Camelot Nursing and Residential Care Home

Camelot Nursing and Residential Care Home is a residential care home providing personal and nursing care to up to 36 people. The service provides support to older people with age related frailties and health conditions, this includes Parkinson’s disease and epilepsy. At the time of our inspection there were 33 people using the service.

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

Quality assurance processes were mostly effective to provide managerial oversight of all systems in the service. Audits of care records carried out by the management team had not always identified some inconsistencies in people’s care records. The registered manager rectified the discrepancies immediately and shared plans to further monitor records. Other quality assurance processes were effective in identifying areas for improvement which fed into a quality improvement plan. The management team worked in partnership with professionals to continually learn and develop the service.

People received their medicines by registered nurses who were trained and competent to administer them safely. People who required time specific medicines received them at the right time each day. People and their relatives were aware of any changes to their medicines. One relative told us, “I'm updated with changes like medication or if [person] has a urine infection, that sort of thing.” People were protected from the risk of infection such as, the COVID-19 pandemic. Staff followed policies to keep people safe, wore appropriate personal protective equipment (PPE) and practices good hand hygiene.

People’s health risks were assessed and managed safely. Where people had associated health risks, such as Parkinson’s and epilepsy, risk assessments and care plans guided staff on how to safely support them. People were supported to go out with friends and family, risk assessments enabled this to be done safely. People told us they felt safe and felt comfortable to speak with staff or management if they had any worries or concerns. One person told us, “I feel safe, if I press the bell, they (staff) will come. Most of the time I don’t need to as they pop in a lot.” Staff received safeguarding training and understood their duty on how to prevent and report potential concerns of abuse.

People were supported by enough staff who knew them well. Staff were recruited safely and received training relevant to their role. People were complimentary of the care staff. Comments included, “I couldn’t be more well looked after. They are really good and work so hard. Lots of staff have a good sense of humour which I like as I think I have too. I have six favourites but I'm not naming names, they are all great.” And, “The staff are extremely good.”

People said they were involved in planning their care and were given opportunities to give feedback on the service. One person told us, “I am very happy with my care, we plan it together and I can make changes when I want.” When speaking about their involvement with the service, one person said, “I have filled in questionnaires I think two already. I have made suggestions, just things like how I wanted my room set up, it was all done for me as I wanted.”

People, their relatives and staff told us they felt comfortable to make suggestions or complain if needed, they were confident the management team would deal with any problems. Most relatives told us staff and management kept them up to date with changes to their loved ones. One relative said, “I know the manager seems to be doing a good job, there is an open door policy, my relative likes them.”

Staff and the management team worked closely with health and social care professionals to improve people’s care, safety and well-being. One visiting health care professional told us, “[Registered manager] is turning things around, staff when they were out of ear shot said how pleased they were that [registered manager] is their manager.”

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 August 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 3 and 4 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to check whether the Warning Notice we previously served in relation to Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance had been met. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camelot Nursing and Residential Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Camelot Nursing and Residential Care Home is a residential care home providing personal and nursing care for up to 35 older people with various support needs, including physical, memory and sensory impairment. At the time of our inspection there were 30 people living at the service. The home had 34 single occupancy rooms in one adapted building, all of which had their own toilet facilities. The home had a recently renovated courtyard garden for people to enjoy.

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

Although some improvements had been made since our last inspection further improvements were required. Risks to people were not always managed safely and tracking and monitoring systems were not always effective in ensuring that people received safe care. People at risk of falls or requiring wound care did not always receive care in accordance with their care plan or the providers policies and procedures. People prescribed time specific medicines did not have care plans to guide staff as to what time their medicines were due to ensure a safe dosing interval.

Staffing levels were not always in line with the assessed number of staff required to meet people's needs. People and staff told us that staffing numbers varied though felt confident that this was being addressed by the manager. Staff were recruited safely and received training which enabled them to provide effective care.

The home was clean and well maintained. Staff had been trained in infection prevention and control, and government guidance specifically relating to Covid-19 was being adhered to.

