Camplehaye Residential Home

We found the following examples of good practice;

The provider was following government guidance to ensure visitors to the home did not spread Covid-19. All visitors were asked to provide proof of a negative lateral flow test (LFT) before entering the home.

A booking system was used to arrange visits. The provider was enabling visits for people living in the home in accordance with current guidance.

The provider ensured enough stock of appropriate protective equipment (PPE) was available for people, staff and visitors.

There was signage around the home about correct donning, doffing and disposal of PPE. Facilities were available to ensure PPE was disposed of safely.

Staff were adhering to PPE guidance and practices. Hand- washing facilities, and hand washing guidance was available around the home.

Where possible staff encouraged people to keep a safe distance from each other.

Enhanced cleaning was in place to reduce the risks of cross infection.

Staff continued to support people to access health services. Arrangements were in place to ensure people remained safe if they required a hospital admission.

The providers recruitment and contingency planning helped ensure staffing levels remained safe in the event of a COVID-19 outbreak in the service.

Policies, procedures and risk assessments relating to COVID-19 were up to date.

Camplehaye Residential Home (referred to as Camplehaye) is registered to provide accommodation with personal care to a maximum of 44 people. The home provides care for older people, some of whom are living with dementia. The service is a Victorian property over two floors with two modern extensions, and accommodation off four corridor areas. 36 people lived at the home when we visited.

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

People told us they received safe care. Relatives and a healthcare professional also told us people received safe care.

Risks relating to people’s care and support needs were assessed and management plans were in place to reduce these. However, some documentation used to monitor people’s safe care had not always been fully completed. This meant staff could not be sure people’s care needs were being met as planned.

Where people’s bedrooms doors were fitted with locks that required a key, better access was required to a master key to be used in emergencies.

Nine of the 13 people who were able to tell us what it was like to live at Camplehaye, said there were sufficient staff to meet their needs. . However, four people told us they had to wait for support when they used their call bells. The registered manager assessed people’s dependency and arranged staffing levels in accordance with people’s needs. They gave assurances they would continue to monitor staffing requirements.

The management team continued to use a number of audits and reviews to assess and monitor the quality and safety of the home. The home worked in partnership with the local authority and community 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 11 October 2018).

Why we inspected

We received concerns in relation to risk management and staffing. One person had been found in a locked room and there was a delay in staff being able to open the bedroom door. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

The local authority's safeguarding team were undertaking an investigation with regard to this concern. The investigation had yet to be concluded at the time of this inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Good. This is based on the findings at this inspection.

We have found evidence that the provider needs to make some improvement. Please see the Safe section of this full report. The registered manager has taken action to mitigate risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camplehaye Residential Home 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.

Camplehaye Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation with personal care to a maximum of 44 people. The home provides care for older people, some of whom are living with dementia. The service is a Victorian property over two floors with two modern extensions, and accommodation off four corridor areas. 36 people lived at the home when we visited, six of whom were there short term for respite, and one person was in hospital.

At the last inspection, on 31 August and 4 September 2018, the service was rated requires improvement overall and in safe and well led, and good in effective, caring and responsive. A breach of regulation 12, safe care and treatment was found. This was because risks for people such as fire safety risks, incorrectly set pressure relieving equipment and a lack of detailed of detail in some care plans managing people’s challenging behaviours. Improvements in leadership were also needed as service had no registered manager. Several changes of managers over a short period, had been unsettling for people, relatives and staff.

At this inspection we found the service had improved to Good overall with further improvements planned.

The service had a registered manager, they started working at the service in January 2018 and registered in May. 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.

Improvements had been made in fire safety, risks assessments and in using equipment. Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. People's risk assessments were comprehensive with actions taken to reduce the risks as much as possible. Further improvements to reduce risks such as from trailing leads, trip hazards were needed. Most areas were clean and odour free but infection control measures could be improved further.

People, relatives, staff and professionals gave us positive feedback about improvements in leadership and ongoing improvements in the quality of people’s care. They spoke positively about improvements in communication, professional development and increased provider support. Quality monitoring systems had improved, with examples of continuous improvements made in response to audits, observation of practice and regular checks of the environment.

People were supported by staff that were caring, compassionate and treated them with the utmost dignity and respect. People concerns and any complaints were listened and responded to and used as opportunities to improve.

People were supported by enough skilled staff so their care and support could be provided at a time and pace convenient for them. Staffing levels were calculated using a dependency tool which was regularly reviewed. Staff understood the signs of abuse and knew how to report concerns, including reporting to external agencies. A detailed recruitment process was in place to ensure people were cared for by suitable staff. People received their prescribed medicines on time and in a safe way.

People were supported by staff who had the skills and knowledge to meet their needs. Recent improvements in training meant staff have better understanding and felt more confident to carry out their roles. People’s health was improved by staff who worked with a range of professionals to access healthcare services and promoted improved health through good nutrition and hydration.

Improvements had been made to improve the environment of the home to make it more suitable to meet the needs of people living with dementia. For example, by helping people identify bathroom/toilet areas independently through use clear word/symbol signage. Further improvements were needed to improve wheelchair access at entrance and to outside areas.

