The inspection took place on 13 and 16 December 2016 and it was unannounced. Camelot Nursing and Residential Care Home is registered to provide accommodation for 35 people who may require nursing and/or personal care. At the time of our inspection 32 older people were living at the home including one person who was staying on a short break. People had various needs including dementia and physical disabilities.

Camelot Nursing and Residential Care Home is two houses that have been converted into one large home with a front driveway. The home is situated in a residential area of Worthing within close proximity to both shops and the seafront. Communal areas included a lounge, an activity lounge a dining area and an additional small coffee lounge area often used for meetings or the visiting hairdresser. A lift was used to take people from the ground to the first floor, stair lifts were is use for people who lived in two mezzanine areas at either side of the building. An attractive patio and garden area to the side and rear of the home could be accessed by people and their relatives.

We found the home to be clean and tidy and maintained to a high standard, there was an action plan in place for areas of the home which required decorating including the replacement programme for all carpets to be replaced by a selection of laminate floorings. Home furnishings such as pictures and ornate framed mirrors decorated communal areas and hallways. Due to the festive season the halls were decorated with Christmas decorations and Christmas trees were positioned in communal areas throughout the home. The front foyer area was complete with a ‘meet the team’ which included photographs of all staff members and their job role. The ambience of the home was warm and inviting. All bedrooms were personalised with pictures and ornaments and were single occupancy. Helpful signs throughout the home supported people to navigate themselves around the building.

A registered manager was in post at the time of our inspection who had managed the service since 2012. 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 and their relatives told us the home provided a safe service and there was enough staff to meet people's needs. Staff were trained in how to recognise signs of abuse and able to speak about what action they would take if they had a concern or felt a person was at risk. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. Medicines were managed safely and people were happy with how their medicines were administered.

The home followed safe staff recruitment practices and provided a thorough induction process to

prepare new staff for their role. Staff demonstrated how they would implement the training they received in core subject areas by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager and the registered nurses.

Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. They also understood the associated legislation under Deprivation of Liberty Safeguards and restrictions to people’s freedom. People could choose when, where and what they wanted to eat. Additional drinks and snacks were observed being offered in between meals and staff knew people's preferences.

Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach. People received personalised care. Care plans reflected information relevant to each

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions:

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what people using the service, visitors to the home and members of staff told us, what we observed and what we learnt from the records we looked at. We spoke with seven people who lived in the home, and with two care assistants, the deputy manager and the registered manager. Records we looked at included four care records, staff training records, management audits and the service’s quality assurance documentation.

Is the service safe?

All staff were up to date with training about safeguarding vulnerable people. Staff we spoke with had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues.

Staffing of the home was organised such that people were seen regularly throughout the day. Their wellbeing was checked and recorded each time staff attended to them. Any concerns were reported promptly to more senior staff. Staff were directed to ensure people had call bells to hand, so they could summon assistance when they needed it.

The home had contingency plans for maintaining people’s safety in the event of emergencies arising. We saw that call bells were answered swiftly in most cases, although we have highlighted to the provider that twice during our inspection this was not the case.

Is the service effective?

Care plans included a range of assessments which were reviewed monthly. This enabled changes to be made to people’s planned care needs and identified risks were reviewed. Staff we spoke with said the care plans guided the care and support people received. They received a handover of updating information each time they started work. People’s descriptions of support they received matched exactly with the care plans that we read.

Records showed staff noticed and recorded changes in people's health and wellbeing. Health professionals were contacted in a timely way, as necessary. Comprehensive planning and recording of wound care showed pressure area ulcers were treated effectively

Staff of the home received regular training to support them to care for the people who lived in the home. This included training about conditions such as Parkinson’s disease and dementia. There was an organised system for all staff to receive individual supervision, which assisted them to make links between their training and practice. Care assistants were supported to achieve diploma qualifications and to identify external additional training to increase their effectiveness.

Is the service caring?

We observed attentive, meaningful and friendly interactions between staff and people in the home. Staff explained care intentions to people and allowed time for responses. Staff told us there were always enough staff to meet people’s needs

People we spoke with said they got up at times that suited them and went to bed when they wanted to. We saw three people being supported to eat their lunch. The staff members were focused on the task, engaged in conversation as people wished and assisted them to enjoy their meals with privacy and dignity.