Staff knew people well and understood their risks and how to manage them. People’s hydration, dietary needs and long-term health conditions were risk assessed with detailed and person-centred care plans to guide staff on how to support them.

People and their relatives told us they felt safe. One relative said they felt their loved one was, “Very safe. They’re looked after well and they’re happy there. [Person] is much more content than where they were previously.” Staff had received training in how to identify and safeguard people from the risk of abuse. One staff member said, “We have safeguarding training every year, I would recognise signs of abuse and let the manager know about the situation. I would go to the local authority if necessary.”

People spoke positively about the staff who supported them and the care they received. People enjoyed the food and were able to make suggestions for additions to the menu. People had access to a range of healthcare professionals and activities within the home.

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.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 29 August 2019) and there was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider provided us with information after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulation 17.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 31 July 2019 and 13 August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Good governance.

We undertook this focused inspection to check that actions identified after the last inspection had been embedded and sustained, and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camelot Nursing and Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The registered manager had considered how to allocate staffing to particular areas of the building, minimising the risk of spread of infection.

The service had prepared a separate room to manage visiting, this included using a one- way system to enter and leave the building. There were no visitors at the time of our visit due to the outbreak.

Relatives were informed about the outbreak and interim arrangements to stay in touch with people were in place. The service provided activities in peoples rooms and this included opportunities for video calls to family and friends.

The registered manager had appropriate arrangements in place to maintain social distancing measures whilst supporting people to have social contact with other residents through the use of the dining room on a rota basis, supporting small groups of people to eat together each day.

Staff were able to demonstrate a good understanding of Infection Prevention Control (IPC).

Camelot Nursing and Residential Care Home is a residential care home providing personal and nursing care for up to 35 older people with various support needs, including physical and sensory impairment. At the time of our inspection, 30 people were in residence. The home has 34 single occupancy rooms, most of which have a toilet while two have en-suite bathrooms. There is a courtyard garden area for people to enjoy.

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

Records of risks identified in people’s care were not always complete. We found significant gaps in records of bowel and fluid monitoring. Whilst we found no evidence that people had been harmed, there was a risk people may not always receive the support they required. Guidance relating to ‘as needed’ (PRN) medicines lacked personalisation and detail. A significant number of staff had not received training in how to use some fire evacuation equipment. We referred our concerns to the West Sussex Fire and Rescue Service.

Although the registered manager used audits to identify issues and improve the service, these had not been effective in picking up the issues identified during our inspection. When we discussed our findings, the registered manager demonstrated a willingness to make appropriate changes and to ensure that all aspects of people’s care were monitored and managed safely.

People felt safe at the service and told us they would recommend the home to others. Compliments sent to the home spoke of, ‘the tender care’ and of how happy people were living there.

Staffing levels were enough to meet people's needs. The home was clean and staff had been trained in infection prevention and control. Lessons were learned if things went wrong.

People spoke positively about the staff who supported them and had confidence in their skills and experience. People were enthusiastic about the food and were able to make suggestions for additions to the menu. People had access to a range of healthcare professionals and support. Premises were suitable and comfortable and met people's needs.

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.

People were looked after by kind and caring staff who knew them well. People were encouraged to be involved in decisions relating to their care and were treated with dignity and respect.

People received personalised care that was responsive to their needs. Activities were organised according to people's preferences, interests and suggestions. People who were physically able enjoyed outings in the local area. As many people were cared for in their rooms, the activity manager ensured that each person received one to one time. There was also a volunteer who visited people in their rooms on a weekly basis.

People could spend the rest of their lives at the home, if their needs could be met and this was their wish.

People considered the home was well-organised and spoke highly of the management team. People were encouraged in their involvement and development of the home and their feedback was encouraged. The home worked proactively with healthcare professionals.

