All inspections: Camelot House & Lodge - Care Quality Commission

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 80 people using the service.

We found the following examples of good practice.

Most people at this service were living with dementia and were unable to fully communicate verbally about their care. However, people were smiling when staff approached and appeared comfortable and relaxed in their environment.

People spoken with felt safe at the service and understood the need for additional protective measures. One person said, “I am absolutely safe. We are well looked after here” and “Staff are tremendous; never a cross word. Anything we want, they get”.

Measures were place to prevent the spread of infection by visitors to the service. All visitors, including relatives; professionals and contractors had their temperature taken on arrival and were required to have a negative COVID-19 lateral flow test prior to entering the service. New admissions to the service were safely managed and followed current guidance.

The registered manager kept people and families up-to-date with the current situation through regular emails and phone calls. They facilitated visits for people living at the service in accordance with the current guidance.

Isolation, cohorting and zoning was used to manage the risk of infection spread. To reduce the risk of further spread, staff were allocated to work in certain areas of the service where people had tested positive for COVID-19.

The premises were clean and odour free throughout. Enhanced cleaning and disinfection of all areas of the service continued in order to reduce the risk of cross contamination. These were recorded daily by staff. High touch point areas were cleaned regularly throughout the day.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. Daily monitoring of people’s health neds was also undertaken. This meant swift action could be taken if anyone became poorly or received a positive test result.

There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. One member of staff had trouble keeping their mask in place. The registered manager said they would investigate whether a different type of mask would be more suitable. Used PPE was disposed of safely.

Staff felt well supported by the management team and their colleagues. Comments included, “We all pull together. We have a tremendous team” and “We have a really good manager”.

The registered manager had oversight of infection prevention and control processes. Regular infection prevention and control audits were undertaken, as well as spot checks of staff to check hand hygiene.

About the service

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 81 people using the service.

People’s experience of using this service and what we found

People and their relatives were happy with the care and support provided, and they felt the service was safe. Comments included, “It suits me beautifully here; I am not a scrap disappointed” and “Here they make him feel special; they give him that extra confidence. I can leave without a worry.”

There were not always suitable arrangements for storing and disposal of medicines, including those needing cold storage and extra security. However, this had been addressed by the second day of the inspection and medicines were stored securely.

Most people were protected from social isolation as a range of varied activities were on offer. The service was working to improve the offer of meaningful occupation to people who did not take part in group activities.

Systems were in place intended to protect people from harm or abuse. There were enough suitably trained and qualified staff to meet people’s needs and staff were recruited in a safe way. Regular health and safety checks were carried out of the premises and equipment to make sure they were safe. The premises were clean and well maintained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care and support were delivered in a line with current legislation and achieved good outcomes for people. People were able to access the healthcare services they required, and staff knew how to recognise when people’s health had deteriorated. People were supported to maintain a balanced diet and enjoyed the food provided.

Staff were friendly and caring, and attentive to people’s needs. People were treated with respect and their privacy and dignity protected. They or their family were involved in discussions about their care.

People received effective, compassionate care at the end of their life. The service had been reaccredited with the Gold Standard Framework (GSF) for the third consecutive time and had been awarded the quality hallmark award of platinum status.

The service had an inclusive ethos and people’s diversity was respected. The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. Staff worked with other professionals to ensure people received the support they required. Professionals expressed confidence in the service and described good working relationships with all staff at Camelot House and Lodge.

Rating at last inspection (and update) - The last rating for this service was good (published 13 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner. This was a planned inspection based on the previous rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 provided strong leadership and there were clear lines of accountability and responsibility. They had been proactive in developing a culture of transparency and openness at the home. Concerns and complaints were fully investigated and outcomes shared with interested parties, including the staff team. Details of actions taken as a result of quality surveys, suggestions and complaints were displayed on notice boards in reception. Staff learning and development was encouraged and supported by a dedicated training manager.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. People’s views were actively sought and suggestions acted on.

The registered manager and provider kept themselves well informed with regard to good practice initiatives and developments in care provision. Their learning was used for the benefit of people living at the home to keep staff up to date with practice, encourage high standards of care and improve to the environment.

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.

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.”