Camelot Care Homes Ltd

Camelot Care Homes Ltd provides accommodation and nursing care for 57 older people in two adapted buildings. People have their own rooms and share communal areas such as lounges, dining rooms and bathrooms. Outdoor space is an enclosed courtyard area. At the time of our inspection there were 40 people living at the service.

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

Since our last inspection improvements had been made in some areas and the service is no longer rated inadequate overall. However, further improvement was required. For example, risks had not been identified regarding distressed behaviours people experienced. There were no care plans to ensure people were supported safely and consistently at these times.

Daily records did not always show what support people were given. this included food and fluids intake, re-positioning and when people were experiencing distress.

Quality auditing systems remained an area for development and were not always used effectively to identify errors, shortfalls and drive improvement. Governance systems in place had not identified concerns found during this inspection. Some CQC notifications had not been sent without delay.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Improvements had been made to the way people were treated. Interactions observed were kind, respectful and attentive.

Improvements had been made to the management of complaints. People and their relatives told us they knew how to raise concerns and felt comfortable to do so.

Improvements had been made with staff offering people choices, and their rights to privacy and dignity were maintained. People and their relatives were complimentary about the staff.

Equipment had been checked or serviced to ensure it was safe and contractors were being sought to undertake work identified in the updated fire risk assessment.

Improvements had been made to infection prevention and control measures and the overall cleanliness within the home.

There were enough staff to support the number of people currently living at the home. The registered manager told us more staff would be recruited as occupancy further increased. Staff told us they were well supported and received a range of training.

People’s needs were assessed prior to them being offered a placement at the home.

The environment had been improved, with no malodours. Some areas had been redecorated and some carpets had been replaced.

People looked well cared for and they, and their relatives, were happy with the care provided. Social activities were arranged, and people were encouraged to have visitors at any time.

People, their relatives and staff were encouraged to give their views about the service. They said the registered manager listened and was happy to implement any ideas suggested.

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 inspection for this service was in November 2022. It was a targeted inspection to follow up on a warning notice for good governance, but not rated. The last rating for this service was inadequate (published 05 September 2022) and there were breaches of regulations. 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 but the provider remained in breach of regulations.

This service has been in Special Measures since 02 August 2022 and remains in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

At this inspection we found the provider remained in breach of regulations.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camelot Care Homes Ltd on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to safe care and treatment, safeguarding people from the risk of abuse, person-centred care and good governance. We have made one recommendation about recording for Deprivation of Liberty Safeguards (DoLS) recording.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Camelot Care Homes Ltd provides accommodation and nursing care for 57 older people in two adapted buildings. People have their own rooms and share communal areas such as lounges, dining rooms and bathrooms. Outdoor space is an enclosed courtyard area. At the time of our inspection there were 51 people living at the service.

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

At the last inspection, risks to people’s safety were identified. These risks related to fire safety, very hot water and hot surfaces, unsecured access to hazards, cleanliness and infection prevention and control. The provider had not identified, assessed or mitigated these risks. At this inspection, some action had been taken to minimise risks to people’ safety, but more was needed. For example, the hot water from some hand wash basins remained excessively hot. Hot water pipes which we had identified as a risk at the last inspection had been covered, but another pipe in the shower room remained unprotected. This increased the risk of a person burning themselves if they fell against it. This place people at increased risk of avoidable scalds.

Improvements had been made to fire safety, but not all actions recommended within the fire risk assessment had been completed. New doors had been fitted to a designated fire escape, yet a key was required to open them. This did not ensure a timely exit of the building in an emergency. Not all portable electrical appliances had been tested to ensure they were safe to use. There was not a system in place to minimise the risk of any being missed when the testing was being completed. There remained items in a refrigerator, which were not covered or dated when opened. The thermometer showed the refrigerator was running too hot, but staff told us the thermometer did not work. The provider could therefore not be assured food was being stored at a safe temperature. Doors to rooms, which had hazards inside, had been fitted with keypad locks. However, the doors to the sluice and kitchen were left open at times. This gave people access to equipment and an urn, which increased the risk of harm.