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

Rating at last inspection The last rating for this service was good (published 24 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Camelot Nursing and Residential Care Home is two houses that have been converted into one large home with a front driveway. The home is situated in a residential area of Worthing within close proximity to both shops and the seafront. Communal areas included a lounge, an activity lounge a dining area and an additional small coffee lounge area often used for meetings or the visiting hairdresser. A lift was used to take people from the ground to the first floor, stair lifts were is use for people who lived in two mezzanine areas at either side of the building. An attractive patio and garden area to the side and rear of the home could be accessed by people and their relatives.

We found the home to be clean and tidy and maintained to a high standard, there was an action plan in place for areas of the home which required decorating including the replacement programme for all carpets to be replaced by a selection of laminate floorings. Home furnishings such as pictures and ornate framed mirrors decorated communal areas and hallways. Due to the festive season the halls were decorated with Christmas decorations and Christmas trees were positioned in communal areas throughout the home. The front foyer area was complete with a ‘meet the team’ which included photographs of all staff members and their job role. The ambience of the home was warm and inviting. All bedrooms were personalised with pictures and ornaments and were single occupancy. Helpful signs throughout the home supported people to navigate themselves around the building.

A registered manager was in post at the time of our inspection who had managed the service since 2012. 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 and their relatives told us the home provided a safe service and there was enough staff to meet people's needs. Staff were trained in how to recognise signs of abuse and able to speak about what action they would take if they had a concern or felt a person was at risk. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. Medicines were managed safely and people were happy with how their medicines were administered.

The home followed safe staff recruitment practices and provided a thorough induction process to

prepare new staff for their role. Staff demonstrated how they would implement the training they received in core subject areas by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager and the registered nurses.

Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. They also understood the associated legislation under Deprivation of Liberty Safeguards and restrictions to people’s freedom. People could choose when, where and what they wanted to eat. Additional drinks and snacks were observed being offered in between meals and staff knew people's preferences.

Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach. People received personalised care. Care plans reflected information relevant to each individual and their abilities, including people's communication and health needs. Staff were vigilant to changes in people's health needs and their support was reviewed when required. If people required input from other health and social care professionals, this was arranged. At the end of their lives, people were supported to have a comfortable and dignified death.

People were offered activities to attend within the home. All complaints were treated seriously and were overseen by the registered manager. People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and treatment. Relatives were also encouraged to give their feedback on how they viewed the service. Staff understood their role and responsibilities.

The registered manager demonstrated a 'hands-on' approach and knew people well. They had implemented a range of audit processes to measure the overall quality of the service provided to people and to make improvements. The registered manager was keen to work alongside external agencies such as the dementia ‘In-Reach Team’ to enhance the lives of people and their families living with dementia.

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what people using the service, visitors to the home and members of staff told us, what we observed and what we learnt from the records we looked at. We spoke with seven people who lived in the home, and with two care assistants, the deputy manager and the registered manager. Records we looked at included four care records, staff training records, management audits and the service's quality assurance documentation.

Is the service safe?

All staff were up to date with training about safeguarding vulnerable people. Staff we spoke with had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues.

Staffing of the home was organised such that people were seen regularly throughout the day. Their wellbeing was checked and recorded each time staff attended to them. Any concerns were reported promptly to more senior staff. Staff were directed to ensure people had call bells to hand, so they could summon assistance when they needed it.

The home had contingency plans for maintaining people's safety in the event of emergencies arising. We saw that call bells were answered swiftly in most cases, although we have highlighted to the provider that twice during our inspection this was not the case.

Is the service effective?

Care plans included a range of assessments which were reviewed monthly. This enabled changes to be made to people's planned care needs and identified risks were reviewed. Staff we spoke with said the care plans guided the care and support people received. They received a handover of updating information each time they started work. People's descriptions of support they received matched exactly with the care plans that we read.

