Camberley Manor

The inspection took place on 14 June 2018 and was unannounced.

Camberley Manor is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Camberley Manor provides facilities and services for up to 60 older people who require personal or nursing care. The service is purpose built and provides accommodation and facilities over three floors. The second floor provides care and support to people who are living with dementia, this area is called Clover. On the day of the inspection there were 40 people living at Camberley Manor.

At our inspection on 1 and 14 June 2017 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following concerns relating to the care people were receiving we completed a further inspection of Camberley Manor on 5 and 10 November 2017 where seven breaches of legal requirements were identified. These related to a lack of consistent leadership, risks to people’s safety not always being identified and acted upon, inconsistent staff training and support, accidents and incidents not being adequately monitored, people’s dignity not always being upheld and safeguarding concerns not always being reported to the local authority or to CQC. Following this inspection we issued warning notices in relation to safe care and treatment and good governance. As a result of our concerns Camberley Manor was placed into special measures. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good.

At this inspection we found significant improvements had been made in all areas of the service and no breaches of legal requirements were identified. A full staff team had been recruited shortly following our last inspection which included the recruitment to key management roles. This had enabled the registered manager to have support while making and embedding the improvements. New staff had undertaken a new induction period where the ethos of the provider had been made clear and their understanding of all procedures and practices had been checked. Staff had embraced the aims and values of the service and were now providing highly personalised care. Training had been completed by all staff and checked through continuous observation and competency assessments to ensure this had been embedded into staff practice. Staff now understood their responsibilities in providing people with safe and effective care. Robust systems had been implemented to monitor risks to people’s safety. Key risk indicators were monitored and discussed by both the management team and care staff on a daily basis, an action taken in a timely way when needed. This new system had helped staff understand their role and ensured that processes to monitor people’s well-being were embedded into practice and sustainable. People and their relatives commented on the extent to which the service had improved since our last inspection and we observed the positive impact this had made to people’s lives. The management team were highly visible throughout the service. Staff people and relatives felt listened to and their ideas and suggestions had been implemented to improve the service. The manager and provider had worked collaboratively to ensure that systems implemented were sustainable and that the positive culture which had developed was reflected within the care people received.

There was a registered manager in post who supported us during our 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 started their employment at Camberley Manor during our last inspection in November 2017.

There was a positive culture embedded into practice and staff were clear about the person-centred ethos of the service. Quality assurance processes were in place and regular audits of the quality of service people received were completed. The registered manager ensured that prompt action was taken to rectify any shortfalls identified. Staff told us they felt supported by the management team and were able to discuss any concerns openly. Staff worked as a team and communicated well.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of the risks to people’s safety and how to support people to manage risks effectively. Systems were in place to ensure that accidents and incidents were recorded and monitored. This enabled staff to identify any trends in order to minimise the risk of them happening again. Staff were aware of their responsibilities in safeguarding people from potential abuse. Positive relationships had been developed with the local authority safeguarding team and concerns were appropriately reported. The provider had a contingency plan in place to ensure that people’s needs would continue to be met in the event of an emergency or if the building could not be used.

There were sufficient staff deployed to meet people’s needs safely. The service was no longer using a high number agency staff which meant that people were cared for by a consistent staff team who knew them well. People’s needs were responded to in a timely manner and staff had time to spend with people. Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. On-going training and development was now a focus within the service and progression training was offered to staff. Safe recruitment processes were in place to ensure people received support from suitable staff.

Safe medicines practices were followed and people received their medicines in accordance with their prescriptions. Staff competency in managing medicines was assessed and medicines audits were reviewed daily to ensure any concerns were identified and acted upon promptly. People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals where required.

People’s legal rights were protected as staff acted in accordance with the Mental Capacity Act 2005. Staff gained people’s consent prior to delivering care and understood the need to offer choice and respect people’s decisions. People were involved in decisions regarding their day to day care.

People were supported by staff who knew their needs well and provided highly personalised care. People and their relatives told us that staff were caring and treated them with kindness. Detailed assessments were completed prior to people moving into the service to ensure that their needs could be met. Care plans were person centred and contained details of people likes, dislikes and life histories. Staff supported people to maintain their independence and respected people’s privacy and dignity. Care plans contained details of the care people wanted when nearing the end of their life.

People told us they enjoyed the food provided and choices were available. People’s nutritional needs were met and the catering staff were informed of people’s needs and preferences. People’s weight was monitored and appropriate action taken where significant changes were identified. The service followed a food first policy and as a result no one living at Camberley Manor required prescribed food supplements.

There was a range of activities available for people to take part in and people received the support they required to be involved. In addition to planned activities, staff spent time with people individually and ensured that people were able to maintain past hobbies and interests. Resident meetings were held quarterly and people and their relatives were able to make suggestions regarding the running of the service and the food and activities provided. People knew the registered manager who spent time in all areas of the service getting to know people and their relatives.

