Camellia House

Camellia House provides care and accommodation for up to 14 people. On the day of our inspection there were 14 people living at the service. The home provides residential care for the elderly and people living with dementia.

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.

There was a registered manager 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. One of the providers is also the registered manager.

At the last inspection on the 22 February 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

We met and spoke with most of the people living in the service during our visit. However, some people were not able to fully verbalise their views, so staff used other methods of communication, for example people’s first language. Others were able to tell us about the care and support they received. Due to people’s needs we spent time observing people with the staff supporting them.

People remained safe at Camellia House. People who were able to told us they felt safe living there. One person said; “I do feel safe here and well looked after.” Staff said people were safe with one saying; “We and the management are always there for people to keep them safe.”

People received their medicines safely by suitably trained staff. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People and the staff team confirmed there were sufficient staff to help keep people safe. Staff said they were able to meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

People continued to receive care from a staff team that had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company.

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’s end of life wishes were clearly documented. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff, some who had worked at the service for a number of years, had built strong relationships with people. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People’s equality and diversity was respected and people were supported in the way they wanted to be. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. People, relatives and staff said the providers were approachable.

People lived in a service which had been designed and adapted to meet their needs. The service was in the process of increasing their number from 14 to 24. This was being achieved by the purchase of the house next door and completely refurbished to a very high standard. This project was near completion.

The provider monitored the service to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service. The provider and registered manager listened to feedback and reflected on how the service could be further improved. The registered manager, who was also the provider, had monitoring systems which enabled them to identify good practices and areas of improvement.

The service had a registered manager 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 registered manager lived at the service and was supported by sufficient numbers of care staff to meet people’s needs. People were being cared for by competent and experienced staff. There were choices available to people in their daily lives and their mobility was supported appropriately.

The service had safe arrangements for the management, storage and administration of medicines. It was clear from the medicine records that people received their medicines as prescribed. Some people required prescribed creams Creams were not dated when opened. The registered manager acknowledged the importance of this and took action to ensure staff knew when the cream would expire and was no longer safe to use.

On the day of the inspection visit there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. People told us, “They [staff] are very good and always a round when you need them” and “Staff are very good and respectful”.

People were able to take part in a range of activities of their choice. One person told us, “I love living here. (Names of manager and staff members) are so patient and very caring. It has made such a difference to my quality of life". A family member told us, “I visit most days and am always made to feel welcome by staff and (manager's name) is here more often than not. I feel very happy with the support (person’s name) gets here”.

There were safe recruitment procedures to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. The recruitment process identified applicants had the appropriate skills and knowledge needed to provide care to meet people’s needs.

Staff supported people to be involved in and make decisions about their daily lives. If people did not have the capacity to make certain decisions the service had systems in place to act in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This was to protect people and uphold their rights.

The environment supported people living with dementia. For example there was signage throughout the service and pictorial images to indicate room functions. People could identify their room because there was a picture of the person and in most instances their name. The activity and daily menu board were presented in pictorial format so that people could access the information in a more meaningful way.

People were protected from the risk of abuse because staff had received training to help them identify possible signs of abuse and knew what action they should take. Staff accurately described the correct sequence of actions and outlined the different types of abuse. Staff told us they supported people in a way that kept people safe.

People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Staff said, “I love working here, we all get on and get the support we need” and “If I was concerned about anything I would go straight to the manager. I have every confidence in them”.

People and visitors all described the management of the service as open and approachable and thought people received a good service. Relatives told us, “We chose this home because it was central and close to where (person's name) lived before” and “The owners live here and its run just like a family. Very good all round”.

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Management were visible in the service and regularly observed and talked with people to check if they were happy and safe living at Camelia House.

Equipment and supply services including electricity, fire systems and gas were being maintained.

We also addressed concerns about the administration and safe storage of medication and whether people were being asked to consent to their care and treatment.

Our inspection team was made up of three inspectors. One of these inspectors was a pharmacist inspector. The community safety officer from the local fire service attended while we were at the home. We had raised concerns about the home's fire safety during our last inspection.

There were 14 people living in the home at the time of our inspection. Due to their condition, not everyone living at the home was able to speak with us. We spoke with all the people we could during our day in the home. One person asked not to speak to us and where people could not tell us how they felt about how their care was being given, we reviewed their care plans. We also observed how staff interacted with people and supported people in the lounge and over lunch.

When we inspect we gather evidence to answer the below 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 the inspection and what we found.

Is the service safe?

People expressed their views and were involved in making decisions about their care and treatment. We observed that staff treated people with respect and they were involved with the planning of their care. People were also consulted about how the home was run. Family told us 'Mum has been 100% better since being here' adding that they were able to relax feeling 'she is well looked after'.

We saw from information sent to the Care Quality Commission (CQC) and in discussion with the Registered Manager that the home understood its responsibilities to safeguard people. They had let us know about concerns about medicines and had informed the local authority adult safeguarding team so this could be fully investigated. This meant the home was ensuring it was meeting its requirements to keep people safe and was open to external scrutiny.

Appropriate arrangements were in place in relation to the recording of the administration, obtaining and storing of medicines.