Care plans directed staff on how to help people manage continence issues in order to maintain dignity. We saw that people’s clothes, nail and hair care indicated they were supported to present themselves as they would wish. Furnishings in private and communal rooms were clean and presentable.

Is the service responsive?

Care records showed people’s needs were assessed before they began living in the home. Care plans were clearly based on these initial assessments, and subsequent monthly reviews. People had signed to show they had been involved in agreeing their needs and how they were to be met, or relatives had done so on their behalf. A person who lived in the home told us they were fully involved in aspects of management of two primary medical conditions they had.

Care plans emphasised the importance of people having the time to make choices. They addressed people’s communication abilities and level of understanding. This included recognising people’s abilities might change from day to day or at different times of day. Plans gave detailed practical guidance on the nature of support people needed. This showed the planning of care was responsive to individual needs and preferences. Care plans for all people in the home contained details of wishes in respect of end of life care. This subject was addressed in a consistent manner, with the involvement of people’s family or other advocates at the start of a person’s stay at the home.

People told us they could always request alternative meals to those on the menu, and often did. We saw the chef was proactive in ensuring people were provided with the meals they wanted, and checking their satisfaction.

Care records showed good information was obtained from people and their families about previous lifestyles, experience and interests. The home had a monthly programme of singing and exercise sessions led by external visitors. An activity coordinator on the staff team arranged small group and one-to-one activities to provide stimulation through the week. However, we have drawn the provider’s attention to a lack of recording of the incidence or effectiveness of activities. People’s social and activity needs were not included in care plans, which meant the home was not reviewing how these needs were being addressed.

Is the service well-led?

The manager saw it as part of their role to speak with all people who lived in the home, and visitors, every day. They undertook a monthly programme of audits, which gave them a factually based oversight of how various aspects of the home were being managed. This meant they were continuously aware of the quality of service offered by the home and could address any shortfall revealed through audit. People told us the provider spent two or three days per week in the home and the manager described a close working relationship with the provider, including annual development planning.

People who lived in the home, with visiting relatives, had quarterly meetings when they discussed the quality of service they experienced. Minutes showed food and activities were always discussed and people were invited to give ideas for improvement. There were annual questionnaire surveys of staff and the relatives of people who lived in the home. We saw examples of changes made in the service as a result of feedback received through these avenues.

Staff had meetings every month, covering care and operational issues. Staff we spoke with said they felt management listened to their views and kept them well informed of developments and plans. They expressed a strong identity as a team working together to meet the needs of people who lived in the home. A care assistant told us, “The manager has made a huge difference, inspecting and pulling us up. People are open in meetings.” The manager and deputy manager had recently attended training on changes in the regulatory requirements of their role, which showed a value was placed on maintaining good leadership of the service.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that documented peoples’ preferences and met individual needs. We saw that the administration of medication was undertaken in a safe and controlled manner.

The people we spoke with told us the staff were kind and that they “Couldn’t be better looked after”. Another person told us “They do their best - they are good girls”. Visitors to the service told us that the staff were very nice and they didn’t have any problem with the care provided. They told us that during the recent refurbishment a bathroom was out of action and this had posed some problems when trying to access alternative facilities. They told us they felt confident to raise any complaint with the staff and were confident their concerns would be acted upon.

There were up to date policies and procedures in place regarding consent that staff followed in practice. This helped to ensure that people’s rights to consent to their care and treatment were upheld.

We asked people who lived at Camelot Nursing and Residential Care Home about their care and treatment. They told us that that the staff were “very kind and considerate”.

People told us that they were treated as individuals and were given information and choices in relation to their care. They told us they were always treated with respect and their dignity was upheld.

We spoke to six people who live in the home. They told us that they enjoyed the food and that there was a good choice of food available. They said there was always enough and that it was always served hot. We were told that where able, people usually went to the dining room for their meals.

We spoke to relatives of people staying in the home. They told us that their relative’s needs and wishes were identified, addressed and that the families opinions were also taken into account. They told us that this was very much appreciated.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk.

The people we spoke with who lived in the home told us they were happy with the care they received. They told us they were treated with respect, that they were well looked after and that staff were kind. People told us that there were usually enough staff for the number of people living at the home; however there were busy times when they had to wait for some time for staff to answer their call bell.

The people we spoke with told us that although they were not always aware of the formal complaints processes, they did feel able to raise with staff any concerns that they had.