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. The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

The service was well led by the registered manager and deputy manager, who led by example. People, relatives and staff were regularly consulted and involved in developing the service.

Further information is in the detailed findings below.

This unannounced comprehensive inspection took place on 31 August and 4 September 2017. It was carried out in response to concerning information received anonymously about low staffing levels at the home, poor moving and handling by some staff, and people’s medicines not always being managed in a safe way. Since the end of July 2017 at Campelhaye, there had been an increase in incidents of verbal and physical abuse between people reported by service to the local authority safeguarding team and the Care Quality Commission (CQC).

On 26 and 27 September 2016 we carried out a comprehensive inspection at the service. This was to check that improvements had been made following our previous inspection on 22 and 29 April and 7 May 2015. At that inspection the service was rated requires improvement overall and in the safe, effective, responsive and well led domains, with caring rated as good. This was because four breaches of regulations were found relating to people’s safe care and treatment, safeguarding, staffing and good governance. CQC took enforcement action in relation to ineffective quality monitoring and a warning notice was served. In September 2016 we found improvements had been made with no breaches of regulations. The service was rated good overall and in the safe, effective, caring and well led domains, and requires improvement in responsive. This was because some people’s care plans needed updating and because activities needed to be more personalised to people’s hobbies and interests. Improvements were found in these areas at this inspection.

The service did not currently have a registered manager. The previous registered manager left in April 2017, and has deregistered. A new manager was appointed in May 2017, who had planned to register with the Care Quality Commission. However following organisational changes, this manager was taking up a newly created quality monitoring role within the company. The new role was to support managers in Campelhaye and a second home in the group with monitoring the quality of care and continuous improvement. A replacement manager had been recruited who was undergoing a period of induction, they were due to take day to day charge of the home the week we visited. For clarity, the manager referred to in this report is the manager who has been in charge of the home since May 2017.

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 were happy and relaxed around staff and said they felt safe living there. The manager had identified a number of safety risks within the service, such as increased falls and verbal and physical aggression incidents which they were working to manage and reduce. However some risks had not been identified in relation to fire safety risks, a lack of detailed instruction for staff about managing a person's challenging behaviours and incorrectly set pressure relieving equipment. The service had increased staffing levels during the day and at night to provide people with additional support and supervision and staff were undertaking falls management training.

People's rights and choices were promoted and respected. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards; they involved the person, family members and other professionals in 'best interest' decision making. We followed up whether gates were used to restrict people’s movements; following concerns raised with us about their use and found they were not.

People, relatives and visiting professionals were happy with the quality of care provided at Campelhaye. Feedback was positive about improvements made at the home over the past few months to improve staffing levels and reduce risks for people. Staffing levels had further increased the previous week, although it was too early to judge the impact of these changes. However, three changes of managers over the last six months was unsettling for people, relatives and staff. The manager reported safeguarding incidents regularly to the local authority and CQC, and outlined measures taken to further protect people. Although we identified one incident which should have been notified but had not been.

The service had a range of quality monitoring systems in place and made continuous improvements in response to the findings of audits and other checks. The manager was working with staff to improve staff awareness and improve the level of detail in incidents reported, to help identify the most appropriate ways to further reduce risk. Care records had improved and further improvements were being made as had activities, which were more tailored to meet people’s individual needs and interests.

Several people were at increased risk because reasons they were having modified soft or pureed food were not always clear to staff or in their care records. The manager had identified this and sought advice from speech and language therapy services to check any choking risks were being appropriately managed.

Staff understood the signs of abuse and knew how to report concerns, including reporting to external agencies. They had completed safeguarding training and had regular updates. A detailed recruitment process was in place to ensure people were cared for by suitable staff. People received their medicines safely from staff that were trained and assessed to manage medicines safely. The concerns raised with the Care Quality Commission about medicines management were not substantiated.

Staff developed positive, kind and compassionate relationships with people. People appeared happy and content in their surroundings and were relaxed and comfortable with staff who were attuned to their needs. People and relatives knew how to raise concerns and complaints, and were provided with information about how to do so. Any concerns raised were robustly dealt and further improvements made.

People experienced effective care that promoted their health and wellbeing. Staff practice was in accordance with moving and handling regulations with one exception, which we made the manager aware of. People praised the quality of food and were supported to improve their health through good nutrition. People had access to healthcare services, staff recognised when a person's health deteriorated and sought medical advice promptly.

Camplehaye Residential Home provides accommodation and personal care to a maximum of 44 people. It is not a nursing home. The home specialises in the care of people living with the condition of dementia. There were 43 people resident at the time of the inspection.

The service is required to have a registered manager. 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. Camplehaye Residential Home had a registered manager.

People’s needs were assessed and a plan of care produced, with their involvement. This should provide staff with the information needed to meet people’s current care needs. However, those plans were not always current and therefore did not always contain up to date information for the staff. The registered manager immediately corrected this. Some care plans were very detailed, person centred and informative for staff.

