Camowen

Camowen is a residential care home providing accommodation and personal care to 20 people living with dementia and other health conditions at the time of the inspection. The service can support up to 20 people.

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

People were safe living at Camowen. One person told us, “I feel very safe living here and have no complaints. Seeing the girls in face masks used to be a bit strange, but these are the times we are living in. They want to keep us safe from Covid and other infections, therefore, the masks are necessary, although I look forward to seeing their faces in the future”. Actions had been taken following the last inspection to ensure people were protected from the risk of the spread of infection. People’s risks had been assessed and were managed well by staff to minimise the risk of harm, with referrals made to healthcare professionals if required. People received their medicines as prescribed.

People’s consent to make specific decisions had been assessed appropriately and was documented within their care plans. Action had been taken following the last inspection to ensure relatives or people's representatives made decisions on people's behalf in line with guidance. 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.

Auditing systems were effective in measuring and monitoring the care and support people received, and to drive improvements. People and their relatives were positive about their experiences of Camowen. One relative said, “I never see staff sitting around. They are on the go all of the time and I cannot fault them. They are patient and they do their best with what they have got. I know who the manager is, and she is very approachable”.

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 22 March 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted in part due to concerns we had received about the service with regard to the management, staffing levels and people not receiving timely support. A decision was made for us to inspect and examine these concerns. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well Led sections of this report.

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led which contain those requirements.

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 has changed from Requires Improvement to Good. 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 Camowen on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People’s experience of using this service:

¿ Actions in relation to the control and management of infection were insufficient to mitigate the risk of infection.

¿ One person had sustained a series of falls, but there was no evidence to show a referral had been made to the falls team. This was followed-up at the time of inspection. The associated risk assessment had not been updated as needed.

¿ Consent to care and treatment had not always been gained in line with the requirements of the Mental Capacity Act 2005. One person was subject to Deprivation of Liberty Safeguards, but the authorisation for this from the local authority had lapsed and there was no evidence to show this had been reapplied for.

¿ A range of audits had been implemented to monitor and measure the quality of care and the service overall. However, these had not been effective overall in that they had not identified the issues we found at inspection. This is an area in need of improvement.

¿ People said they felt safe living at the home and spoke positively about the staff who supported them. One person said, “No-one is ever angry or impatient, you cannot fault them”. People were protected from the risk of potential abuse or harm and staff had been trained in safeguarding. People’s risks were identified and assessed as needed. Staffing levels were sufficient to meet people’s needs and new staff were recruited safely. Medicines were managed safely.

¿ We observed people were comfortable in their surroundings and felt safe and happy. People were relaxed and willing to have a conversation with us. Throughout our inspection, we observed positive interactions between people and staff. People were treated with dignity and respect and involved in all aspects of their care. One person said, “Carers are very good and friendly, they will stop and have a chat”. Staff had been trained in a variety of areas and were skilled and experienced in supporting people. They had regular supervisions and annual appraisals.

¿ People were complimentary about the food on offer and told us they had a choice of what they would like to eat. One person said, “I like to go down to the dining room and I enjoy talking to my friends”. People had access to a range of healthcare professionals and services. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ People received personalised care that was tailored to meet their individual needs, preferences and choices. Care plans were detailed in the information and guidance provided to staff. Staff encouraged people in decisions relating to their care and in care planning. Complaints were logged and managed appropriately. People could stay at the home until the end of their lives if this was their wish and their needs could be met.

¿ People and staff were involved in developing the service and their views were listened to and acted upon. Staff felt the managers were approachable and there was an ‘open-door’ policy. Staff enjoyed working at the home.

Rating at the last inspection: Good. The last inspection report was published on 20 August 2016.

The overall rating has changed to Requires Improvement.

Why we inspected: This was a planned, comprehensive inspection. The inspection took place in line with CQC scheduling guidelines for adult social care services.

Enforcement: Action we have told the provider to take is included at the end of the report.

Follow up: We will review the service in line with our methodology for ‘Requires Improvement’ services.

