The Care Quality Commission
  • Care Home
  • Care home

Archived: Camelot Care Homes Limited

1 Countess Road, Amesbury, Salisbury, Wiltshire, SP4 7DW (01980) 625498

Provided and run by:
Xcel Care Homes Ltd

Important: The provider of this service changed. See new profile

All Inspections

11, 12 June 2014

During a routine inspection

The inspection team who carried out this inspection consisted of two adult social care inspectors. They visited the location and spoke with seven people who use the service, two relatives, and a friend. We spoke with the registered manager, six members of staff, a visiting GP, physiotherapist, occupational therapist, social worker and registered nurse. We also reviewed various records relating to the management of the service which included six people's care plans and risk assessments, staff rotas, quality monitoring records and building maintenance records.

The inspectors gathered evidence against the outcomes we reviewed to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary describes what people who use the service, relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

Possible risks to people had been identified in their care plans and the appropriate action taken to manage those risks. These included risk of developing pressure ulcers, falls and moving and handling.

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 it from happening. People we spoke with told us they felt safe in the home. A relative said 'X is as safe here as they would be anywhere'.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager was aware of a recent Supreme Court judgement relating to 'deprivation of liberty' and had liaised effectively with the local authority DoLS team.

We saw evidence that regular maintenance of the premises had been undertaken, for example, fire and electrical systems. However, people who use the service, staff and visitors were not always protected against the risks of unsafe premises because the security of the premises was poor. There was also a risk that people who use the service and others could access hazardous equipment and substances in cupboards around the home because they were not locked.

People's personal records including medical records, staff records and other records relevant to the management of the services were accurate and fit for purpose. However we found that people's care records were not kept securely.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safety of the premises and storage of records.

Is the service effective?

People's needs were assessed and care was planned and delivered in line with their individual care plan. We looked at six people's care records. The plans of care contained all the relevant information to enable staff to appropriately care for people.

Is the service caring?

We spoke with people who use the service and their relatives. They were all complimentary about the care they or their family member received. One person told us they had choices in 'just about everything' and 'I'm happy'. Family members told us staff were providing good care and their relatives needs were being met. We observed care workers supporting people who use the service. Staff were respectful and caring.

Is the service responsive?

We saw care records and risk assessments had been recently reviewed and updated. If any changes to people's needs were identified these were made. Care plans were then updated and staff informed.

Staff confirmed that if they raised any concerns about people's care needs, managers would act on them. If required a review of care would be undertaken, and care plans updated accordingly.

Is the service well led?

People and relatives we spoke with confirmed they were regularly asked for their feedback about the service and it was acted on. The provider identified, assessed and managed risks relating to the health, welfare and safety of people who use the service and others.

6 June 2013

During an inspection looking at part of the service

This inspection was to follow up on shortfalls we identified in our previous inspection in relation to the care people received and the staffing levels in the home. Whilst we were there we looked at other outcomes as part of our routine inspection work.

There were 36 people living in the home. We spoke with six support staff and two domestic staff, five people who used the service and one relative.

People told us the care they received was satisfactory. One person said 'It's really nice here. I like it.' Another person told us 'sometimes it's (care) excellent, sometimes a bit slapdash. However everyone is very sweet.' People told us they felt safe living in the home. They said overall staff responded to their needs in a timely manner.

We saw people were involved in social activities. People who remained in their rooms or who were confined to bed had regular contact with staff.

Staff told us staffing levels had improved.

The home was clean. Staff were knowledgeable about their role in preventing cross infection.

People's care records were reviewed regularly and updated when people's needs changed. Visiting healthcare professionals were contacted appropriately to ensure people's health needs were addressed.

The provider had an effective system in place to monitor the quality of the service.

28 November 2012

During an inspection in response to concerns

Overall people were satisfied with their care. One person told us: 'the staff are very nice and helpful. They tend to all my needs.' another said 'people are very kind although it's not like home.' Care plans and risk assessments were regularly updated. However for people However for We noted people confined to bed were not always repositioned in line with their care plan. We saw for people cared for in bed there was little sensory stimulation. There was minimal directional signage or visual prompts to support people with dementia to find their way around the home.

We saw staff attended mandatory training and new staff were supported by an induction programme and the opportunity to shadow more experienced staff.

One person told us 'I sometimes have to wait for my bell to be answered, but staff are very busy'. Another person said: 'they do their best, they are always busy'. We observed in some parts of the home staff were not generally visible and accessible. We noted from staff rotas the staffing levels did not always met the provider's own stated levels.

During an inspection looking at part of the service

We did not talk with people during this inspection as we undertook a review of documentation provided by the service.

We found there were were appropriate arrangements in place to manage medicines.

Appropriate checks were undertaken before staff began work.

Important events that affected people's welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken.