The provider had a complaints policy and people told us they felt any concerns would be addressed. The registered manager maintained a complaints log which showed that concerns had been responded to. Records were regularly updated to ensure that staff had the guidance they required to meet people’s needs. Records were securely stored.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Camberley Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Camberley Manor accommodates up to 60 people in one building which is divided into three units. One of the units specialises in providing care to people living with dementia, one provides care to people assessed as requiring nursing care and the third units supports people with residential care needs. At the time of our inspection there were 53 people living at the service.

There was no 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. At the time of our inspection an interim manager was in post. On the second day of our inspection we were introduced the newly appointed manager of the service. They told us they intended to apply to register with the Care Quality Commission.

At our last inspection on 1 and 14 June 2017 four breaches of regulations were identified. The concerns found related to insufficient, skilled staff being available to meet people’s needs, risks to people’s safety not being adequately managed, safe medicines practices not being followed, people’s dignity not always being respected and people’s health care needs not being monitored. In addition we made recommendations regarding how complaints processes were managed and the effectiveness of quality assurance systems.

Following the last inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. At this inspection we found that whilst improvements had been made in some areas, there were continued concerns regarding the quality of the service provided to people. We also identified additional concerns regarding people’s safety and the leadership of the service

There was a lack of consistent leadership. There had been numerous changes in the management structure of both the service and organisation which had led to instability within the service. Quality assurance processes were in place but systems were not effectively monitored to ensure they were embedded into practice. Actions arising from audits were not consolidated into an overall action plan to ensure shortfalls in the quality of the service were addressed. The central complaints log did not record all complaints made which meant the service was unable to accurately monitor and identify trends in the concerns raised. Records were not always accurately maintained. Not all care records contained up to date information regarding the care people required.

Safeguarding concerns were not always identified and acted upon. We identified a number of concerns which had not been reported to the local authority safeguarding team to ensure that appropriate action was taken to keep people safe. The local authority told us they had on-going concerns regarding how the service managed safeguarding incidents. Accidents and incidents were not always recorded and tracked to minimise the risk of them happening again.

Risks to people’s safety were not consistently managed well. Although improvements were seen in the way medicines were managed, errors in recording and administration were still occurring. Safe moving and handling techniques were not always used by staff. People’s fluid intake was not effectively monitored and the risk of dehydration had not been identified for two people we observed. In some areas risks were managed well. People received the support they required when mobilising and where people were identified as being at risk of choking appropriate action had been taken.

Staff did not always receive training and supervision in line with provider’s policy. Records relating to the support staff received were not up to date to enable the management team to monitor supervision and training. Staff told us they had received an induction when starting at the service. People told us they had on-going concerns regarding the high level of agency staff used. The interim manager had taken steps to ensure that the same agency staff were regularly used to provide consistency. Recruitment of permanent staff was on-going and the provider told us that following recruitment checks they hoped the service would be fully staffed within the next few months. There were sufficient staff deployed to respond to people’s needs in a timely manner. Safe recruitment processes were in place to ensure staff employed were suitable for their role.

People’s dignity was not always respected. Several people had not received support to clean their teeth and records showed there were a number of incidents of people being found wearing two continence aids. We observed occasions when staff did not interact appropriately with people. On other occasions we found that staff engaged well with people and treated them with kindness. People’s privacy was respected and independence encouraged. People were offered choices regarding their day to day routines and these were respected by staff. People received the support they required with regards to their religious and cultural needs.

Improvements had been made in the meals provided and people had a choice of nutritious food. Staff were aware of people’s dietary needs. People had access to a range of healthcare professionals and appointments were recorded. The principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed to ensure people’s legal rights were protected. People’s needs were assessed prior to them moving into the service to ensure they could be met. Improvements had been made to the way in which the service responded to people’s needs to ensure people were now receiving the care they required. Information regarding people’s wishes when nearing the end of their life was not consistently recorded. We have made a recommendation regarding this.

People lived in a clean and well maintained environment. Staff were aware of infection control procedures and we observed these were followed. Cleaning schedules were in place and all areas of the service were cleaned to a high standard. Maintenance records were up to date and equipment used was regularly serviced. The provider had developed a contingency plan to ensure people would continue to receive care in the event of an emergency.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 19 October 2016. The provider was breaching legal requirements as people's healthcare needs were not always addressed in a timely manner and guidance on specific healthcare needs was not always provided for staff. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach. We undertook an unannounced focused inspection on 1 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements. However, due to additional concerns identified during this inspection we returned to the service on 14 June 2017 to complete a fully comprehensive inspection.

Camberley Manor provides accommodation, nursing and personal for up to 60 older people. The home is set over three floors. The second floor provides care and support for people who are living with dementia. At the time of the inspection there were 52 people living at Camberley Manor.

There was no 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 had left the service in April 2017. At the time of our inspection the service was being managed by a peripetetic manager and regional support manager who supported us during the inspection. We have been informed since the inspection that a new manager has been appointed.

There were insufficient staff deployed throughout the service to ensure people’s needs could be met safely. People’s needs were not always addressed in a timely manner and people requiring supervision were left unattended for periods during in the day.

