Cameron House

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

Although some improvements were noted since our last inspection in June 2022, not all risks for people using the service were recorded in sufficient detail to mitigate the risk or potential harm for people using the service. Improvements were still required to some aspects of medicines management. We have made a recommendation about this.

People were at risk of harm and injury because poor moving and handling practices were witnessed during the inspection. Poor deployment of staff meant people’s needs were not always met. Governance arrangements at the service continued to require improvement to ensure improvements were sustained in the longer term.

People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff demonstrated an understanding of safeguarding and how to raise concerns internally and external agencies. Staff recruitment practices at Cameron House were safe. People were 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.

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 16 August 2022).

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 in relation to the provider’s safeguarding arrangements and they were no longer in breach of Regulation 13 (Safeguarding service users from abuse and improper treatment) but remained in breach of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

The service remains rated Requires Improvement. The service has been rated Requires Improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service and in part due to concerns received about medicines management.

A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of Safe and Well-Led only. 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 remained the same based on the findings of this inspection for a second consecutive time.

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

Enforcement

We have identified breaches in relation to risk management, staffing and quality assurance at this inspection.

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.

Cameron House is a residential care home providing the regulated activity or accommodation and personal nursing care to up to 44 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 42 people using the service.

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

Although there was no impact for people using the service, not all risks to people’s safety and wellbeing were assessed, recorded or provided enough detail as to how identified risks should be mitigated. Improvements were required to some aspects of medicines management. Staff, including the management team, did not understand their role and associated responsibilities to protect and keep people safe from harm. People, relatives’ and staffs’ comments relating to staffing levels at the service were variable, with staffing levels and the deployment of staff not always maintained. However, the latter improved on the second day of inspection and following an additional member of staff being rostered throughout the day.

The provider’s arrangements to assess and monitor the service were not effective. Though audits were in place, they needed to be used more effectively, as they failed to pick up the issues identified as part of this inspection.

People were 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. However, where people had bedrails or a sensor mat in place to keep them safe, reasons for this were not recorded to evidence these had been agreed as part of 'best interest' procedures.

People spoken with told us they felt safe and had no concerns about their wellbeing. Suitable arrangements were in place to ensure the service’s recruitment practices were safe. The service was clean and odour free. Relatives confirmed there were no restrictions to visiting and that government guidance was being followed.

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 April 2020]

Why we inspected

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 a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about unexplained injuries. A decision was made for us to inspect and examine those risks. We inspected and found there was a concern with staff’s moving and handling practices and the service’s safeguarding practices and procedures, so we widened the scope of the inspection to become a focused inspection which included the key questions of ‘Safe’ and ‘Well-Led’.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

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

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, safeguarding and the service’s governance arrangements.

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.

Cameron House is a residential care home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 44 people.

Cameron House is one building set over two floors. There are two double bedrooms with the rest being single rooms. All rooms have ensuite toilet and hand basin facilities.

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

People and relatives told us staff were caring and respectful. They said staff were very dedicated and organised. Relatives spoke highly of the registered manager and deputy manager and said the communication with service was good.

The mealtime experience was positive. People chose where they wanted to dine. Staff were attentive to people’s needs and offered choice of meals and beverages. Staff were patient and treated people with dignity.

People were 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.

The service had an activities co-ordinator who provided a varied programme of activities. On the day of the inspection, there was an entertainer who visited the service regularly. People were enjoying the singing and we observed staff interacting in a positive way with people.

Staff had received infection control training. The service was clean, tidy and odour free. Personal protective equipment was available to staff and we observed staff following infection control procedures.

Medicines were stored safely. Medicine stock and administration records reviewed were found to be correct, demonstrating people received their medicines as prescribed.

People had access to health and social care professionals. One professional told us that communication with the service was good and the staff were caring.

The registered manager had made improvements since the last inspection. They were enthusiastic and passionate about the service and maintaining standards of care. Audits were carried out by the registered manager and the area manager who visited regularly.

Safe staff recruitment process was followed, which included an induction programme and staff completed the Care Certificate. Staff received training through on-line and face to face sessions for practical courses. Staff meetings were held, and staff told us they felt supported by 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 and update

The last rating for this service was requires improvement (published 13 March 2019) and there were two 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 and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about this service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cameron House is a residential care home that provides personal and nursing care for up to 44 people aged 65 and over. At the time of the inspection there were 41 people living at the service.

