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Inspection carried out on 4 March 2019

During a routine inspection

About the service:

Cameron House is a residential care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cameron House is registered to provide care for up to 18 people. At the time of the inspection, there were 16 people living at the service, some of whom had a diagnosis of dementia.

People’s experience of using this service:

• At our last comprehensive inspection on 3 and 6 April 2018 we identified breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The service failed to ensure the proper and safe management of medicines, to ensure the correct management of pressure relieving equipment, to ensure that people received the care required to meet pressure area risks and to operate effective systems to assess, monitor and improve the service.

• We met with the provider and registered manager and told them they must make improvements to ensure effective systems were operated to comply with regulations and to monitor and improve the quality of the service provided. We added a condition to the location registration requiring them to send us regular action plans, which we have reviewed.

• At this inspection we found that the provider and registered manager had addressed these concerns and they were no longer in breach of the Health and Social Care Act 2008 (Regulated Activities) 2014.

• People told us they were happy living at Cameron House. There was an established staff team that knew people well. One person told us, “Everyone is helpful and there’s always staff about and they are friendly.”

• Quality assurance processes were robust and risks to people and the environment were managed safely.

• The environment was clean and homely. A new kitchen was planned in the near future and some rooms had recently had new flooring, whilst all bedrooms had new curtains.

• Individual and environmental risks were managed appropriately. People had access to appropriate equipment where needed, which meant people were safe from harm.

• Medicines were administered safely and as prescribed. Records confirmed people received their medicines as prescribed and audits were completed to ensure that systems were followed.

• Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

• Staff recognised people’s individual needs and supported them to make choices in line with legislation.

• People and their families were involved in the development of personalised care plans that were reviewed regularly.

• The registered manager and provider carried out regular checks on the quality and safety

of the service. A new robust electronic auditing system was in place. This ensure the registered manager could monitor the effectiveness of the service and take action when needed.

• The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection:

The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 12 October 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.

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

Inspection carried out on 3 April 2018

During a routine inspection

The inspection took place on the 3 and 6 April 2018 and was unannounced. Two inspectors carried out the inspection.

Cameron House is registered to provide accommodation for up to 18 older people. There were 15

people, most living with dementia, at the home at the time of the inspection. The home is situated in a residential area of Ryde and is an adapted building with bedrooms provided over two floors in single or shared double occupancy rooms. A stair lift provided access between the floors. There is a communal lounge, conservatory, a dining room and appropriate toilet, bathing and shower facilities. Externally there is a level enclosed garden.

Cameron House is a 'care home'. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in place. 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 previous inspection of the service in February 2017 had identified one breach of the Health and Social Care Act 2008 and associated Regulations in relation to a duty of candour. We found this was now in place and when required people or relatives were provided with a written explanation and apology for any incidents.

A quality assurance process was in place. However, this had not identified the areas of concern we found during this inspection. Medicines were not always managed safely and people had not always received these as prescribed. We also found that not all risks to people were managed safely and people had not always received the care they required. This was a breach of regulations. These concerns had not been identified by the provider’s quality assurance systems. We discussed these and some other minor issues with the registered manager who was responsive to the issues raised and undertook to take action.

People were treated with dignity and their right to privacy was respected.

Recruitment practices ensured that all pre-employment checks were completed before new staff

commenced working in the home. Staff were suitably trained and felt supported in their work they worked well as a team and with external professionals.

Where necessary Deprivation of Liberty Safeguards (DoLS) applications had been made. Equality and diversity was seen to be actively supported with people being able to express themselves. Staff offered people choices and respected their decisions.

People received the personal care they required and were supported to access other healthcare services when needed. People were supported and encouraged to be as independent as possible.

Staff were aware of people's individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed.

People received a varied diet and where needed were supported to eat their meals in an unrushed manner.

People felt safe and staff knew how to identify, prevent and report abuse. People and external health professionals were positive about the service people received.

People were encouraged to maintain relationships that were important to them.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering our regulatory response.

Inspection carried out on 6 February 2017

During a routine inspection

This inspection took place on 6 and 9 February 2017 and was unannounced. Cameron House provides accommodation and personal care for up to 18 older people, including people with dementia and physical disabilities, who do not require nursing care. There were 16 people living at the home when we visited.

There was a registered manager for the home; however, whilst they retained oversight and responsibility for the service they were not in day to day charge of the home. 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. A new manager had been appointed and was in the process of registering with CQC to become the registered manager.

At the last inspection, in December 2015, we identified breaches of regulation and told the provider to take action to ensure people were safe and their legal rights protected. The provider was also told to ensure there were sufficient staff available at all times and medicines were managed safely. The provider had also not ensured CQC were notified of all incidents in the home. We issued requirement notices. At this inspection we found action had been taken in respect of these areas, but improvement was needed in other areas.

