Camellia House. Miss Sunita Jhugroo. Overall rating for this service. Inspection report. Ratings. Good

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1 Miss Sunita Jhugroo Camellia House Inspection report 5 Belmont Place Plymouth Devon PL3 4DN Tel: Date of inspection visit: 22 February 2016 Date of publication: 21 March 2016 Ratings Overall rating for this service Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? 1 Camellia House Inspection report 21 March 2016

2 Summary of findings Overall summary We carried out this unannounced inspection of Camelia House on 22 February Camelia House is a care home that provides residential care for up to 14 people. On the day of the inspection there were 14 people using the service. The service was last inspected in April 2014 and met the requirements of regulation. 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. The registered manager lived at the service and was supported by sufficient numbers of care staff to meet people's needs. People were being cared for by competent and experienced staff. There were choices available to people in their daily lives and their mobility was supported appropriately. The service had safe arrangements for the management, storage and administration of medicines. It was clear from the medicine records that people received their medicines as prescribed. Some people required prescribed creams Creams were not dated when opened. The registered manager acknowledged the importance of this and took action to ensure staff knew when the cream would expire and was no longer safe to use. On the day of the inspection visit there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. People told us, "They [staff] are very good and always a round when you need them" and "Staff are very good and respectful". People were able to take part in a range of activities of their choice. One person told us, "I love living here. (Names of manager and staff members) are so patient and very caring. It has made such a difference to my quality of life". A family member told us, "I visit most days and am always made to feel welcome by staff and (manager's name) is here more often than not. I feel very happy with the support (person's name) gets here". There were safe recruitment procedures to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. The recruitment process identified applicants had the appropriate skills and knowledge needed to provide care to meet people's needs. Staff supported people to be involved in and make decisions about their daily lives. If people did not have the capacity to make certain decisions the service had systems in place to act in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This was to protect people and uphold their rights. The environment supported people living with dementia. For example there was signage throughout the 2 Camellia House Inspection report 21 March 2016

3 service and pictorial images to indicate room functions. People could identify their room because there was a picture of the person and in most instances their name. The activity and daily menu board were presented in pictorial format so that people could access the information in a more meaningful way. People were protected from the risk of abuse because staff had received training to help them identify possible signs of abuse and knew what action they should take. Staff accurately described the correct sequence of actions and outlined the different types of abuse. Staff told us they supported people in a way that kept people safe. People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Staff said, "I love working here, we all get on and get the support we need" and "If I was concerned about anything I would go straight to the manager. I have every confidence in them". People and visitors all described the management of the service as open and approachable and thought people received a good service. Relatives told us, "We chose this home because it was central and close to where (person's name) lived before" and "The owners live here and its run just like a family. Very good all round". There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Management were visible in the service and regularly observed and talked with people to check if they were happy and safe living at Camelia House. Equipment and supply services including electricity, fire systems and gas were being maintained. 3 Camellia House Inspection report 21 March 2016

4 The five questions we ask about services and what we found We always ask the following five questions of services. Is the service safe? The service was safe. The management, storage and administration of medicines were safe. There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. Staff knew how to recognise and report the signs of abuse. They knew the correct procedures to follow if they thought someone was being abused. Is the service effective? The service was effective. Staff had a good knowledge of each person and how to meet their needs. Staff received on-going training so they had the skills and knowledge to provide effective care to people. People saw health professionals when they needed to so their health needs were met. Management understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. Is the service caring? The service was caring. Staff were kind and compassionate and treated people with dignity and respect. People and their families were involved in their care and were asked about their preferences and choices. Staff respected people's wishes and provided care and support in line with those wishes. Is the service responsive? The service was responsive. People received personalised care and support which was responsive to their changing needs. People were able to take part in a range of group and individual 4 Camellia House Inspection report 21 March 2016

5 activities of their choice. Information about how to complain was readily available. Is the service well-led? The service was well led. The service sought the views and experiences of people, their families and the staff in order to continually improve the service. Staff said they were supported by management and worked together as a team, putting the needs of the people who lived at the service first. Staff were motivated to develop and provide quality care. 5 Camellia House Inspection report 21 March 2016