There had been redecoration to some rooms, corridors and door frames. A plan was in place for more refurbishment. This incorporated skirting boards and windowsills, which could not be kept hygienically clean because of chipped paintwork. New flooring had been fitted in the kitchenette and laundry room, but some carpets remained stained. There was also dust on some people’s possessions but overall, the environment was cleaner than at the last inspection. Staff were wearing personal protective equipment (PPE) safely.

Improvements had been made to the monitoring and recording of people’s food and fluid intake. This minimised the risk of dehydration and malnutrition. Staff told us they had received group supervision and individual meetings with their line manager. This gave greater opportunities for discussion and shared learning, to ensure improvements within the service were made.

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 inadequate (published 03 August 2022) and there were breaches in 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 the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camelot Care Homes Ltd on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified not enough improvement has been made following the requirements of the last inspection. This has meant there are continued breaches of regulation in relation to risk management, infection prevention and control and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Camelot Care Homes Ltd provides accommodation and nursing care for 57 older people in two adapted buildings. People have their own rooms and share communal areas such as lounges, dining rooms and bathrooms. Outdoor space is an enclosed courtyard area. At the time of our inspection there were 51 people living at the service.

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

People’s safety was not ensured. This was because there were shortfalls in fire safety and risk management. We observed inadequate fire safety systems in place which were not dealt with in a timely way. Whilst we shared our concerns with the registered manager, they could not confirm or provide assurance the work had been completed.

There were other risks within the environment. This included blocked fire escapes, trip hazards, unprotected hot water pipes, excessive hot water from hand wash basins, and unrestricted access to scalding water and hazardous substances. These hazards had not been identified by the registered manager or provider.

Inadequate systems were in place to prevent and control infection. Not all areas of the home were clean, as there were cobwebs in people’s bedrooms, stained carpets and brown marks on furniture and bed rail covers. Some areas were difficult to keep clean and needed repair. For example, there were peeling surfaces on the kitchen cupboards and missing tiles on some walls. There was carpet in the laundry room, which was not hygienic.

Not all accidents and incidents had been appropriately reported to CQC or the local safeguarding team. Adequate action had not always been taken to minimise a reoccurrence of an accident or incident. This included ensuring all external doors were secured, after a person went outside unsupported at nearly midnight and fell.

The provider had made some improvements regarding the safe administration of medicines since the last inspection. However, medicines were still not always being managed safely at the home.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This was because people’s capacity had only been assessed in terms of them living at the home. There were no decision specific capacity assessments in place.

Staff supported people to eat and drink, and some people had their intake monitored. However, the monitoring records lacked detail or had not been fully completed. This showed people were not having enough food or fluid, so the monitoring process was not effective. The shortfalls had not been identified or escalated as a concern.

The information within people’s care plans lacked detail and did not always reflect individual needs and choices. There was limited information about health conditions, and wound care plans were not consistently in place. The terminology staff used within care records, was not always respectful and did not show an understanding of people’s needs.

People’s privacy and dignity was not always promoted. There were limited interactions between staff and people who used the service unless interventions were taking place. Not all showed a caring approach and there was mixed feedback about the staff. Staff were positive about their role, and said they enjoyed working with people.

There were auditing systems in place but these were not effective, as shortfalls found during this inspection had not been identified. The registered manager was not able to answer some questions about the management of the service, and some requested information could not be located. The registered manager did not have clear oversight of the service.

There were enough staff to support people, and call bells were answered in a timely manner. Staff covered any sickness or annual leave as necessary, and agency staff were also used. There were approximately 180 vacant care hours. Recruitment was ongoing with an aim to fill these vacancies. Robust recruitment procedures were being followed.

Staff received a range of training, which was deemed mandatory by the provider. This included health and safety, moving people safely and food safety. Some staff however were waiting for safeguarding training, and positive behavioural management training had not been undertaken. The registered nurses completed training for their professional development. Staff felt well supported and had one to one meetings with their line manager. They also had annual appraisals, to discuss achievements and areas to work on.