6 June 2012

During an inspection looking at part of the service

We visited the Camelot Nursing Home in Amesbury on 6 June 2012 and spent the day at the service. Our visit was made to check on improvements we had required the service to make following inspections in March and April 2012. Since our previous visits a new manager had been appointed. The new manager had begun to make significant improvements to the service. People living at the home and their relatives and friends commented that the service had changed and was rapidly improving. The new manager acknowledged that this was a work-in-progress and improvements would continue.

During this visit we met and talked with people living at the home and asked them for their views of the care they received. We met and talked with staff working at the home and discussed how they were being supported in their roles.

We also met and talked with peoples' relatives and visitors who were there during the day and asked them for their views. We inspected the home for cleanliness and infection control procedures. We looked at care records, discussed how staff ensured people were safe and protected from abuse, and observed care given to people.

We discussed with people and staff how the service was able to ensure people were treated with respect and able to be involved in how the service was provided. We asked senior management how they assessed and monitored the quality of the service they provided.

We found the service had made some significant and important improvements to the quality and safety of care provided. This included an overhaul of care plans where essential information about people was now being recorded. We saw actions taken to address concerns about people's health and wellbeing. The provider may find it useful to note, however, the work on care plans was not yet finished and needed to be completed. This is to ensure all care needs were identified and included sufficient information to help guide staff in meeting those needs.

We found the home to be clean and free from clutter. People's rooms were clean, well decorated, beds were made, and people told us they were happy with the condition of their rooms and other communal areas. A visitor told us 'I have seen a big improvement in the tidiness of the rooms over the last few months. They used to be really messy but now they are much better'. Staff were able to demonstrate an understanding of the care people needed which we cross-checked with peoples' care plans. They were also able to say how they ensured people were safe and what they would do if they had suspicions of a person being abused.

Senior staff were putting together a system of audit to ensure they regularly monitored and assessed the quality of the service. Some of these audits had been completed and action taken, while others were in progress or planned to take place over the next few months. The service had developed a robust system for acknowledging, responding to and acting upon incidents, accidents and complaints.

A programme for supervising, appraising and supporting staff with training had been put in place. Some of the planned training had been delivered and the manager had a realistic programme to complete training for all staff.

People who lived at Camelot we met and spoke with told us they were happy with their care. We were told "I am very happy living here" and "staff are kind and friendly". The new manager was "very good" and we were told "I have really seen changes in the last two months and things are definitely better here".

Relatives said they had also noticed improvements at the home. Two people visiting a relative said their relative would tell them if things were not right and this person "certainly seems quite happy at the moment". A visitor told us they had noticed a "warmer and friendlier attitude in staff" and "staff smile easily and welcome us". We were told "the food is good and seems to be more varied" and "most residents are up and about in the day, which is good to see as they need one another's company". One relative said "I have some trouble understanding some of the staff, but that's not to say they are not very kind".

The provider may find it useful to note some of the improvements being made were still work in progress. These are referred to in each relevant outcome area.

13 April 2012

During an inspection in response to concerns

We visited the home because we had received information that staff were not being properly supported by the provider and senior management. Due to continued non compliance the home was subject to on going regulatory action by us. We found that a new manager had been appointed and had started work two weeks before our visit.

Since the concerns had been raised with us the new manager had implemented changes, so that staff were more aware of and could discuss the day to day issues. Regular staff meetings were now being held so the nursing and care staff could be updated on changes being made. Despite these improvements, at this visit we found the service to still to be not meeting the relevant regulation in respect of supporting staff. In addition we found that people being engaged by the service in a volunteer capacity were not being subject to appropriate recruitment checks.

Two relatives told us that they were very pleased with the care and treatment provided by staff. They described staff as "exceptionally helpful, very accessible."

We saw staff engaging with people in a positive and friendly manner.

28 March and 5, 13 April 2012

During an inspection looking at part of the service

We carried out this inspection to check on improvements the provider told us they had made since our last visit. We found that although some improvements had been made since our last visit, care and treatment was not always delivered in a way that considered and met the needs of each person as an individual. Care plans did not show people's current care and treatment needs.

People were seen to be moved using unsafe moving and handling techniques. We saw that although staff had been trained in correct moving and handling, they were not always following this in practice.

Members of staff did not know how to properly report allegations or observations of abuse.

Standards of cleanliness were not being maintained. Wash bowls in people's rooms were stained, some mattresses and bed protectors were stained and sticky to touch. Foul laundry was not being appropriately managed. The infection control lead had not obtained or been given the most up to date Department of Health guidance on infection control.

Some training had commenced, but sessions were only an hour long. This meant that more complex subjects could not be covered in sufficient detail. There was little evidence of routine and regular supervision for staff.

