Camelot Lodge

Camelot Lodge provides support to up to 9 people with long term mental health needs. At the time of the inspection the service was full. The service is also responsible for a small community support service for three people none of whom were in receipt of the regulated activity personal care so this part of the service was not inspected on this occasion.

The provider is actively involved in the running of the service and a registered manager is in place for the day to day running of the service. A registered manager is a person who has registered with CQC to manage the agency. 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 agency is run.

We last inspected the service in December 2016 and found two breaches of regulation and rated the service as requiring improvement. The identified breaches related to shortfalls in the checks made during the recruitment of staff, and also identified that existing quality assurance checks were not being conducted robustly to picked up omissions in recording. Following the inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least Good. At this inspection quality assurance checks had improved and improvements made to records and recruitment records to show these had been carried out appropriately.

People showed that they were comfortable in each other’s company and with staff; they said they felt safe living in the service and liked the staff working with them. Staff demonstrated a kind and respectful attitude towards people. Mental health professionals spoke positively about this service and the professional and caring attitudes of staff.

People lived in a safe, clean environment with all safety checks and tests routinely completed. There were enough skilled staff to support people and this was kept under review if circumstances changed. New staff were inducted appropriately into their role, they said that they felt well supported and listened to and that there was a good sense of team work. They had opportunities to meet regularly with their manager individually and within staff meetings. The registered manager and staff used handovers and email circulation to ensure effective communication about people's needs and any changes.

People understood they could report concerns and staff were trained to understand how to support those people with diverse needs. Complaints information was displayed. People knew they could raise concerns at individual meetings or in house meetings if they chose. Staff understood their responsibilities to keep people safe from harm.

People were supported to be independent. Risks were well managed: staff took appropriate action and any learning was incorporated into practice or risk assessments. People were supported to have maximum choice and control of their lives. People’s legal status meant that they were subject to some restrictions on their movement outside the service but a culture of least restrictive practice and positive risk taking ensured this was managed in a way that was acceptable to them and was reviewed with them regularly.

People were supported to keep healthy. People had regular health checks and access to healthcare professionals. Changes in health needs were incorporated into care plans to ensure staff understood how the changes impacted on the support they provided. People received their medicines safely and there were clear processes in place for the management of medicines.

Healthy eating was promoted and people were supported to gain or lose weight dependent on their needs. People could make drinks as and when they wanted them.

There was on going investment in the maintenance and upgrading of the premises to provide people with a pleasant communal and personal space to live in, servicing and visual checks and tests of equipment used was undertaken at regular intervals, to ensure this remained in safe working order. The service was clean and well maintained.

New people had their needs assessed over a lengthy period prior to admission to ensure these could be met. Care plans developed from initial assessment showed the support people needed and how they preferred this to be delivered; people said they were actively involved in their care plan development and regular review.

Activities such as a musical entertainment and art and craft activities were offered; people availed of these when they wanted to. For most people weekly activities were tailored to their specific needs, so they may have opportunities for home baking, gardening, working in a voluntary capacity in a charity shop or attending adult education if they showed an interest.

Staff demonstrated thoughtfulness in maintaining the dignity of people whose behaviour may be impacted by their mental health. Staff showed that they knew people well and had developed good working relationships with them, people and staff showed that they were able to share a laugh and a joke with each other.

People, other professionals and some relatives were asked for feedback about how the service was doing and could improve, any comments were looked into and feedback given to the person making the comment. All comments viewed were positive. The registered manager undertook regular quality checks of the service to ensure all areas were working well. The provider attended a number of external meetings and boards that provided additional opportunities for learning in regard to new best practice but also to advocate on behalf of mental health services.

Camelot is a residential service for up to ten people. With mental health problems. Although registered for ten people the provider had taken the decision not to use any bedrooms in a shared capacity and only nine people therefore were accommodated in single use bedrooms some with ensuites. The accommodation is arranged over four floors with no lift and is unsuitable for people with mobility problems. The service was full at the time of inspection. It is also registered to provide a personal care service to a small number of people living in supported living accommodation nearby. At the time of the inspection none of the people in the supported living were in receipt of personal care and this was therefore not inspected. Camelot is located in a residential area of Folkestone within a short walk of the town centre shops, cinema, clubs, pubs and other social activities. There is a bus terminus to a range of destinations in the Shepway area and also easy access to mainline rail services.

There was a registered manager in post who was present throughout the inspection. A registered manager is a person who is 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.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve, action was taken to implement improvements, but some audits were not being carried out robustly enough and people could be placed at risk of harm because of this. Recruitment checks to ensure suitability of staff were not always completed. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do, staff said they practiced the action to take every time the fire bell was tested, but recording of staff attendance at drills and practices is an area for improvement.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People at the service were assessed as having capacity to make decisions and choices about their care and welfare and were not subject to DoLS authorisations. Some people were subject to community treatment orders restrictions on their movements as part of the conditions of their section and being able to live in the community. People understood their rights and choices around this and had full information regarding the appeals process should they wish to do so.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

The premises were well maintained. Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe.

The complaints procedure was on display in a format that was accessible to people. Before people moved into the service their support needs were assessed to make sure the service would be able to offer them the care that they needed.

The care and support needs of each person were different, and each person's care plan was personalised to reflect their specific needs and preferences. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff spoke about people in a respectful way, which demonstrated that they cared about people's welfare. Staff knew people and their support needs well.

Staff were caring, kind and respected people's privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. People were encouraged to eat and drink enough and were offered choices around their meals and drinks.

People made their own drinks and undertook their own personal care, including laundry and keeping their room clean. Those moving towards independence were supported to plan, purchase and cook their own meals and to gain other skills that would help when they moved out to their own accommodation. Staff understood people's likes and dislikes, promoted people to eat a healthy diet and supported and encouraged those people with special dietary requirements to adhere to them.

People received their medicines safely and when they needed them. They were monitored for any side effects and reviewed with their GP or consultant to ensure they were still suitable. If people were unwell or their health was deteriorating staff contacted the person’s doctor or specialist services. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

There were enough staff to ensure people were safe and received the right support day and night, this was kept under review to respond to changes in needs. Staff received appropriate induction and training to ensure they had attained the right skills and knowledge to be able to care for, support and meet people's needs.

Professionals spoke positively about the service and how well the service worked with people with chronic mental health problems. Staff told us that the service was well led and that they had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to.

We found two 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 the report.

People had had their needs assessed, and care plans developed to meet these. People's physical healthcare needs were responded to. The service worked with other health and social care professionals to ensure that people's needs were met.

People were satisfied with the food provided by the service.

The service was adequately maintained, and was undergoing refurbishment at the time of the inspection.

Staff received adequate training and supervision.

People using who used the service told us they were able to make choices. One person told us 'I feel I have a say in what I do' and 'they let us do our own thing.' One of the people who received the supported living service said 'I decide and tell them what I need doing'. They said they felt able to tell staff what they wanted, and 'they cater for all my needs.'

The service had effective systems in place for the safe management and administration of medication.

There were effective recruitment and selection processes in place. The service had processes in place for the recruitment and management of staff, and the staff working there had had the necessary recruitment checks.

Records were kept of people's care and both these and staff records were updated and kept securely by the service.