Camelot Care Homes Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 8 quality statements for this key question. The safety of the environment had improved, and no hazards were identified. The management of risk had improved, but people were not always supported with their posture to ensure safety whilst eating. This increased the risk of choking. There were enough staff to support people, and there were system to minimise the risk of abuse. Care plans had been developed to help staff support people with any distressed behaviour. Improvements had been made to the cleanliness of the home and there were systems to prevent and control infection. Improvements had been made to the management of medicines and there was a clear focus on learning and improving the service.

This service scored 72 (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 were complimentary about the staff and their skills. One relative told us the best thing about the service was the professional care and friendliness of the whole team. People and their relatives felt listened to and were confident any concerns would be properly investigated and resolved.

Leaders told us there was always something to learn and develop, so ensured a learning culture throughout the home. They said the management team and staff had worked hard to successfully improve the service following the last inspection. Staff told us they completed a range of training and always undertook reflective practice after an accident or incident. This enabled lessons to be learnt so further occurrences were minimised.

There were various learning opportunities for staff, including face to face, online and external training courses. Some staff were qualified to train others in subjects such as moving people safely. Others had specialisms such as tissue viability, due to additional training they had completed. There were group supervision sessions for staff to discuss topics such as managing any distressed behaviour people experienced. Reflective practice for accidents and incidents took place and staff had regular one to one meetings with leaders.

Relatives told us staff always contacted the relevant health and social care professional if they were concerned or needed advice. They said staff called them after any consultation, to keep them informed.

Leaders told us they had worked with staff to ensure people had a smooth transition between services. This included discussions about what information needed to be shared and written guidance for staff, when contacting the emergency services. Leaders told us good relationships had been established with all involved health and social care professionals.

Health and social care professionals did not have any concerns in this area. One professional told us the service was responsive when an urgent placement was needed. They said staff provided a safe place, and then worked with them to consider the best way forward for the person. This included whether they should remain at the home or return to their previous address in the community.

Records showed staff had requested specialist support from health and social care professionals as required. Relevant information had been shared to ensure a smooth transition, and the outcomes of any consultations, were clearly documented. Records showed people’s wishes for their clinical care in an emergency.

People told us they felt safe, but 2 people raised concerns about a female member of staff. They said they were rude and not nice. Once informed, leaders told us they would investigate the allegations. Relatives had no concerns about safety. One relative said this was because of the attentiveness and attitudes of staff. They said they would readily raise any concerns with leaders and were confident any issues would be resolved.

Leaders told us they would investigate the concerns raised about a female member of staff. They said they had recently improved their knowledge of safeguarding, including what needed to be reported. Their learning was discussed with staff and a clear message of being alert and vigilant at all times, was given. Staff told us they had received safeguarding training and were clear about their responsibilities to identify and report any allegation of abuse or avoidable harm.

People were relaxed within their environment and when interacting with staff. The home was calm, and people were encouraged to take their time. Staff were relaxed and spoke to people in a friendly manner.

Safeguarding systems had improved, which enhanced people’s safety. For example, leaders now observed any injury such as unidentified bruising and then checked it was correctly documented, reported, and investigated. Reflective practice was held with staff to minimise a future occurrence. Discussions had taken place with staff, about what constituted abuse, and mandatory safeguarding training was up to date. There was a safeguarding policy and leaders had devised an ’easy read’ poster for people about safeguarding. Whilst a staff member had discussed this with each person, it was work in progress to fully ensure understanding.

People and their relatives told us risks particularly related to falling, poor nutrition and hydration were managed well. However, 2 people told us they were not regularly supported with their continence needs. This increased the risk of skin damage. Leaders told us they would investigate this and ensure improvement.

Leaders told us improvements had been made to risk management. They said risk assessments had been reviewed, staff had received training and care plans had been developed for each person who displayed distressed behaviour. Leaders told us techniques to best support people at these times were discussed in group supervision sessions. Staff told us they informed the registered nurses if they identified any risks to people’s safety.

Staff did not always identify risks to people’s safety. For example, staff had not always ensured people were in a good position to safely eat in bed, which increased their risk of choking. Staff also encroached on some people’s personal space by leaning over them during an intervention. This intrusion increased the risk of distressed behaviour or an altercation. Staff minimised other risks by walking with people, checking all wheelchairs were in good working order and safe techniques when using the hoist. Staff had identified some people needed a quiet, calm space. This was enabled, and individual activities were arranged for stimulation.