At this inspection we found the provider had failed to ensure the rating from the previous inspection was displayed at the home and had also failed to ensure that information was provided in writing to relevant people after significant accidents and incidents occurred.

The manager was aware of legislation designed to protect people’s rights and freedoms; however, assessments of people’s ability to make some decisions such as the use of specialist equipment to reduce the risks of falls or breakdown in skin integrity, which had been made on their behalf, had not been formally assessed or recorded.

People, visitors and external health and social care professionals were positive about the service people received. People were positive about meals provided and, where necessary, received support to eat and drink. People were supported and encouraged to be as independent as possible and their dignity was promoted.

Care plans provided information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. Medicines were managed safely and people received these as prescribed.

People felt safe and staff knew how to identify, prevent and report abuse. Staff offered people choices and respected their decisions. The home provided a suitable environment for people who were offered activities suited to their individual needs and interests.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work. Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care.

People and relatives were able to complain or raise issues on a formal and informal basis with the manager and were confident these would be resolved. Visitors were welcomed and there were good working relationships with external professionals.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

The manager was aware of areas for development of the service. Quality assurance systems were in place using formal audits and through regular contact by the provider and manager with people, relatives and staff.

We found one breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You

Inspection carried out on 30 November and 3 December 2015

During a routine inspection

This inspection took place on 30 November and 3 December 2015 and was unannounced. The home provides accommodation and personal care for up to 18 older people living with dementia. There were 15 people living at the home when we visited.

There was a registered manager at the home. 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’s safety was compromised. People were not always supported to move safely, and necessary moving and handling equipment was not available in all parts of the home. Action had not been taken to investigate and reduce the risk of incidents between people or where people had experienced frequent falls. General and individual risk assessments had been completed but were not always followed.

There were not always enough staff to meet people’s needs at all times.

Quality assurance systems were largely informal with formal audits not being completed. There was regular contact by the provider and registered manager with people, relatives and staff.

Medicines were managed in a satisfactory way however there was a lack of information as to how some ‘as required’ medicines should be administered.

Recruitment records showed pre-employment checks had been completed. Staff received appropriate training and were supported through the use of one to one supervision and appraisal.

Legislation designed to protect people’s legal rights was not fully applied. Best interest meetings to make decisions on behalf of people who lacked the ability to make these decisions had not been held. Staff were offering people choices and respecting their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors when needed.

People and their relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals but did not receive the support they required at all meals. People did not have adequate mental and physical stimulation.

People and their relatives were able to complain or raise issues on an informal basis with the registered manager and were confident these would be resolved. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

We found five 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 this report.

Inspection carried out on 22 November 2013

During a routine inspection

We spoke with three care staff and the manager. Staff were aware of people�s needs and told us how particular people should be cared for. To help us to understand the experiences people have, we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time observing what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We found that people had positive experiences. Staff were respectful of people�s wishes and spoke warmly to people.

We observed staff providing care to people and the care provided matched their care plans. We spoke with a visiting health professional who told us �I have no concerns at all� about the care provided to people within the home. A visiting relative told us �I am very happy [with the care their relative received]. I have no worries at all�.

We also spoke with domestic staff. They demonstrated a good knowledge of infection control procedures and we observed all areas of the home to be clean. Quality assurance systems were in place to ensure the service sought and acted on feedback received from.

It should be noted that the name of the registered manager that appears in this report, Sarah Cottell, is what was held on our records at the time of our inspection. A new manager has since taken over and this will be reflected in future reports.

Inspection carried out on 9 January 2013

During a routine inspection

The people who live at Cameron House have dementia and therefore were not able to tell us about their experiences. To help us to understand the people's experiences have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time observing what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We found that people had positive experiences. We observed that staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The staff supporting them knew what support they needed and they respected their wishes. The support that we saw being given to people matched what their care plan said they needed.

We also spoke with visitors to the service, three relatives and a health professional. They were positive about the home and care people received. We found that people received an appropriate diet, medication was correctly managed and good staff recruitment procedures were undertaken. Care plans were relevant to people and the necessary records were maintained.

Inspection carried out on 8 December 2011

During a routine inspection

Some people using the service were able to tell us about their experiences and we also spoke with relatives and health professionals. However most people were unable to talk to us due to their age related memory loss. We spent some time in the home�s communal lounge observing people and staff. Interactions we observed were warm and friendly with staff clearly having a good knowledge about the people they were caring for.

Relatives were positive about the way the home meets the needs of their relatives. They confirmed that they were kept informed about any illness or untoward incidents and this gave them peace of mind when they were not visiting. Relatives felt that health and personal care needs were being met and were positive about staff and felt they did a good job. Relatives said that they did not have any concerns or complaints but would raise these with the staff or the manager if they did.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about how people�s health and care needs were met.

Reports under our old system of regulation (including those from before CQC was created)