People’s experience of using this service:

Suitable measures were not put in place to mitigate risks or potential risk of harm for people using the service, as not all risks to people had been identified and assessed. People were at risk of having their safety compromised as equipment to enable them to summon staff assistance and to alert staff could not be used at the same time. Recommendations highlighted within the most recent fire risk assessment remained outstanding. However, these are recommendations and not a legal requirement.

People who could become anxious and distressed did not receive their medicines as prescribed and accurate records to evidence the rationale for these being administered were not recorded. Sometimes medicines were not stored securely.

Staff did not always have sufficient time to give people the care and support they needed and staffing levels were not always maintained.

Care planning arrangements did not ensure all of a person’s care needs were recorded. Records did not always evidence the care and support provided for people living at Cameron House. Staff were aware of people’s end of life care needs but these were not recorded.

Investigation reports were not completed to show how conclusions and outcomes had been reached relating to safeguarding concerns and complaints. Following the inspection the registered provider wrote to us and advised documentation was in place to evidence investigations undertaken and outcomes. This did not concur with our findings at the time of inspection.

Although quality assurance arrangements were in place these had not picked up the issues highlighted as part of this inspection.

People were treated with care and kindness and spoke positively about the caring attitude of staff. People were treated with respect and dignity and had a good relationship with staff.

Staff received appropriate training and induction relating to their role. Staff were supported by the management team and received regular supervision.

The dining experience for people was positive and people received sufficient food and drink throughout the day.

People received positive outcomes regarding their health and wellbeing; and the service worked jointly with other organisations.

Recruitment arrangements were robust to ensure the right staff were recruited and people were protected by the provider’s infection control procedures.

People’s capacity to make day-to-day decisions had been considered and assessed and the provider was working within the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People enjoyed the activities provided but stated there were occasions when they were bored and there was nothing for them to do.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around risk management and medicines arrangements. Details of the action we have asked the provider to take can be found at the end of this report.

Rating at last inspection:

Following the last inspection the rating of the service was ‘Good’ (Last report published 29 June 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. If any concerning information is received we may inspect sooner.

The inspection took place on 17 May 2016 and was unannounced.

Cameron House provides accommodation and personal care for up to 44 older people who may also have dementia. Care is provided on two floors people living with dementia do not have a separate unit the people living on each floor are a mix of older people and people with dementia related needs. At the time of our visit there were 42 people living in the service.

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.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were appropriate arrangements in place for medication to be stored and administered safely, and there were sufficient numbers of care staff with the correct skills and knowledge to safely meet people’s needs.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act.

People’s care plans were individual and contained information about people’s needs, likes and dislikes and their ability to make decisions.

People had access to healthcare professionals. A choice of food and drink was available that reflected their nutritional needs, and took into account their personal lifestyle preferences or health care needs.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times.

People were encouraged to follow their interests and hobbies. They were supported to keep in contact with their family and friends.

There was a strong management team who encouraged an open culture and who led by example. Staff morale was high and they felt that their views were valued.

The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements where this was required.

Staff spoken with said they had been properly recruited and trained. Staff told us that they received very good support in their roles.

We saw that people's care and support was planned and reviewed regularly. Risks to the health, welfare and safety of the person were identified and managed.

Some of the people we met at our inspection could not, because of their complex needs, tell us verbally about their experiences and so we used observation to help us understand their experience of the service. We also looked at care records, gained feedback from staff about people's care and support needs and we spoke with relatives of people using the service.

People we were able to speak with told us that they were very satisfied with how they were treated, with the level of support provided and with the facilities and activities available. One person told us, "I like the staff and it's like being at home here.' Another person told us that, 'The food is good and the staff are lovely.' One person said, 'I can't fault it here the staff are hardworking and my room is kept spotless.' Relatives we spoke with told us, 'The staff are very caring and the manager is lovely'. Another relative said, 'The staff do an excellent job.'

Peoples' needs were assessed, care and treatment was planned and delivered in line with their individual care plan. We saw that the provider had appropriate arrangements in place to manage medicines. There were enough qualified, skilled and experienced staff to meet the people's needs although this should be monitored as the provider has recently admitted people with dementia which could impact on staffing needs in the future. We saw that the provider had a system to regularly assess and monitor the quality of the service people received.