The provider has taken steps to provide care in an environment that was suitably designed and adequately maintained. We found that any concerns were addressed quickly and a regular check of the premises ensured that people were protected.

There was enough qualified, skilled and experienced staff to meet people's needs. People spoke fondly of all the staff. One person specifically stated the Registered Manager went to great lengths to buy them items such as their toiletries as they did not have family who could do this for them. One person told us 'more staff is better' as their call bells is answered quicker. Staff also told us they felt better able to meet people's needs with the staffing levels have improved.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report what we find. The DoLS apply to care homes and hospitals. We found that the home had knowledge of people's capacity and their requirement to assess need to ensure that the decisions made are in people's best interests. We also found the home had knowledge of the Deprivation of Liberty Safeguards (DoLS). We found that people's capacity to make decisions about their care was being appropriately regarded and assessed and their human rights respected.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. For people who did not have the capacity to consent, the provider acted in accordance with their legal requirements.

People told us that staff always asked before delivering their care. We observed that staff asked before care was given. People told us that if they did want to consent at that time this would be respected. People or their representatives were asked to sign at regular intervals that they agreed the care in their care plans.

Staff received appropriate professional development. The provider had ensured staff were appropriately trained to ensure a high level of care could be maintained. Staff received supervision and training. Staff told us that since our last inspection the training, support and supervision from the managers had improved.

Is the service caring?

We found that people were spoken to kindly and were supported to remain as independent as possible. Comments from people included: 'good food', "nice place to sleep and live' and 'good company'. One person told us 'I have them trained' with a wink when it came to describing how the staff looked after them. This person and their relative told us what lengths the staff would go to, for example, in ensuring they had a choice of food.

We found that when people required help, support or reassurance this was given. For example, the home had to change the lunchtime routine due to maintenance work in the dining room; this was handled carefully. Staff reminded people what was happening with gentleness and humour when they forgot. A special occasion was made of the situation and everyone ate in the lounge followed by watching a quiz on television together.

People's care plans detailed that support from outside agencies, such as their GP, was obtained when there was a concern. Instructions were followed to ensure people's care was safe for them.

There was always a staff member available in the lounge to meet people's needs and we observed and heard interactions that demonstrated people were comfortable in the company of the staff. Where people chose to remain in their room, we were told that the staff checked on them regularly, would speak to them and offered to spend time completing an activity.

Is the service responsive?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We found that any changes in people's care needs were acted upon. For example, it was recorded one person had recently lost weight. This was referred to the GP and the follow up actions and instructions recorded. The person and their relative were included in the decision making process. Staff had recorded the amount of food and nutrition the person had in a 24 hour period. This was then discussed with the person, their family and their GP. We were told 'All the staff help you; you can't get any better. I only have to ask and they get it for you.'

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The provider took account of complaints and comments to improve the service.

Is the service well led?

The home was led by a Registered Manager and two deputy managers, who all lived on site. Staff told us they were always available to support them and were on call out of hours day and night.

We found since our last inspection that there was evidence that learning from incidents and follow up investigations took place. Appropriate changes were implemented. People were protected from inappropriate care as a result.

The Registered Manager and deputies carried out regular audits and reviews of all aspects of running the home. This meant that the home ensured the care they delivered was safe and appropriate. We were told '(The Registered Manager) buys all my toiletries; I get everything I want here'.

We talked with five people who lived at the home. There were both positive and negative comments about the care that they received but all people expressed their feelings about the care staff in a positive manner.

We found that the care plans were not always felt to be an accurate reflection of the person's current needs or understood by the person receiving that care. They were not signed by them or their representative and assessments about the people's capacity to make decisions did not evidence that the best interest of the person had been served. A person who had multiple falls and another with increased in mobility were felt to be not having their care needs fully met.

We saw that there was limited social and recreational activity and limited access to outside space. This means that people had limited choices about how their social time was spent

We spoke with six staff on duty over both days. They told us that they would like more training to do their jobs well. The staff when asked felt they were not able to meet all the care needs of the people who had complex needs. Staff supervision and appraisal systems were not available to view to identify if this issue had been discussed with the management of the home.

We reviewed timesheets and found that the staffing levels were not always in balance with the need of those requiring high levels of personal care and would leave people vulnerable to falls and not having their care needs met.

There were not sufficient systems in place to audit the service to ensure it met people's needs and had not involved people living there to contribute their views to the running of the service. The issue of the quality of the ingredients for the food was a constant comment.

We talked with eight people who lived at the home. They said 'I couldn't be anywhere better', 'any problems you can speak to the staff' and 'I feel safe here, staff are as good as gold'.

We spoke with all the four staff on duty. They told us that they had sufficient training in all areas to help them do their jobs well.

We looked at records relating to three people and observed how staff cared for them. Records relating to people's care were detailed and personal to each person and this enabled staff to meet people's individual needs.

People using the service told us there were sufficient staff on duty to meet their needs. One person told us 'I feel looked after and cared for, we are pampered'.

Auditing systems undertaken by the management of the home were in place to monitor the service. These were seen to address any problems found and were used to develop good practice at the home.