Records showed staff noticed and recorded changes in people's health and wellbeing. Health professionals were contacted in a timely way, as necessary. Comprehensive planning and recording of wound care showed pressure area ulcers were treated effectively

Staff of the home received regular training to support them to care for the people who lived in the home. This included training about conditions such as Parkinson's disease and dementia. There was an organised system for all staff to receive individual supervision, which assisted them to make links between their training and practice. Care assistants were supported to achieve diploma qualifications and to identify external additional training to increase their effectiveness.

Is the service caring?

We observed attentive, meaningful and friendly interactions between staff and people in the home. Staff explained care intentions to people and allowed time for responses. Staff told us there were always enough staff to meet people's needs

People we spoke with said they got up at times that suited them and went to bed when they wanted to. We saw three people being supported to eat their lunch. The staff members were focused on the task, engaged in conversation as people wished and assisted them to enjoy their meals with privacy and dignity.

Care plans directed staff on how to help people manage continence issues in order to maintain dignity. We saw that people's clothes, nail and hair care indicated they were supported to present themselves as they would wish. Furnishings in private and communal rooms were clean and presentable.

Is the service responsive?

Care records showed people's needs were assessed before they began living in the home. Care plans were clearly based on these initial assessments, and subsequent monthly reviews. People had signed to show they had been involved in agreeing their needs and how they were to be met, or relatives had done so on their behalf. A person who lived in the home told us they were fully involved in aspects of management of two primary medical conditions they had.

Care plans emphasised the importance of people having the time to make choices. They addressed people's communication abilities and level of understanding. This included recognising people's abilities might change from day to day or at different times of day. Plans gave detailed practical guidance on the nature of support people needed. This showed the planning of care was responsive to individual needs and preferences. Care plans for all people in the home contained details of wishes in respect of end of life care. This subject was addressed in a consistent manner, with the involvement of people's family or other advocates at the start of a person's stay at the home.

People told us they could always request alternative meals to those on the menu, and often did. We saw the chef was proactive in ensuring people were provided with the meals they wanted, and checking their satisfaction.

Care records showed good information was obtained from people and their families about previous lifestyles, experience and interests. The home had a monthly programme of singing and exercise sessions led by external visitors. An activity coordinator on the staff team arranged small group and one-to-one activities to provide stimulation through the week. However, we have drawn the provider's attention to a lack of recording of the incidence or effectiveness of activities. People's social and activity needs were not included in care plans, which meant the home was not reviewing how these needs were being addressed.

Is the service well-led?

The manager saw it as part of their role to speak with all people who lived in the home, and visitors, every day. They undertook a monthly programme of audits, which gave them a factually based oversight of how various aspects of the home were being managed. This meant they were continuously aware of the quality of service offered by the home and could address any shortfall revealed through audit. People told us the provider spent two or three days per week in the home and the manager described a close working relationship with the provider, including annual development planning.

People who lived in the home, with visiting relatives, had quarterly meetings when they discussed the quality of service they experienced. Minutes showed food and activities were always discussed and people were invited to give ideas for improvement. There were annual questionnaire surveys of staff and the relatives of people who lived in the home. We saw examples of changes made in the service as a result of feedback received through these avenues.

Staff had meetings every month, covering care and operational issues. Staff we spoke with said they felt management listened to their views and kept them well informed of developments and plans. They expressed a strong identity as a team working together to meet the needs of people who lived in the home. A care assistant told us, 'The manager has made a huge difference, inspecting and pulling us up. People are open in meetings.' The manager and deputy manager had recently attended training on changes in the regulatory requirements of their role, which showed a value was placed on maintaining good leadership of the service.

The people we spoke with told us the staff were kind and that they 'Couldn't be better looked after'. Another person told us 'They do their best - they are good girls'. Visitors to the service told us that the staff were very nice and they didn't have any problem with the care provided. They told us that during the recent refurbishment a bathroom was out of action and this had posed some problems when trying to access alternative facilities. They told us they felt confident to raise any complaint with the staff and were confident their concerns would be acted upon.

There were up to date policies and procedures in place regarding consent that staff followed in practice. This helped to ensure that people's rights to consent to their care and treatment were upheld.