Camelot Care Homes Ltd

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed 6 quality statements in this key question. People’s needs were assessed before a placement at the home was agreed, and regularly thereafter. Staff received regular training and were up to date with evidence-based practice. There were systems to help people remain healthy, and improvements had now been made to monitoring the food and fluid intake of those at risk of dehydration and malnutrition. People’s capacity had been assessed and staff asked consent before providing support. However, the quality of information within capacity assessments was not always consistent. Staff worked well with those in the wider staff team and involved health and social care professionals.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us leaders assessed their needs before they started using the service. One relative told us they spent the afternoon with leaders and the staff team to make sure the home was suitable for their family member. Another relative said leaders could not do anymore to understand their family member and what they needed.

Leaders told us they gained as much information as possible when assessing a new person to the service. They said this was then discussed with staff, so they could be assured the person’s needs could be met. Staff told us leaders listened to them and would not accept the person if it was not safe to do so. They said they received training if the new person had a health condition, they were not familiar with. This ensured the person’s needs would be met effectively.

Records showed the person’s initial needs assessment, and those undertaken on a monthly basis or as needs changed. Areas such as nutrition, skin integrity, choking and falling had been assessed and associated care plans were in place. There were assessments of any wounds, which demonstrated changes to treatment were made as required.

People and their relatives were complimentary about the staff and the support provided. They said staff knew people’s preferences and how they liked their care to be delivered. Relatives told us staff were very good at healing pressure sores, which had been acquired in hospital, and helping mobility after a period of ill health. One relative said their family member’s health had deteriorated significantly in another care setting, but they were now making significant improvement.

Leaders told us they ensured staff completed regular training, so were up to date with evidence-based care and treatment. This included skin integrity training for registered nurses. Staff confirmed this and were proud of their wound care, which included hospital acquired wounds healing well. Staff were knowledgeable about people’s health conditions such as diabetes and best practice. They said people were regularly weighed to monitor any weight loss. If this was identified the person would be referred to the dietician and have additional calories such as fortified foods.

Nationally recognised tools were used to assess people’s risk of sustaining pressure sores and malnutrition. Associated care records demonstrated how the risks were being minimised. This included charts to demonstrate how often a person was being repositioned, and food and fluid intake monitoring. These systems were fully completed and in line with best practice.

People and their relatives told us staff were good at contacting the required health and social care professionals when needed. This included the GP, chiropodist, and specialist nurses. One relative told us staff were good keeping up to date with hospital appointments.

Leaders told us a whole home approach had been further developed to ensure effective team working. This had been through handovers at the start of each shift, heads of department meetings and group supervision sessions. They said the team worked well together and alongside other professionals such as the GP, dieticians and speech and language therapists. Staff confirmed this. One staff member told us all ancillary staff completed similar training to the care staff, as they were all part of one large team.

Professionals were positive about the staff team. One health and social care professional told us they regularly visited the home and had built good relationships with staff. They said staff were overly cautious rather than lacking in contact. Another professional told us leaders had been very accommodating and had gone above and beyond to provide support and move things forward for the person they were overseeing.

Systems were effective in ensuring teams worked together. There were regular staff meetings, formal group supervision sessions and handovers at the start of each shift. Leaders had restructured the whole staff team into smaller teams. Each team was then allocated a number of people to oversee, which enabled more in-depth relationships to be developed. Some health and social care professionals such as the GP routinely visited the home. The same staff generally supported them, which ensured consistency and good relationships.

We observed people ate well and enjoyed their meals. People were complimentary about the food and were assisted to have regular drinks. People and their relatives told us staff tried to ensure good health. This was through fresh air, exercise, and activities, or by encouraging and assisting with nutritional intake. People told us they also saw the GP and attended other appointments when required.

Leaders told us they had excellent support from professionals to ensure people remained healthy. They said staff were good at recognising any ill health and gaining advice, so any treatment could be started in a timely manner. Staff told us social activities were arranged to promote exercise and enable people to get outside for fresh air. They said they supported people to have a walk in the garden, or a coffee in the town to enhance wellbeing, whenever possible.

People were encouraged to live healthier lives. This included having a balanced diet and good hydration, as well as appointments with various healthcare professionals to meet their health care needs. There were now effective records to monitor the fluid and food intake of those people who were at risk of malnutrition and dehydration. Social activity was viewed as promoting wellbeing, so people were encouraged to participate within a range of activities, both in house and within the local community.

People told us they were happy at the home, and relatives confirmed their family member’s wellbeing. People said they enjoyed the social activities on offer, but also the ability to stay in their room if they wanted to. Relatives told us staff put effort into celebrating special occasions such as birthdays and anniversaries.

Leaders told us they wanted people to live, not just receive a service, so social activity and keeping active was important. Staff told us people were being asked about their bucket list, with an attempt to achieve certain aspects if possible. People were supported to go to events within the community such as church and the local coffee shop. Days at the beach and a summer fete were being planned.

Records showed people’s care was regularly reviewed, to ensure it met their needs. Family and friends were invited to attend the review, or there were occasions when discussions were held over the telephone. The review ensured people were able to raise any requests or concerns, so amendments could be made in a timely manner.

People and their relatives told us staff asked for their consent before undertaking any care intervention. We observed this in practice throughout the assessment. This included whether people wanted to wipe their hands before lunch or wear a clothes protector whilst eating. Staff also asked if they could take crockery from each person once finished.

Leaders told us they had enhanced their learning in relation to mental capacity. This had shown the need for additional assessments, which they had not realised were necessary. Leaders told us these were being addressed. They said improved recording had now been made to demonstrate how the conditions of any Deprivation of Liberty Safeguards (DoLS) were being met. This enabled better monitoring to ensure the conditions were being complied with. Staff showed an understanding of their responsibilities to gain people’s consent before providing any support.

People had been assessed for their mental capacity to consent to aspects of their care and support. However, the quality of the assessments varied. For example, not all assessments showed who was involved in the decision-making process or whether less restrictive options had been considered. One person had bed rails for safety rather than a lowered bed, but the rationale for this was not documented. This did not always show the process was correctly followed. Records showed leaders had reviewed all DoLS and there was now a clear structure for evidencing how staff were meeting the conditions.