Camberley Manor

Updated 18 August 2018

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 2014.

The inspection took place on 14 June 2018 and was unannounced. The inspection was carried out by two inspectors, a nurse specialist and an expert by experience. The nurse advisor specialised in the care of older people. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed records held by the Care Quality Commission which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the registered person is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection. We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

As part of our inspection we spoke with 12 people who lived at Camberley Manor and observed the care and support provided to them. We spoke with five relatives, nine staff members and the registered manager. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a variety of documents which included the care records for eight people, three staff files, medicines records, complaints and compliments, quality audits and various other documentation relevant to the management of the service.

Updated 18 August 2018

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.