Camellots Care Home

Camellots Care Home is a residential care home providing regulated activities of accommodation and personal care for up to 9 people living with a learning disability and autistic people. The standard registration for Camellots care home is for 8 people to be accommodated, however the registered provider currently has a condition on their registration allowing them, for the purposes of COVID 19 response, to accommodate a maximum of 9 people. This is a maximum of 7 people in the main house and a maximum of 2 people in the annexe at Camellots Care Home. At the time of our inspection, 7 people were living in the main building and 1 person in an annex in the garden. Accommodation is provided over two floors. Communal areas include a sitting room, conservatory/dining room and kitchen. All rooms are of single occupancy.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were mostly 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.

Staff did not always support people to have a range of opportunities and experiences to learn to be more independent and have greater control over some areas of their own lives. Some people had limited opportunities to build skills and participate in individual activities. Staff carried out daily tasks such as cooking and cleaning without always actively supporting people to take part. The registered manager was seeking additional training for staff to understand how to be more focused on people’s strengths and promote what they could do, so people had a fulfilling and meaningful everyday life. Each person had their own room, which was generally personalised to meet their needs and preferences.

Staff supported people with their medicines in a way they wanted, and achieved the best possible health outcome. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care:

People and their relatives told us they received kind and compassionate care. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing. Staff and people cooperated to assess risks people might face. Staff encouraged people to take positive risks and make decisions.

People received good quality health care, support and treatment because trained staff and specialists could meet their needs. Most staff knew and understood people well. Staff demonstrated they understood people’s communication needs and the registered manager and staff knew where they needed to improve to develop greater clarity about people’s sensory needs.

Right Culture:

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Internal quality assurance systems and processes to maintain and develop the safety and quality of care were not always operating effectively.

People and their relatives told us, they liked living at Camellots care home and liked the managers and staff.

The provider was aware of and were committed to providing resources to make any necessary improvements as quickly as possible. Staff equality and diversity was respected and promoted at the service and within the provider’s organisation.

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 25 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified a breach in relation to governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camellots care home on our website at www.cqc.org.uk.

At the last inspection, the service was rated Good. At this inspection, we found the service remained Good.

People were supported by staff who understood how to keep them safe and had been trained in safeguarding adults at risk. Risks to people were identified, assessed and managed appropriately. Staffing levels were sufficient to meet people’s needs and safe recruitment systems were in place. Medicines were managed safely.

Staff completed a range of training in order to provide effective care to people. Regular supervisions and staff meetings took place. Consent was gained in line with legislation. People were supported to have sufficient to eat and drink and were supported by a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. People’s preferences were recorded and staff understood how people wished to be cared for and supported them appropriately. People were encouraged to express their views and to be involved in all aspects of their care. They were treated with dignity and respect.

Care plans were written in an accessible way to enable people to be involved in reviewing their care. Staff were provided with detailed information and guidance about people’s care needs. Activities were organised, although many people followed individual interests and pursuits. Some people went out independently. An accessible complaints policy was in place.

People were involved in developing the service and could help interview new staff. Feedback from people about the home was obtained through 1:1 meetings. Healthcare professionals and relatives were positive about the service provided at the home. Staff felt supported by the management team and enjoyed working at the home. A range of systems was in place to monitor and measure the quality of care provided and to drive continuous improvement.

Further information is in the detailed findings below.

Some of the people using the service had complex needs and this meant they were unable to tell us directly about their experience. The summary below describes what three people using the service, a relative, three care staff and the registered manager told us, what we observed and the documents and records we looked at.

This is a summary of what we found:

Is the service safe?

People were treated with respect by the staff and their dignity was upheld.

Two people we spoke with told us they felt safe, and were supported by staff in making their own decisions. This was confirmed by the four care plans seen and through observation and discussion with care staff.

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS), which applies to care homes. No applications had been submitted and we found that no one was subject to restrictions on their liberty.

The registered manager and care staff had attended training in safeguarding people and were aware of the principles underpinning the Mental Capacity Act 2005 (MCA) and DoLS. We saw care records which showed that the registered manager had recently coordinated an assessment of the capacity of one person to make a decision with regard to their prescribed medicine. This demonstrated that the registered manager was aware that the assessment was needed, and of the rights of the individual to make that decision.

People were protected from the risk of poor nutrition because their needs were assessed and appropriate support was provided.

Is the service effective?

People had their needs assessed. Care plans were regularly reviewed to ensure they remained effective, and were kept up to date to reflect the changing needs of people. Care plans seen did not always include all the information known by the care staff about people's needs and preferences.

Whilst people clearly received good care we found that there were areas where independence was not encouraged and promoted, so that people could have done more for themselves to maintain and develop their skills.

Staff had received training to enable them to meet the specific needs of people living at Camellots. One person told us, 'Give them their due, it's good here.'

Is the service caring?

Three people we spoke with told us they were well cared for and their needs were met. From speaking with staff and observing how they supported people it was clear that they knew people well and understood their needs. This was especially evident where people had complex needs and were unable to communicate verbally. Staff were attentive and responded promptly to non-verbal communication.

We saw that care staff supported people in way that was unhurried.

A relative told us, "It's very homely and welcoming here".

People were safe and their care and welfare needs were met because there were effective systems in place to ensure staff were competent to do their jobs.

Is the service responsive?

Two people told us they were able to do what they wanted to do when they wanted. One person said, 'I can have breakfast more or less when I want it. I like it after 6'.

We saw that the care and support provided for people was flexible according to their preferences at the time. Care staff were sensitive to people's changing moods.

People's views about the service were regularly sought in ways appropriate to their individual communication needs.

Is the service well-led?

Staff had a good understanding of the values that underpinned the care provided at the home. There were quality assurance processes in place including audits, monitoring visits and surveys.

People were cared for by staff who were trained and well supported. We spoke with the registered manager and the three care staff on duty, all of whom said they felt supported by their managers.

People told us they liked living at Camellots Care Home.

One person told us, "it's nice it's good. It's convenient for shops".

Another person told us, "I am happy here, they are very caring".

As part of this inspection we spent time observing the interaction between staff and people. We saw that staff spoke to people in a calm and relaxed manner. We observed that staff reacted to non-verbal clues from people who were unable to speak. They demonstrated a clear knowledge of people's needs.

We saw people's individual records and saw that they had been involved in the planning of their support. Staff demonstrated that they knew how care was to be delivered in line with people's wishes and preferences.

Staff told us they liked working at Camellots Care Home and felt supported by the management team.

We looked at how the provider stored, handled and administered medication. We saw that there were appropriate arrangements for the management of medicines.

We looked at the systems the provider had in place to deal with comments and complaints. The service had an effective complaints procedure.

One person said, "I wasn't sure at first but I like living at Camellots now. Staff are helpful and I can do my own thing."

Another person told us that they were happy with the support the received and enjoyed going out on trips with staff.

As part of this inspection we spent time observing the interaction between staff and people. This was seen to be positive and valuing. Staff spoke to people in a polite and supportive way when responding to their requests. We observed staff reacting to non verbal cues from people who were unable to speak. They demonstrated a clear knowledge of people's needs.

Staff told us that they feel supported by the manager and provider to carry out their roles; they enjoyed working at the home and had a wide range of training.