Camowen is a care home situated close to the town centre of Worthing and is registered to provide accommodation and care for up to 20 older people with a variety of healthcare needs. At the time of our inspection, 20 people were living at the home. Camowen is a large detached older-style property surrounded by accessible and well-tended gardens. All rooms have en-suite facilities comprising a washbasin and toilet, except for one room which accommodates a person cared for in bed. All rooms are of single occupancy. Communal areas include a main lounge in the conservatory, dining room and two small lounges, one upstairs and one downstairs.

A registered manager was in post. 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.

The service was well led by a registered manager who was highly respected by, and supportive of, all the staff at Camowen. Their pro-active and enthusiastic approach and leadership skills had resulted in a well-managed home that delivered high quality, effective care. People, relatives and staff all spoke highly of the home and the service provided. People were asked for their feedback and all responses rated the home as either outstanding or good. A range of audits continually monitored and reviewed the care provided and the service was committed to delivering improvements. People and staff felt they were listened to and that their comments would be taken seriously and acted upon. Feedback obtained by the home and posted on various websites consistently described the service in glowing terms.

People told us they felt safe living at the home and staff had been trained to recognise the signs of potential abuse, knowing what action to take if they suspected abuse was taking place. People’s risks were identified, assessed and managed appropriately. Accidents and incidents were acted upon promptly, reported appropriately and care plans reviewed as needed. Staffing levels had been assessed based on people’s care and support needs and there were sufficient numbers of staff on duty. New staff were recruited following a robust process and checks undertaken to ensure their suitability to work in care. People’s medicines were managed so they received them safely. The home was clean, tidy and free from offensive odours.

New staff studied for the Care Certificate, a universally recognised vocational qualification. Training was provided on a rolling programme and staff had completed and updated training in a range of essential areas. Staff were encouraged to study for additional qualifications or undertake further training. Staff received regular supervision meetings with their managers and annual appraisals had been completed. Mini training sessions were organised at team meetings to update staff knowledge and skills. People had sufficient to eat and drink and were encouraged to maintain a healthy diet. They had day-to-day choices from home cooked food and special diets were catered for. People had access to a range of healthcare professionals and support.

People were looked after by kind and caring staff who were dedicated to their work; some staff supported people at the home even when they were not due to come into work. People were involved in all aspects of their care and supported to express their views. They were treated with dignity and respect and had the privacy they needed.

Care plans provided comprehensive, detailed information about people to staff and how they wished to be cared for. Information was personalised and captured people’s likes, dislikes and preferences, as well as their day-to-day care needs. A range of activities was available to people twice a day and other activities were planned in advance. People told us they enjoyed the activities on offer and were encouraged to participate in activities that were of interest to them. Complaints were managed in line with the provider’s policy, but no formal complaints had been received within the last year.

Generally, the premises were managed safely. However, the downstairs bathroom had not been well maintained, as the bath was chipped and scraped, revealing the metal beneath. The bath panel was cracked and broken in places and there was cracked floor tiling by the door. A rim of grime was present around the base of the fixed bath hoist and the underside of the bathseat had not been cleaned effectively. Within days of our inspection, the registered manager and provider had obtained estimates for refurbishment of the bathroom and work was expected to be completed by the end of July 2016.

Whilst people’s consent to their care and treatment on a day-to-day basis was obtained in line with legislation under the Mental Capacity Act 2005 (MCA), staff had a limited understanding of the requirements of this legislation. Following the inspection, the registered manager took steps to update the staff’s knowledge in this area by compiling a quiz.

We reviewed the training records and found staff received appropriate training for their roles. The training provided staff with the knowledge and skills to deliver care that was safe and appropriate for people living in their own home.

We found people had personalised care plans and risk assessments. We found for every identified risk there was a plan in place to address the risk.

We found the provider had a system in place to monitor the quality of the service they

provided.

We found that people's care was planned and delivered in line with their needs and preferences. Staff understood people's needs and how people liked to be supported. People's care needs were regularly documented and reviewed which meant that records were accurate and fit for purpose.

We found that people were protected from the risks of abuse and neglect. Staff had received training in safeguarding vulnerable adults and had background checks done to ensure they were of good character. Potential risks to people were assessed and staff understood how to avoid or minimise these risks. People told us they felt safe living at Camowen.

We found that there were appropriate recruitment procedures in place to ensure staff were fit for their roles. The provider had systems in place to monitor their own quality.