People and their relatives knew how to raise a concern. Records showed formal complaints which had been raised, but investigations or any correspondence to the complainant was not evidenced. People had been asked for feedback about the quality of the service they received.

Staff gave very positive feedback about the registered manager.

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

Rating at last inspection

At the last focused inspection, the rating for this service was Good (published 04/12/21).

Why we inspected

The inspection was prompted in part due to concerns received about people’s support and alleged restraint of a person and them being forced to eat. A decision was made for us to inspect and examine those risks.

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 Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Camelot Care Homes Ltd on our website at www.cqc.org.uk

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to risk management, the safe management of medicines, ensuring consent, person centred care, reporting incidents and accidents, and good governance.

We made on recommendation for the provider to improve documentation to evidence compliance with their complaint procedure.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures:.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Camelot Care Homes Ltd provides accommodation and nursing care for 57 older people in two adapted buildings. People have their own rooms and share communal rooms such as bathrooms, lounges and dining areas. There is an enclosed courtyard area for people to access outside space. At the time of our inspection there were 51 people living at the service.

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

Since our last inspection improvements had been made in the management of medicines. People received their medicines in line with the prescriber’s requirements, from staff who were trained and competent. People who were prescribed medicines to be administered 'as and when required' (PRN) had detailed care plans to guide staff when PRN medicine should be administered.

People and their relatives told us they felt safe, were well supported and there were sufficient numbers of staff providing care. Care plans and risk assessments identified people's needs and how to support them to stay safe. Infection control practices were in line with current government guidance. Staff were recruited safely and received appropriate training, relevant to their role.

The registered manager promoted a culture of learning and putting people first. Good governance arrangements were in place to help monitor the service and management acted to address to any shortfalls identified. Staff felt supported by the management team and said they enjoyed their jobs. People and their relatives expressed confidence in the management team. Numerous relatives told us they would recommend the home to others. Staff communicated with health professionals when required to meet people’s needs.

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 8 March 2021) and there was a breach in regulations. 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

The inspection was prompted in part due to concerns received about the management of medicines and the cleanliness of the service. A decision was made for us to inspect and examine those risks.

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.

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 full 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 and well led which contain those requirements.

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 Camelot Care Homes Ltd 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.

Camelot Care Homes Ltd provides accommodation and nursing care for 57 older people in two adapted buildings. People have their own rooms and share communal rooms such as bathrooms, lounges and dining areas. There is an enclosed courtyard area for people to access outside space. At the time of our inspection there were 51 people living at the service.

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

People’s medicines were not always managed safely. We found there were some discrepancies in stock and records were not always in place to give staff guidance.

People, their relatives and staff told us that at times there were not enough staff. This had an impact on keeping people in touch with their relatives. We have made a recommendation about staffing numbers.

Quality monitoring was not always effective to identify all areas of improvement. Whilst some medicines improvements had been identified, there were areas that had not. We have made a recommendation about medicines audits. There was a service improvement plan for environmental actions which helped make larger scale improvements to the environment.

The home was clean, and staff were cleaning touchpoints more frequently. Staff had access to personal protective equipment and had been given training and guidance on using it safely. Staff were being tested for COVID-19 weekly and people were tested monthly as per the government guidance.

Staff followed government guidance for new admissions into the home making sure people isolated as needed. Visiting for relatives was not permitted at the time of inspection due to national lockdown. Though staff supported relatives with compassionate visiting as needed by making sure they had personal protective equipment.

Risk management plans were in place to guide staff on how to provide care and support safely. Referrals to other professionals had taken place and risks were reviewed monthly. Accidents and incidents were recorded and reviewed to identify any learning. The registered manager carried out monthly monitoring of all incidents and looked for any patterns or trends.

Maintenance checks were carried out and equipment serviced regularly. There was regular testing of fire systems and staff were given fire training and completed drills. The registered manager had an environmental action plan to ensure there was a regular refurbishment of areas in the home.

