We carried out an unannounced comprehensive inspection on 22 and 29 April and 7 May 2015. We had decided to bring forward a planned inspection because of concerns raised with the Care Quality Commission (CQC) about provision of care at the home and because of a change in the management situation.
We last inspected the home in May 2014 and found no breaches in the regulations we looked at.
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 37 people resident when we visited.
The home had a registered manager during this inspection. 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 registered manager had not been in continuous day to day control of the service since 12 January 2015. There has been an acting manager in their place since 13 March 2015, supported by a provider representative with the provider assuming “day to day” control since that date.
People said they felt safe and looked relaxed with staff who had their welfare at heart. However, some staff had not received training in protecting people from abuse and did not understand their responsibilities. Consequently when a person using the service had hit another this was not reported to the local authority safeguarding team as it should have been.
Risk was not always managed effectively. Records of falls and incidents could not be guaranteed as accurate and there were conflicting risk assessments and care planning, for example, regarding the use of bedrails. Risk assessments had not identified the risk from free standing wardrobes. Unattended spray bottles of cleaning products put people at risk who might not understand the danger from the chemicals.
Evacuation plans were not up to date. There were examples where the provider and staff had already recognised risk and reduced it, such as safety on the stairs but also examples where they had not identified risks.
Medicines were generally well managed. However, two people had not received the sufficient amount of one medicine; their GP was immediately informed when we identified this.
Staff had not received adequate induction, training and supervision of their work. This had been identified and was being addressed prior to the inspection.
People were involved in decisions about their care. The acting manager and the provider representative understood the principles of the Mental Capacity Act 2005 and protected people unable to make decisions about their care. However, at least one person was being deprived of their liberty unlawfully. The provider representative informed the local authority immediately this was identified.
Records at the home could not be guaranteed as accurate or useful. They did not help staff members provide safe and responsive care. They increased the potential for risk.
The home appeared clean and was fresh but there was no cleaning schedule and so the need for cleaning behind furniture had not been identified and there was some old debris.
Some of the issues of concern had been identified by the provider before the inspection and were actively being dealt with. Issues we identified were followed up straight away. However, the auditing and monitoring arrangements established by the provider had not been effective.
Some staff morale was low and they said they felt unsupported.
People said staff responded to their needs in a timely way. Staffing arrangements were flexible where people’s needs or circumstance changed. Staff recruitment included checks to be sure the person was suitable to work in a care home environment.
People liked the food, which they said was tasty. People received a nutritious diet and staff understood how to protect people from poor diet or fluids. Any concerns about people’s diet were followed up by the service.
Staff were considered to be kind and caring. One of many comments was, “The people who help me are wonderful.”
People’s privacy and dignity were promoted. Staff readily provided support, a smile and encouragement, especially where people were anxious or upset.
Community nurses had no concerns about the care provided at Camplehaye. People had access to their GP, dental, eye and foot care and were supported to attend hospital and other appointments.
People had many and varied activities available to them, such as gardening, chair exercises and regular discussions about current events. An activities worker ensured people who stayed in their rooms were visited on a regular basis to help reduce any isolation.
Complaints brought to the provider’s attention were investigated and followed up in a timely way. Where they had identified the need for improvement this was put in place.
We found four breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.