6 Camellia House Detailed findings Background to this inspection We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act This unannounced inspection took place on 22 February The inspection team consisted of one inspector. We requested and were provided with a Provider Information Return (PIR) from the provider prior to the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. Before the inspection we reviewed information held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law. During the inspection we spoke with six people who were able to express their views about living at Camelia House and three visiting relatives. Following the inspection visit we spoke with Local Authority commissioners of the service. We spoke with the registered provider and registered manager, deputy manager and three staff members. We looked around the service and observed care and support being provided by staff. We looked at three people's records of care. We looked at three records relating to the care of individuals, three staff recruitment files, staff duty rosters, staff training records and records relating to the running of the service. 6 Camellia House Inspection report 21 March 2016

7 Is the service safe? Our findings People told us they felt safe living Camelia House and with the staff who supported them. One person said, "It's a very homely pace to live and I feel very safe living here". The staffing rota showed there were enough skilled and experienced staff on duty to keep people safe and meet their needs. People received care and support in a timely manner and staff were not rushed. We observed staff were available to people in all areas of the service, so that people could call upon them if required. Staff told us, "Working here has been a good move for me. I love it and making sure people are safe is really important". People were protected from the risk of abuse because staff had received training to help them identify possible signs of abuse and knew what action they should take. Staff received safeguarding training as part of their initial induction and this was regularly updated. They were knowledgeable in recognising signs of potential abuse and the relevant reporting procedures. Staff told us if they had any concerns they would report them to management and were confident they would be followed up appropriately. There were risk assessments in place which identified risks and the control measures in place to minimise risk. For example, how staff should support people when using equipment, reducing the risks of falls and reducing the risk of pressure ulcers. The assessments were specific to the care needs of the person. For example, there was clear guidance that directed staff to know what equipment was needed to move a person safely. Risk assessments were being reviewed monthly or where required should there be a change of risk level. For example one persons health needs had changed. Staff were being supported with advice from health professionals to ensure the person's medical and care needs were being managed. Incidents and accidents were recorded in the service. We looked at records of these and found that appropriate action had been taken and where necessary changes made to learn from the events. Events were audited by the deputy manager to identify any patterns or trends which could be addressed, and subsequently reduce any apparent risks. Medicines were managed safely at Camelia House. Medicines were stored appropriately and Medicines Administration Record (MAR) charts were fully completed. Medicines which required stricter controls by law were stored correctly and records kept in line with relevant legislation. A lockable medicine refrigerator was on order to improve the current provision. Staff had received appropriate training in administrating and managing medicines and weekly audits were completed by the deputy manager. Some people were prescribed creams. Prescribed creams had not been dated upon opening. This meant staff were not advised when the cream would not be safe to use and need to be disposed of. The registered manager recognised the need to address this and started to take action to date all prescribed creams. A homely remedy procedure was followed to make sure any medicines administered which were not prescribed were recorded and could be clearly audited. Staffing levels were based upon the level of needs for people living at Camelia House. Rotas showed there was a skills mix of staff on each shift being supported by the registered manager. In addition to care staff 7 Camellia House Inspection report 21 March 2016

8 there were ancillary and kitchen staff. People said there were enough staff to meet their needs, and the staff we spoke with said staffing levels were good. Relatives said, "They (staff) are always around" and "I have never been concerned there were not enough staff. Whenever I visit there are plenty of staff and the manager is always here". Staff had completed a thorough recruitment process to ensure they had the appropriate skills and knowledge required to provide care to meet people's needs. Staff recruitment files contained all the relevant recruitment checks to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. The environment was clean and there was an on-going programme to re-decorate people's rooms and make other upgrades to the premises when necessary. There were a number of levels within the service but all were served either by a passenger lift and stair lifts so all areas were accessible to people. Records showed that manual handling equipment, such as hoists and bath seats, had been serviced. There was a system of health and safety risk assessment. Fire alarms and evacuation procedures were checked by staff and external contractors to ensure they worked. There was a record of regular fire drills. 8 Camellia House Inspection report 21 March 2016