Systems to manage risk had now improved. Risk assessments had been reviewed and care plans to help staff support people with distressed behaviour had been developed. However, not all staff were familiar with the most effective techniques to use when a person became distressed, and there was inconsistency in some information. This increased the risk of inconsistent care. Staff had received training in managing distressed behaviour and incidents were now recorded. Reflective practice was used to review the incident and minimise a reoccurrence.

People and their relatives told us the environment was safe. They said all small portable appliances were tested for safety and there were no trip hazards. People said they had the equipment they needed such as hoists and specialised beds.

Leaders told us improvements had been made to the environment to ensure safety. This included a new fire alarm system, new fire doors and compartmental works to minimise the spread of smoke and fire in an emergency. Leaders told us they toured the environment daily to identify any hazards and had instructed staff to be extra vigilant whilst they went about their role. They said the maintenance staff had been given responsibility for various environmental audits, but they continued to have oversight.

Improvements had now been made to the safety of the environment. Staff ensured rooms which housed hazardous substances were locked and there was restrictive access to the kitchen and kitchenettes. There were no trip hazards and fire exits were free of obstructions.

Improvements had now been made to the systems to ensure the environment was safe. This included formal checks of the window restrictors, the temperature of the hot water and new fire safety equipment. Portable electrical appliances had been tested and hoists had been serviced. A new fire risk assessment had been completed and all previous recommendations regarding fire, had been addressed. Health and safety meetings were held, and staff had received health and safety training. We observed staff putting their learning into practice by using the hoists safely.

People gave us variable feedback about the number of staff available and their experience. Some people said there were enough staff, but others said they sometimes had to wait for assistance. People felt staff were well trained although one person said some staff did not manage people’s orientation very well. Relatives told us there were enough staff and always a staff presence, but collecting prescriptions took staff away from people’s support.

Leaders told us they used a dependency tool to determine the number of staff required for each shift. They said this included factors such as layout of the building as well as the complexity of people’s needs. Leaders told us they had the correct number of staff to support people safely. Staff confirmed this and said more staff had been recruited so agency staff were no longer required. This had had a positive impact on the team and service delivery. Staff told us they felt trained for their role and were fully supported.

There was a staff presence, and people were supported in a timely manner.

Safe systems were used to recruit new staff. Discussions were held with staff about capacity, and leaders took this into account when assessing the number of staff required on each shift. Audits were completed to analyse how long it took staff to respond to people’s call bells. These were used to identify busier times of the day and whether staffing levels needed to be adjusted. Records showed there were systems for individual and group staff supervision and regular staff meetings.

People and their relatives told us they were happy with the cleanliness of the home. They said their room was cleaned regularly, and there were no malodours. Relatives told us practice during the Coronavirus pandemic was well managed.

Leaders told us infection prevention and control had improved. They said this was because of additional staff training, increased auditing, and improved monitoring. Staff told us they had received training in infection control and there was personal protective equipment to use when needed. They said they had cleaning schedules, time and the equipment they needed, to keep the home clean.

We observed improvements had been made to cleanliness and the home was visibly clean. However, one person’s bedrail bumper was stained, and their room had a strong odour. Staff told us they were planning to change the bumper after assisting the person to get up, and focus was being given to the odour. Staff wore aprons when handling food and asked for consent to wipe people’s hands before eating their meal.

There was an infection prevention and control policy and staff had access to the required personal protective equipment. Records showed staff had received training and leaders checked their hand washing techniques. Regular infection prevention and control audits took place, and group supervision sessions were held to discuss the findings and any change of practice required.

People’s medicines were given in a safe and caring way. People’s preferences about how they liked to take their medicines were respected and they were asked if they needed any medicines, which were prescribed ‘when required’. People’s medicines were kept under review by the GP surgery.

Staff were knowledgeable about people’s needs and their medicines. They said they were supported with medicines by the GP surgery and pharmacy. Staff told us they received yearly training in medicines, and their competency was checked. Staff were aware of the initiatives to stop over medication of people with a learning disability and autism.

Improvements had been made to the safe administration of medicines. There were risk assessments for high-risk medicines, and staff had signed the medicine administration record correctly. This showed people had received their medicines as prescribed. There were suitable arrangements for the storage, and disposal of medicines. Storage temperatures were monitored appropriately and there was suitable management and oversight of controlled drugs. Medicines policies and procedures supported staff, but staff did not record the administration of thickeners to residents with dysphagia. This was not in line with good practice. There were regular audits, and any errors with medicines were investigated appropriately.