “Yes, I have plenty to eat and drink. I don’t feel hungry.” We met with a visitor who visited their relative several times a week. They told us they were offered meals and were able to eat with their relative. They said “I have lunch here every time I visited and it is very good indeed. I am also offered refreshments during my visit. They are very good.”

Catering staff were employed. They had a good knowledge about people’s preferences and needs for food and drink. There was a good supply of fresh, frozen and tinned foods. Fresh meat was delivered twice a week by a local butcher. The four week menu was varied and a choice was available for each meal. People had access to specialist aids which enabled them to eat and drink independently. Examples included plate guards and beaker type cups.

Care plans contained information about people’s mobility needs and the level of assistance they required to transfer or move in bed. Staff were confident and competent when they assisted people and they used equipment appropriate to people’s assessed needs. People looked relaxed and comfortable when being assisted and staff offered reassurance and an explanation before and during the time they assisted them.

Two people were being treated for a pressure sore and two people for a leg ulcer. Wound care plans had been completed and records showed dressings had been changed at regular intervals. A visitor, whose relative was being treated for a leg ulcer said “It’s taking a while to heal but they have been very good. They got the doctor back recently and the antibiotics have been changed. Hopefully that will help.”