People and relatives spoke positively about the registered manager and their approach and most staff spoke positively about the culture at the service. The service worked in partnership with professionals and we received positive feedback about the service and staff.

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 19 December 2018).

Why we inspected

This inspection was prompted to seek assurances about the safety and care of people following information received as part of an ongoing safeguarding concern. As the investigation was ongoing this inspection did not examine the circumstances of that incident. We undertook a focused inspection to review the key questions of Safe and Well-led only.

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 coronavirus and other infection outbreaks effectively.

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 changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camelot Care Homes Ltd on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified one breach of regulation for failing to manage medicines safely 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Camelot Care Homes Ltd is a ‘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. The home accommodates 57 people in two adapted buildings. At the time of our inspection there were 53 people living at the service. Five of the rooms at the home were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery.

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.

People had individual care plans which were personalised. We found that information was not always current to give staff guidance to provide responsive care. We have made a recommendation about updating care records.

Medicines were managed safely; we observed medicines administration and observed that staff practice was safe. Medicines administration records contained the information required to make sure people had their medicines as prescribed.

Pre-employment checks had been completed before staff started work. There were sufficient staff available to meet people’s needs. Staff understood their role in keeping people safe and had received training on safeguarding people from harm.

Staff were well trained and had opportunity for regular supervision. They told us they felt well supported and could approach the registered manager at any time. New staff received an effective induction.

People had a choice of meal and were supported by staff to eat where needed. Mealtimes were inclusive and relaxed. There were drinks available throughout the service.

Premises were kept clean and staff followed effective infection prevention and control practices. There was a programme of planned maintenance and decoration in place.

People were supported by a staff team that knew their needs well. 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 had been given the opportunity to record their end of life wishes. The service had supported people at the end of their lives with assistance from healthcare professionals.

Activities were varied and provided daily. People had the option to be involved but could also choose to spend time doing their own activity. Visitors were welcomed without restrictions.

There were regular meetings for people, relatives and staff and minutes were kept. People, relatives and healthcare professionals all stated they thought the service was caring, responsive and well-led.

There had been no formal complaints since our last inspection, however there was a policy in place to manage any complaints. There were suggestion boxes in the receptions of both building so people, relatives and staff could leave their views or suggestions.

No risks or concerns were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Camelot Care Homes Ltd is a ‘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.

Camelot Care Homes Ltd provides accommodation with nursing and personal care for up to 57 older people, some of whom have dementia. At the time of our inspection, 52 people were resident at the home. Five of the beds were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery.

The service is housed in two separate buildings on one site. One building is called Comilla and one is called Countess. There are landscaped gardens, which both buildings share. Accommodation was arranged over the ground and first floors and there were lifts for access. There are a range of communal areas that people can access such as dining rooms, lounges and a conservatory. Parking was available.

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.

People we spoke with felt safe living at the service, there were sufficient numbers of staff to meet people’s needs. Staff understood their responsibility to safeguarding people from harm and what to do if they were concerned.

Medicines were managed safely, registered nurses were responsible for the administration of medicines and we observed their practice was safe.

The environment had been decorated in some communal areas such as corridors, toilets and bathrooms. The environment was clean with no evidence of odours in any part of both buildings. Flooring in some areas had been replaced and there was a plan in place to make further improvement to areas such as flooring, painting and decorating.

Maintenance checks were completed and where needed external contractors were used to service equipment and check for safety. Staff were observed to use safe infection prevention and control practices such as use of gloves and aprons.

Risks had been assessed and measures put in place to support safe practices. Clinical staff regularly reviewed risks and they shared good practice with care staff. Accidents and incidents were analysed for trends or any lessons that could be learned.

People, relatives and staff were complimentary about the management of the service and thought the home was well managed. The service worked in partnership with other agencies to make sure people got the care and support they needed.

Quality monitoring had improved and was used to produce action plans. The provider was involved in monitoring at the service and reviewed action plans with the registered manager at their visits.

