This unannounced comprehensive inspection took place on the 21 and 22 August 2018. The inspection was to follow up to see whether improvements had been made from the previous inspection in August 2017.

Camplehaye Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation with personal care to a maximum of 44 people. The home provides care for older people, some of whom are living with dementia. The service is a Victorian property over two floors with two modern extensions, and accommodation off four corridor areas. 36 people lived at the home when we visited, six of whom were there short term for respite, and one person was in hospital.

At the last inspection, on 31 August and 4 September 2018, the service was rated requires improvement overall and in safe and well led, and good in effective, caring and responsive. A breach of regulation 12, safe care and treatment was found. This was because risks for people such as fire safety risks, incorrectly set pressure relieving equipment and a lack of detailed of detail in some care plans managing people’s challenging behaviours. Improvements in leadership were also needed as service had no registered manager. Several changes of managers over a short period, had been unsettling for people, relatives and staff.

At this inspection we found the service had improved to Good overall with further improvements planned.

The service had a registered manager, they started working at the service in January 2018 and registered in May. 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.

Improvements had been made in fire safety, risks assessments and in using equipment. Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. People's risk assessments were comprehensive with actions taken to reduce the risks as much as possible. Further improvements to reduce risks such as from trailing leads, trip hazards were needed. Most areas were clean and odour free but infection control measures could be improved further.

People, relatives, staff and professionals gave us positive feedback about improvements in leadership and ongoing improvements in the quality of people’s care. They spoke positively about improvements in communication, professional development and increased provider support. Quality monitoring systems had improved, with examples of continuous improvements made in response to audits, observation of practice and regular checks of the environment.

People were supported by staff that were caring, compassionate and treated them with the utmost dignity and respect. People concerns and any complaints were listened and responded to and used as opportunities to improve.

People were supported by enough skilled staff so their care and support could be provided at a time and pace convenient for them. Staffing levels were calculated using a dependency tool which was regularly reviewed. Staff understood the signs of abuse and knew how to report concerns, including reporting to external agencies. A detailed recruitment process was in place to ensure people were cared for by suitable staff. People received their prescribed medicines on time and in a safe way.

People were supported by staff who had the skills and knowledge to meet their needs. Recent improvements in training meant staff have better understanding and felt more confident to carry out their roles. People’s health was improved by staff who worked with a range

Camplehaye Residential Home provides accommodation with personal care to a maximum of 44 people. The home provides care for older people, some of whom are living with dementia. 43 people lived at the home when we visited, four of whom were there short term for respite, and one person was in hospital.

This unannounced comprehensive inspection took place on 31 August and 4 September 2017. It was carried out in response to concerning information received anonymously about low staffing levels at the home, poor moving and handling by some staff, and people’s medicines not always being managed in a safe way. Since the end of July 2017 at Campelhaye, there had been an increase in incidents of verbal and physical abuse between people reported by service to the local authority safeguarding team and the Care Quality Commission (CQC).

On 26 and 27 September 2016 we carried out a comprehensive inspection at the service. This was to check that improvements had been made following our previous inspection on 22 and 29 April and 7 May 2015. At that inspection the service was rated requires improvement overall and in the safe, effective, responsive and well led domains, with caring rated as good. This was because four breaches of regulations were found relating to people’s safe care and treatment, safeguarding, staffing and good governance. CQC took enforcement action in relation to ineffective quality monitoring and a warning notice was served. In September 2016 we found improvements had been made with no breaches of regulations. The service was rated good overall and in the safe, effective, caring and well led domains, and requires improvement in responsive. This was because some people’s care plans needed updating and because activities needed to be more personalised to people’s hobbies and interests. Improvements were found in these areas at this inspection.

The service did not currently have a registered manager. The previous registered manager left in April 2017, and has deregistered. A new manager was appointed in May 2017, who had planned to register with the Care Quality Commission. However following organisational changes, this manager was taking up a newly created quality monitoring role within the company. The new role was to support managers in Campelhaye and a second home in the group with monitoring the quality of care and continuous improvement. A replacement manager had been recruited who was undergoing a period of induction, they were due to take day to day charge of the home the week we visited. For clarity, the manager referred to in this report is the manager who has been in charge of the home since May 2017.

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 happy and relaxed around staff and said they felt safe living there. The manager had identified a number of safety risks within the service, such as increased falls and verbal and physical aggression incidents which they were working to manage and reduce. However some risks had not been identified in relation to fire safety risks, a lack of detailed instruction for staff about managing a person's challenging behaviours and incorrectly set pressure relieving equipment. The service had increased staffing levels during the day and at night to provide people with additional support and supervision and staff were undertaking falls management training.

People's rights and choices were promoted and respected. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards; they involved the person, family members and other professionals in 'best interest' decision making. We followed up whether gates were used to restrict people’s movemen

The unannounced inspection took place on 26 and 27 September 2016. A previous inspection on 22 and 29 April and 7 May 2015 found that improvement was needed. This related to the standard of service monitoring, a lack of safety with regard to the delivery of care, unlawful deprivation of people’s liberty, protecting people from abuse and a lack of staff training and support. The following inspection, on 26 and 27 November 2015, looked only at how the standard of service was being monitored, and found significant improvement.

Camplehaye Residential Home provides accommodation and personal care to a maximum of 44 people. It is not a nursing home. The home specialises in the care of people living with the condition of dementia. There were 43 people resident at the time of the inspection.

The service is required to have a registered manager. 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. Camplehaye Residential Home had a registered manager.