9 Is the service effective? Our findings People were able to make choices about what they did in their day to day lives. For example, when they went to bed and got up, who they spent time with and where, and their choice of food. People made their own choices about whether to stay in their rooms, use the lounge area or both. There were no restrictions on how people chose to spend their time. People told us, "I like to stay in my room. I have everything I need but I go down for parties and other things that go on" and "I chose to come and live here because I can do what I want when I want. That's important to me and it's respected by the staff". People were cared for by staff with the appropriate knowledge and skills to support them effectively. People told us, "I am very confident in all the staff they are very good at what they do" and, "They (staff) are all very patient because I need time to move around. They never rush me". Families felt the service was effective in meeting their relative's needs. Their comments included, "(Person's name) could not be in a better place" and "They (staff) have made sure the doctor had been called when (person name) has been off colour. They follow everything up and always let us know what's going on". During the inspection visit staff were available to support people. Staff were chatting with people about their interests and what they would like to spend their time doing at various times of the day. People's bedrooms contained personal pictures and ornaments which helped the service to have a familiar homely feel for people who lived there. People had access to healthcare professionals including doctors', dentists, chiropodists and opticians. Health checks were seen as important and were recorded on people's individual records. One staff member told us, "We have a good relationship with the doctors and district nurses". Staff made referrals to relevant healthcare services quickly when changes to health or wellbeing had been identified. A person required emergency support during the inspection visit and this was arranged by the registered manager. Emergency treatment was provided and family were informed of the issue with immediate effect. A relative said, "They [staff] keep us informed of any changes in (person's name) health". The service was aware of the new Care Certificate which replaced the Common Induction Standards. This is designed to help ensure care staff have a wider theoretical knowledge of good working practice within the care sector. The most recent care worker employed by the service was working through the new system to achieve the care certificate. There were training opportunities for staff working at the service. Staff told us they thought access to training was good and reflected their roles and responsibilities. One staff member said, "The training has been very good. I have really moved on". Staff told us they felt supported and they had the opportunity to discuss their performance and development with the manager. Staff training needs were discussed with individual staff and reflected training which supported them in their roles. Staff also said there were regular staff meetings which gave them the chance to meet together as a staff team and discuss people's needs and any new developments for the service. 9 Camellia House Inspection report 21 March 2016

10 Care planning and reviews were written in a 'person centred' way. This showed the persons needs and choices were at the centre of care planning. People gave us examples of when they had been involved in their care planning and reviews. One person said, "They (staff) regularly talk to me about what I need. Only the other day they talked about my doctor's appointment and what tests I needed". A relative told us, "I can't thank the staff enough. They keep me informed of the slightest change in (person's name)". The registered manager and the staff were aware of the Mental Capacity Act 2005 (MCA). People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. The service considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards (DoLS). Referrals had been made where the service was concerned about people's right to liberty was being restricted due to their level of mental capacity. Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. We observed the support people received during the lunchtime period. Staff asked people where they wanted to eat their lunch and most people chose to eat in the dining room. There was an unrushed and relaxed atmosphere and people talked with each other, and with staff. People told us, "I like to eat here in my room. It's always a nice meal" and "If I don't like something I always get a choice".the activity and daily menu board were presented in pictorial format so that people could access the information in a more meaningful way. 10 Camellia House Inspection report 21 March 2016