A district nurse described the end of life care at Camplehaye as “Very good” and a GP described it as “Really impressive.” People, their family members and health care professionals felt that people’s care needs were well met. Where external health care advice was required, this was sought in a timely manner so people’s health was promoted. Individual risks to people were understood and measures were in place to reduce risk, where necessary.

People were protected through robust staff recruitment, induction, training, supervision and support. Staff said they felt supported and their training was good. There were enough staff to meet people’s individual care needs. Staffing numbers and roles were under regular review.

People received their medicines as prescribed. They received a varied and nutritious diet. They had choice and any special dietary needs were being met.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service was meeting its obligations to protect people’s legal rights in accordance with the MCA and DoLS.

Staff were kind, caring, patient and treated people with respect and dignity. People’s views were sought and responded to.

A programme of varied activities provided people with stimulation and enjoyment. Activities were not, however, based on people’s history and individual interests. We have recommended that some activities are tailored to people as individuals, taking into account their past history and interests.

The standard of service was monitored through a variety of quality monitoring arrangements, which included seeking people’s views, and audits to identify risks. A service improvement plan was under regular review. Any complaints were responded to appropriately.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the two days of our inspection there were 39 people using the service. The summary is based on conversations with six people using the service, six care workers supporting them, one person's family and two health care professionals. We looked at records, visited every room and observed what happened at the home throughout our visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe because knowledgeable and skilled care workers knew people's needs well and ensured those needs were met. Health care professionals said they had no concerns about the care provided.

The service is safe because people's needs are assessed and how those needs are to be delivered is planned in detail. This takes into account people's individuality; strengths and vulnerabilities. Where risk is identified this is reduced without unnecessary restriction. People's rights are upheld in line with legal safeguards.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager at Camplehaye Residential Home told us there had been no DoLS applications by the service.

The service is safe because medicines were handled safely on people's behalf.

The service is safer because the standard of record keeping has improved since our last inspection. However, there remains some room for further improvement as there were some gaps in recording.

Is the service caring?

The service is caring because people are treated as individuals and with respect. We saw care workers supporting a person who was upset and people being asked what they wanted and how they could be helped. People said "Extremely kind staff all of them" and "Thank you for being so caring.'

The service is caring because people's needs and wishes are recorded and there are plans in place to meet those needs and wishes. People had the opportunity to be involved in their care arrangements or their families were consulted on their behalf. One person's family said 'Extremely kind staff all of them'.

The service is caring because people's social needs are attended to. There is regular input from a designated activities worker. There is also entertainment arranged at the home.

Is the service effective?

The service is effective because people receive the care and support they require to promote their health and wellbeing. For example, health care is monitored, health promoted and concerns followed up. We saw that there is regular contact with people's GP and the district nursing service.

Is the service responsive?

The service is responsive because staff take notice of people's needs and wishes and they respond to any concerns. For one person who had fallen, additional measures were put in place to prevent further falls. Where another person was unwell a GP was called promptly.

Where requests had been made to improve people's lives these had given proper consideration. For example, pets, items for a room and how activity arrangements can be improved.

The service is responsive because the registered manager and senior care workers expect high standards. Where CQC had identified areas for improvement there had been positive improvements, such as medicines management and seeking people's views. Senior staff know what is needed for people's safety and comfort and try hard to achieve this. A health care professional said 'They do a good job'.

Is the service well led?

The service is well led because there is now a manager registered with the CQC.

The service is well led because there are arrangements in place to check the standards of service provided, through seeking the views of people using the service and regular audits and monitoring. A health care professional told us 'It is a good and well run home'.

The service is well led because there are arrangements for communication which protect people from misunderstandings and mistakes.

The service is well led because the provider works with the registered manager towards continuing improvement.

We found that there were enough staff to meet people's individual needs.

We found at our last inspection that the home was not gaining people's consent to care or treatment or using the legal safeguards, the Mental Capacity Act 2005 and deprivation of liberty safeguards, to protect people. At this inspection we found that there were still no working arrangements to gain people's consent to care and treatment.

At our last inspection we found that records management had the potential to put people at risk. We found at this inspection that people were still not protected through the home's recording arrangements.

A recent incident around the home's management of medicines had increased risk to people at the home and had the potential to cause harm. The home acted promptly following this incident to make medicines management safer.

The registered manager ensured that each person using the service received a high standard of care. However, there was insufficient overview of the quality and safety of the service to ensure it was safe and reduce risks to a minimum.

We found that there were lots of activities available for people to share or do alone, as they preferred. People received a high standard of personal care and their individuality was supported. Visiting health care professionals said that their clients and families were happy and that they had no concerns about the home. One added, The staff are very kind and always very knowledgeable. The care assistant's expectations of standards is high".

People told us that they had what they needed and their accommodation was comfortable. We saw that the home had adaptations to help maintain people's independence, a wide variety of rooms domestically furnished and that it was well maintained.

Staff were not recruited until checks had confirmed that they were suitable to work with vulnerable adults.

Care workers did not understand their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards and so people's human rights were not being protected. We saw no evidence that people's consent was sought. Records lacked detail, were not kept securely at all times and some were in pencil and so not fit for purpose.