This inspection took place on 17 August 2017 and was unannounced. We returned on 18 August 2017 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

At the last inspection in May 2016 we found medicines were not always managed in ways that protected people or were safe. At this inspection we found the registered manager had taken action to address these concerns and ensure medicines were managed safely. People received support to take the medicines they had been prescribed and staff kept good records of medicines they supported people to take. Medicines were stored securely.

At the last inspection in May 2016 we found people did not always have a care plan in place and people received personal care at times that did not suit them. At this inspection we found the provider had taken action to address these concerns. The provider had reviewed the care plans in place for people. People had a care plan which was personal to them. The plans included information on maintaining health, daily routines and goals to maintain skills and maximise independence. Care plans set out what people’s needs were and how they wanted them to be met.

Although the provider had taken action to address the issues we found at the last inspection, we found further shortfalls at this inspection.

The home was not clean and action was needed to control the risk of cross infection. Bathrooms, shower rooms and toilets in both wings of the home had not been effectively cleaned. Equipment had not been maintained in a good state of repair, which increased the risk of cross infection.

During the inspection we found an area of the home that was unsafe. A window on the first floor of the home had a broken pane of glass. This had left the window with exposed sharp edged glass, which was accessible to people using the service. Staff were not able to tell us when the window had been broken. Action had been taken to board up the broken window by the second day of the inspection.

The service had audit and quality assurance systems in place. However, these systems were not effective and had not ensured shortfalls in the home were identified quickly and action taken to resolve them. This is the third inspection we have completed since the service was registered. At each of these three inspections we have identified breaches in the regulations and told the provider improvements were needed. The provider had taken action to address the specific issues we have raised on the two previous occasions. However, on each subsequent inspection we have identified different breaches of regulations. The provider did not have effective systems to assess, monitor and improve the quality and safety of the service being provided.

We received mixed feedback from people about the quality of food. Some people were very complimentary about the choice and quality of meals. However, some people did not receive support to meet their dietary needs or preferences.

People told us staff treated them well and they felt safe living at Camelot. People said there were usually enough staff available to provide care for them when they needed it and most staff understood their needs. Comments included, “They have worked so hard to meet my needs” and “We get what we need”.

Systems were in place to protect people from abuse and harm and staff knew how to use them. Staff were appropriately trained and skilled. They received a thorough induction when they started work at the service. They demonstrated a good understanding of their roles and responsibilities.

People were confident that they could raise concerns or complaints and they would be listened to.

We received positive feedback from a social care professional about the way the service worked with them to meet people’s needs.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see details of the action we took in the main section of this report.

This inspection took place on 5 May 2016 and was unannounced. We returned on 11 May 2016 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

At the last inspection we found the systems for assessing and managing risks did not always ensure there was clear information for staff on the action that was needed to keep people safe. At this inspection we found the registered manager had taken action to address this concern. Risks people faced were assessed and plans were in place showing staff how to manage them.

Medicines were not always managed in ways that protected people or were safe. There was a lack of information about when people should be supported to take ‘as required’ medicines. Medicines were not always stored securely and the records did not always match medicines held in the home.

People were not always able to choose when they received care and support. Comments from people included, “We just do as we’re told” and “You’ve got to follow and fit in with everyone else”. Care plans contained information about what people’s needs were, but not always how those needs should be met. Staff provided the care people needed, but sometimes this was task focussd, and not focussed on the person and their wishes.

People said they felt safe living at Camelot. Comments included ‘‘I do feel safe here” and “I feel safe and well looked after”. A relative told us “I’m confident (my relative) is safe and happy here”.

Systems were in place to protect people from abuse and harm and staff knew how to use them. Staff understood the needs of the people they were supporting. We saw that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They received a thorough induction when they started work at the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

People were confident that they could raise concerns or complaints and they would be listened to.

The provider and registered manager assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements. We received positive feedback from health and social care professionals about the registered manager and their ability to resolve concerns or shortfalls in the service.

We found 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.