People’s needs were assessed and a plan of care produced, with their involvement. This should provide staff with the information needed to meet people’s current care needs. However, those plans were not always current and therefore did not always contain up to date information for the staff. The registered manager immediately corrected this. Some care plans were very detailed, person centred and informative for staff.

A district nurse described the end of life care at Camplehaye as “Very good” and a GP described it as “Really impressive.” People, their family members and health care professionals felt that people’s care needs were well met. Where external health care advice was required, this was sought in a timely manner so people’s health was promoted. Individual risks to people were understood and measures were in place to reduce risk, where necessary.

People were protected through robust staff recruitment, induction, training, supervision and support. Staff said they felt supported and their training was good. There were enough staff to meet people’s individual care needs. Staffing numbers and roles were under regular review.

People received their medicines as prescribed. They received a varied and nutritious diet. They had choice and any special dietary needs were being met.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service was meeting its obligations to protect people’s legal rights in accordance with the MCA and DoLS.

Staff were kind, caring, patient and treated people with respect and dignity. People’s views were sought and responded to.

A programme of varied activities provided people with stimulation and enjoyment. Activities were not, however, based on people’s history and individual interests. We have recommended that some activities are tailored to people as individuals, taking into account their past history and interests.

The standard of service was monitored through a variety of quality monitoring arrangements, which included seeking people’s views, and audits to identify risks. A service improvement plan was under regular review. Any complaints were responded to appropriately.

We spoke to five people who used the service. Their comments included, "They're very good about my diet"; "Quite comfortable here" and "I wouldn't change anything". One person's family told us, "The standard of care is consistently excellent. There is a caring and friendly attitude from staff. Xxxx is very content here. It never smells".

We found that there were lots of activities available for people to share or do alone, as they preferred. People received a high standard of personal care and their individuality was supported. Visiting health care professionals said that their clients and families were happy and that they had no concerns about the home. One added, The staff are very kind and always very knowledgeable. The care assistant’s expectations of standards is high".

People told us that they had what they needed and their accommodation was comfortable. We saw that the home had adaptations to help maintain people's independence, a wide variety of rooms domestically furnished and that it was well maintained.

Staff were not recruited until checks had confirmed that they were suitable to work with vulnerable adults.

Care workers did not understand their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards and so people's human rights were not being protected. We saw no evidence that people's consent was sought. Records lacked detail, were not kept securely at all times and some were in pencil and so not fit for purpose.

People using the service are cared for by staff who are said to be patient and kind. People consider the numbers of care workers to be satisfactory to meet people's individual needs and they are fully supported by house keeping staff.

People told us that they know the manager well and have complete confidence in her. Comments included: "She is wonderful. She said if I have any ideas I can let her know" and "Very professional". People's family say that communication is very good.

People are assisted at their own pace and the atmosphere at the home is relaxed and unhurried. People receive care in a respectful and kind manner. Community nurses have confidence in the staff, who contact them appropriately and are knowledgeable about people's needs. The level of health care monitoring ensures that any change in health is quickly noted and acted upon.

Care workers know how to safeguard people from abuse and how people who lack the ability to make decisions about their own welfare have legal safeguards. The home has systems in place to ensure that people receive a service which is safe and which is regularly reviewed.

We carried out an unannounced focused inspection on 26 and 27 November 2015.

We carried out an unannounced comprehensive inspection of this service in May 2015. Breaches of legal regulations were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal regulations in relation to the breaches.

We initially gave the provider until July 2015 to meet the breach in ‘Good governance’. We then met with the provider where it was agreed the timescales would be extended to mid-October 2015. This was because we were confident risks had been identified and were being addressed. Also, the provider had already employed a new manager and time was required for them to take forward the service action plan.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met the legal requirement for good governance. This was because this related to the way the home was run. The other breaches will be looked at during a subsequent inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Camplehaye Residential Home on our website at www.cqc.org.uk

Camplehaye Residential Home provides accommodation and personal care to a maximum of 44 people. The home specialises in the care of people living with the condition of dementia and is not a nursing home. There were 37 people using the service at this time of this inspection.

The home is required to have a registered manager. 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 home had a registered manager during this inspection but they had not been in continuous day to day control of the service since January 2015 and had not taken steps to remove their name from the register. A new manager had been appointed to run the home. They started their employment on 2 November 2015 and had taken steps to register with the Care Quality Commission.

The improved standard of monitoring had led to a safer home for people. There were monitoring visits by the provider and a manager at a sister home and an internal system for monitoring on a weekly, monthly and quarterly basis at the home. The deputy manager said, “There have been a lot of changes in governance and staff have been very supportive.”

Where monitoring arrangements had previously failed and breaches in the regulations had been found in May 2015, there were improved arrangements. These included auditing of medicines, training, including how to protect people’s legal rights, and staff were now receiving face to face supervision of their work. This meant that people were more likely to receive a safe and efficient service and their legal rights were now being upheld.

The manager had a clear and achievable improvement plan on how to improve the standards of care and manage risk, with timescales. Their auditing had shown where staffing improvements were needed. The provider had resourced staffing changes through the use of agency staff; people were safer. Where people’s experience had not been good, for example, people becoming angry with each other in the lounge, a change in the staffing had led to people’s support improving.

Health and social care professionals said they had confidence in the staff and the manager had addressed issues correctly.

The manager had a good understanding of how to improve people’s lives and a clear vision of how to achieve this. Some staff were finding the pace of change was a challenge but one said, “She’s doing a pretty good job so far”.