One person told us they were appreciative of the care and support provided by members of staff. Another person told us they could make choices about their life in the home. They said "Mostly I remain in my room, I like that." They also told us they liked the routine of the home. Two people told us they had to wait too long for staff to respond to their call bells.

Although the provider had sent us weekly updates on achieving their action plan, the quality monitoring systems in place were not working to address all the issues.

Records were not up to date and did not reflect people's current care and treatment needs. Records were not always written in a person centred way.

The service had delayed to notify us of a serious injury to one person.

19 January 2012

During an inspection looking at part of the service

We observed staff did not always assist people to move in a safe and comfortable way. People who were frail or showed behaviours associated with dementia did not have staff regularly supervising them to ensure their safety and some people were not treated with dignity. Staff did not fully take principals of infection control into account when providing care.

Training and supervision were provided for staff but the managers had not ensured staff followed what they had learnt, to meet people's needs in a safe way. Some records were not consistent with each other, so did not provide a clear picture of how people's needs were being met.

The new area manager told us they had identified some areas for action to improve care provision. These included development of recreational activities for people and improvements in cleanliness.

16 November 2011

During an inspection in response to concerns

People's views on the service were mixed. Some people and their relatives were happy with the care and support provided. Other people said they were not receiving care when they needed it.

We found that not all members of staff were engaging with people in a meaningful way when providing care. Members of staff were more involved in completing tasks rather than taking time to talk with people. Members of staff were polite and friendly.

Care plans were not detailed enough to show how people's needs were to be met. Immediate care charts for pressure ulcer prevention and fluid intake were not being filled out or monitored sufficiently well enough to make sure that people were receiving the care and support they needed.

Some areas of the service that were not always visible were not being cleaned regularly. Two raised toilet surrounds had not been cleaned underneath.

Although there was a training plan in place, it was not extensive enough to cover all the areas of caring for older people, particularly those people with dementia.

There was a quality audit in place but it did not assess all aspects of the service so that improvement could be made.

24 August 2011

During an inspection looking at part of the service

People were generally satisfied with the provision of care. A relative told us that they were kept up to date with developments in their family member's health needs.

People who used the service made positive comments about how they were cared for by members of staff.

Some people were staying in bed during the day without any record of the reason. Care plans did not always record details of how people's care and support needs were to be met and monitored.

Members of staff made sure that people looked nice and were comfortable.

14 June 2011

During an inspection in response to concerns

People living at the home, visitors and staff all told us the home had been through a period when meals provided were poor quality and often served late, but that these issues had been resolved. People had a choice of meals, which used good ingredients and were served hot and when required. There was sufficient support to people who needed assistance to eat meals and take drinks. The manager, who had joined the service in April 2011, had recognised and prioritised catering shortfalls, and was working on more permanent solutions for maintaining good provision of meals, such as a new menu that was being introduced.

Staff responsible for delivery of care identified personal care tasks that were not being fulfilled because care staff were diverted to tasks such as clearing and washing up after meals. A person living in the home told us there was a shortage of staff around after a meal time was finished. Kitchen staff felt under undue pressure because they had to clean and wash up as well as preparing meals.

2 March 2011

During an inspection in response to concerns

The people that live in the home said they had slept well and enjoyed their breakfast. They were each able to go on to other activities when ready, with staff support. We saw they had received attention to personal care such as nail care, and clothing. There was an easy and natural level of interaction between them and members of staff.

Staff members in different roles said they were very busy. They felt they needed more staff available at certain times to keep up with meeting people's needs without rushing.

The deputy manager and manager told us in detail about the care arrangements for individuals who were subject of concerns we had received.

8 December 2010

During a routine inspection

People we spoke with told us they felt safe in the home and received the care they expected. One person said "I feel well cared for". A person who was largely nursed in bed considered their care to be "well organised". They were able to choose "within reason" the times of their morning and evening routines. A person told us 'I've no need to complain, it's very good here. I can't remember things and they (staff) understand that'.

A visitor to another person told us they had never had cause to worry about staff attitudes towards their family member, or the way care was delivered. They said "I'm glad my (parent) is here".

A person said that meals 'are never hot enough'. The other people at the meal table agreed, as did a person who was served meals in their own room. One person said 'meals aren't very nice'. Two people in different parts of the home said they would like more fresh fruit. One person said 'I don't enjoy the food much, meals aren't interesting'.

People told us they liked their bedrooms and the communal rooms. One person disliked the bathrooms because of a lack of home comforts.

People found that staff came to them when requested and we saw that people were treated with kindness and attentiveness. However, one person said 'staff haven't the time to talk to you', and another said 'it would be nice if they could stop and talk'. Some members of staff expressed disappointment that interaction with the people they cared for was mostly bound up with performing tasks, rather than being able to develop conversation for its own sake.