11 Is the service caring? Our findings People told us they were happy living at Camelia House. They found it to be a good place to live where staff knew what people's needs were and responded to them in a kind and caring way. People told us, "I like to have a lie in and the girls know my routine so don't disturb me. It's a lovely place to live". and "Very caring. Couldn't ask for more patient and considerate staff". A relative told us, "Staff could not be kinder. They (staff) are always around when I come and visit. Nobody has to wait long for anything". On the day of our inspection there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. People were cared for by attentive and respectful staff. Staff showed patience and provided encouragement when supporting people. People's choices were respected and staff were sensitive and caring. Staff were friendly, patient and discreet when providing care for people. They took the time to speak with people as they supported them and we observed many positive interactions that supported people's wellbeing. For example, we saw staff assisting one person to move from their armchair to a standing position. Staff were patient and gentle explaining each step of the manoeuvre and talking with them throughout the procedure to prevent them from becoming anxious. During the day people moved freely around the service without restriction. Staff were available to support people when they needed it. A staff member said, "People need to feel confident they are getting the care they need and I think that really happens here". A relative told us, "When I leave here I am very confident (person's name) is being very well cared for". Interactions between staff and people at the service were caring with conversations being held in a gentle and understanding way. Staff always engaged with people at eye level, for example kneeling next to the person if they were sitting down. Staff knew the backgrounds of the people they cared for and we noted the staff used this information when they were with them in relevant conversations. For example speaking with somebody about their interests. Where possible people's life histories were documented in their care plans. Staff told us it helped them gain an understanding of what has made the person who they are today. Staff were able to tell us about people's backgrounds and past life events. This supported equality and diversity and helped ensure individualised care was provided. Staff told us, "Getting to know people is really important because you can usually link into something which helps them to have a conversation" and "Everybody has a story to tell. A lot of people lived locally and tell us a lot of things that have changed over the years. It's all really interesting". Some people living at Camelia House were living with dementia or memory difficulties and their ability to make daily decisions could change. Staff had a good understanding of people's needs and used this knowledge to help people to make their own decisions about their daily lives wherever possible. For example, a care worker said, "We look at the individual and help them to make choices. (Person's name) likes to listen to music so we put the radio on the channel they like in their room". Another person liked to walk around and was supported to do this by staff who were showing respect and a caring approach to the person. 11 Camellia House Inspection report 21 March 2016

12 Staff were respectful and protected people's privacy and dignity. When people were being supported to move around the service staff spoke with them in a low voice and assisted them with the minimum of fuss, reassuring them throughout. People responded positively to this support. People's bedroom doors were closed when care was being provided for them. Staff assisted people in a sensitive and reassuring manner throughout the inspection visit. People were dressed in clean and coordinating clothes and looked well cared for. Some people used the lounges and dining room and other's chose to spend time in their own rooms. One person told us, "I like my own company most of the time but I do go down when I want to join in things that are going on". Staff supported people to maintain contact with friends and family. Visitors told us they were always made welcome and were able to visit at any time. People were able to see visitors in the lounge or in their own room. We observed that staff greeted visitors on arrival and made them feel comfortable. 12 Camellia House Inspection report 21 March 2016

13 Is the service responsive? Our findings People told us they felt their needs were being well met at Camelia House. One person told us, "Living here I can do what I want when I want" and "The staff really listen to what I have to say and when I'm in the lounge staff sit down with people and have a chat". A relative told us, "We are always told If there are any changes or when they have had to get the doctor in. Always kept up to date with what's going on". People who wished to move into the service had their needs assessed, prior to moving in, to help ensure the service was able to meet their needs and expectations. The registered manager and deputy manager were knowledgeable about the level of support people required. Their decisions about any new admissions were made by balancing the needs of any new person with the needs of the people already living at Camelia House. Care plans were personalised to the individual and gave clear details about each person's specific needs and how they liked to be supported. These were reviewed monthly or as people's needs changed. Care plans gave direction and guidance for staff to follow to meet people's needs and wishes. For example, one person had a specific diagnosed condition. Staff had an information sheet about the condition on file so they understood how the condition presented itself and they could respond appropriately. Staff spoken with told us they had found the information useful as they now understood how to interpret symptoms and respond to them. Staff told us care plans were informative and gave them the guidance they needed to care for people. Daily records detailed the care and support provided each day and how they had spent their time. Staff told us this system made sure they were up to date with any information affecting a person's care and support. Where people required additional support from specialists including dentist and consultant referrals had been made and responded to. People, who were able to, were involved in planning and reviewing their care. Where people lacked the capacity to make a decision for themselves, staff involved family members in writing and reviewing care plans. People told us they knew about their care plans and staff would regularly talk to them about their care. People said they were happy living at the service and were able to spend the days doing what they chose to. The service had gained a Dementia Quality Mark award issued by the local authority. The service had developed a portfolio which helps to promote a quality of life for people living with dementia. This included specific signage around the service, meaningful activities and improving person centred care by planning care which reflected individual needs. Activities were seen as an important part of the day to day planning and there was a range of activities available to people. During the morning people played floor skittles which generated a lot of interaction and there was also a reminiscence session. Staff sat with people at regular intervals and engaged in conversations with them. In the afternoon a film with interactive songs was played and most people 13 Camellia House Inspection report 21 March 2016

