About the service:

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.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We saw people being treated with dignity and respect. Relatives and visiting health care professionals we spoke with were complimentary about the caring approach and people who use the service told us “the staff are lovely” and “nothing is too much trouble”.

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.

Cameron House provides accommodation and personal care for up to 44 older people. Some people also have dementia related needs.

The inspection was completed on 12 August 2015 and 14 August 2015. There were 43 people living at the service when we inspected.

A registered manager was 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.

The deployment of staff was not appropriate to meet the needs of people who used the service and required reviewing so as to ensure people’s care and support needs were met.

Robust procedures and processes to protect people’s rights and prevent people from being abused required improvement.

Inconsistencies across the service in relation to the quality of information included in people’s care records were found and improvements were required.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service. Staff felt well supported in their role and received regular supervision.

Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided. People who used the service and their relatives were involved in making decisions about their care and support and told us that their healthcare needs were well managed.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety. People received proper support to have their social care needs met.

People and their relatives told us that if they had any concern they would discuss these with the manager or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

You can see what actions we told the provider to take at the back of the full version of the report.