Risks to people’s safety were not always safely managed as staff did not always have access to guidance to enable them to take appropriate action to protect people.. Where guidance was available staff did not always follow this. Behaviour monitoring forms were not appropriately completed and reviewed by staff to ensure people’s needs were identified and met.

Safe medicines practices were not always followed as medication administration charts were not always completed and stock control was not always effective. Medicines were stored safely. People’s healthcare needs were not always identified by staff and during the first day of inspection we found people requiring nursing care were not routinely seen by a nurse.

People were not always treated with dignity and their privacy was not always respected. Staff were heard to use derogatory language on occasions and not all staff acknowledged people when entering their rooms.

People did not always receive responsive care as staff were not always aware of their needs and care plans did not contain up to date guidance. Records regarding people’s care did not always reflect their needs. People gave us mixed responses regarding the quality of the food provided although the majority of people said they had noticed recent improvements. The provider was working alongside people to address these. concerns.

Complaints received by the service had not always been acted upon. However, systems were now in place and people’s concerns were being responded to. We have made a recommendation that the provider continues to monitor complaints to ensure systems are embedded into practice.

Quality assurance systems were not always effective in addressing concerns and driving improvement. People, relatives and staff told us there had been concerns within the service which they felt were now being addressed by the management team. There was an action plan in place and this was being shared with staff throughout the service. Concerns identified during the inspection were responded to by senior managers in a timely manner. Details of their responses can be found in the main body of the report. We have made a recommendation regarding continued monitoring of the service to ensure timely improvements are made and embedded into practice.

Robust staff recruitment procedures were in place to ensure staff were suitable to work at the service. Induction and training programmes for staff had improved and staff told us they were now receiving the training they required. Staff received supervision to monitor and improve their performance.

Each person had a personal emergency evacuation plan in place and fire systems were regularly checked and maintained. The provider had developed a contingency plan to ensure people would continue to receive care in the event of an emergency.

People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed and staff understood their responsibilities. People were provided choices regarding their day to day lives. People had access to a range of activities and were supported to maintain their hobbies and interest. We observed instances of staff treating people with kindness and people were encouraged to maintain their independence.

In some areas we found risks were well managed and accidents and incidents were reviewed to minimise the risk of reoccurrence. The service had implemented additional measures to identify where people were experiencing pain or infections.

People and their relatives had the opportunity to feed back their views of the service provided through regular meetings and annual questionnaires. Visitors told us they were made to feel welcome and were updated on any changes or concerns regarding their family member’s care.

Staff meetings took place regularly and staff were able to share any concerns with the management team. Staff told us that in recent months communication had improved and they now felt supported by the management team.

There was no 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 and associated Regulations about how the service is run. A manager had been appointed in May 2016 and was in the process of registering with the CQC. They supported us with the inspection on the day and demonstrated a good knowledge of the running of the service.

People had access to a range of healthcare professionals. However, we found that people did not always receive healthcare support in a timely manner which had led to delays in people receiving the treatment they required. People were supported to maintain a healthy diet although people told us the food provided was not always to their liking. We have made a recommendation regarding this.

Prior to starting work at the service recruitment checks were completed to help ensure only suitable staff were employed. We found a number of gaps in staff members’ previous work histories and have made a recommendation regarding this.

There were sufficient staff available and staff were attentive to people’s needs. Staff were able to demonstrate their responsibilities to keeping people safe and were able to describe reporting procedures should they have concerns. Risk assessments were completed appropriately and control measures implemented to reduce the risk of harm. Accidents and incidents were reported and reviewed to ensure that any trends were identified and changes were made to people’s care in order to keep them safe. Medicines procedures were in place and people received their medicines in line with relevant guidelines.

Safety checks on the environment and equipment used were completed regularly. The provider had developed a business continuity plan which meant that people’s care would not be interrupted should an emergency occur.

The provider had implemented systems to ensure that staff were working in accordance with the Mental Capacity Act 2005. Staff were knowledgeable about protecting people’s rights and spent time with people ensuring they gained consent prior to delivering care.

Peoples support needs were assessed before they moved into Camberley Manor. Care plans were person centred and contained detailed guidance for staff on how to meet people’s needs. Staff were knowledgeable about the support people required and their preferences. People were involved in developing their care plans and regular reviews were completed.

People were treated with kindness and respect by staff who knew them well. Staff respected people's choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated. Links had been developed with the local community.

Systems were in place to manage complaints and concerns. People and their relatives had the opportunity give feedback on the service they received and the provider took steps to ensure improvements were made. The provider conducted a range of quality assurance audits to enable them to monitor the quality of the service. Action was taken to address any areas identified as requiring improvement.

People and staff told us they believed the home was well-led. Staff told us they felt supported by the manager and senior staff and were able to discuss any concerns openly. Records showed that staff received regular supervisions to support them in their role. Staff received training and induction prior to starting work and records showed that staff training was regularly monitored and updated.