14 participated in the event. People had the choice to participate. Some chose to stay in their rooms or use the dining area. People said, "Never a dull moment" and "I go to church most Sundays and am supported to go. We also have services in the home which is good for those who can't get out like me". Staff members were familiar with people's interests. Most people could vocalise their likes and dislikes and wanted to share their life experiences with staff. People were supported to maintain contact with friends and family. Visitors were always made welcome and were able to visit at any time which we saw during the inspection visit. People and their families were provided with information about how to make a complaint. Details of the complaints procedure were displayed at the service. People told us they would speak to the manager or staff if they had any concerns. The service had not received any complaints since the previous inspection. One person told us they felt confident the manager would act on any issues they might raise with the service. 14 Camellia House Inspection report 21 March 2016

15 Is the service well-led? Our findings People who lived at the service spoke positively about the registered manager and the staff and felt they could approach them with any issues and that they would be heard. Staff felt well supported by the registered manager. People told us, "This is a lovely homely place to live we are well looked after and I feel I can say what I think about things without me worrying about it" and "Don't have to worry about a thing. They (staff) sort everything out for me. My mind is at rest here". The management structure in the service provided clear lines of responsibility and accountability. The registered manager, who had overall responsibility for the service, was also the provider as they were one of the owners of the service. They were supported by a deputy manager. There were systems in place for the registered manager to monitor the quality of the service provided to people. This included regular formal and informal meetings with people living at the service, relatives and staff. Comment cards had been completed in 2015 and showed people were happy with the service they received. They made comments on all aspects of living there including, food, care, premises, daily living and management. Staff told us the philosophy of the service was to make it as homely for people as possible. One staff member said, "I think this home is homely and very personal for the people living here". It was important to all the staff and management at the service that people who lived there were supported to be as independent as possible and live their life as they chose. People and visitors all described the management of the service as open and approachable. Managers were clearly committed to provide good care with an emphasis on making people's daily lives as contented as possible. The management team led by example and this had resulted in staff adopting the same approach and enthusiasm in wanting to provide a good service for people. Relatives told us, "We chose this home because it was so homely and we were made to feel very welcome from the beginning" and "It is a family run home and I believe that is important". Staff said that as well as formal staff meetings, day to day communication was good and any issues were addressed as necessary. They felt confident the registered manager and deputy manager respected and acted on their views. Comments included, "It's a very close staff team and we work well together but we do get very good support every day. That makes the difference" and "We (staff) are kept up to date with things going on. Like doctor's appointments or visits and if there are any changes when the district nurse has been". Everybody we spoke with told us that the registered manager always promoted an open dialogue. Staff said they shared information every day and between shifts. A visitor told us each time they came into the service the registered provider always updated them about what was going on. The registered manager oversaw quality assurance systems to drive continuous improvement within the 15 Camellia House Inspection report 21 March 2016

16 service. Some of the audits included medicines, accidents and incidents and maintenance of the home. Further audits were carried out in line with policies and procedures. For example we saw fire tests were carried out weekly and emergency lighting was tested monthly. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The managers worked alongside staff to monitor the quality of the care provided by staff. The deputy manager told us that if they had any concerns about individual staff's practice they would address this through additional supervision and training. The managers carried out audits of falls, medicines, and care plans. The registered manager and deputy manager were visible in the service and regularly observed and talked to people to check if they were happy and safe living at Camelia House. 16 Camellia House Inspection report 21 March 2016