Archived: Camberwell Green

Is the service caring?

We found that people did not always receive appropriate care following advice and input from a health professional. For example we found that people did not always receive regular repositioning, as recommended in the repositioning charts. This put people at greater risk of developing pressure ulcers.

Care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. For example, people with specific health needs such as diabetes or people with unintentional weight loss, did not have care plans which described the support they required.

People and their relatives told us that staff were busy and there was a quick turnover of staff. The manager had told us that there had been a number of changes in the staff team, and some new staff had been recruited.

Is the service responsive?

We saw that referrals had been made to a social worker for people, meeting their changing care needs. People told us they were sometimes involved in reviewing their plans of care when their needs changed and we saw that following the review appropriate support recommended was implemented. For example a change in the management of their medicines.

Is the service safe?

There were systems in place so staff were able to learn from events such as quality audits. This helped to reduce the risk to people and improved the quality of the care they received.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is the service effective?

People had an assessment of their needs before receiving care and support; from this information individual care plans were developed. Assessments considered people's needs for any equipment, mobility aids and their specialist dietary requirements. Risks associated with people's health and medical needs were assessed and a management plan developed and implemented to minimise them. We found examples where these were not always implemented or reviewed regularly by staff caring for people.

Is the service well led?

People told us that they did not know who to raise or discuss concerns with. One person said, 'There are so many managers here, I don't know who to talk to. I just talk to the staff around, if I need to.'

There were quality assurance systems in place to improve the lives of people. There were regular team meetings to discuss improvements to the service. The home manager regularly met with residents and relatives and changes were made in response to their views, for example, a change in the menu.

The manager had sent notifications to the Care Quality Commission (CQC).

We found that people did not always experience care, treatment and support that met their individual needs or protected their welfare and safety. Although people's needs were assessed, care and treatment was not always delivered in line with their individual care plan. There were enough staff available, but some were insufficiently knowledgeable about people's individual needs to ensure that they were met.

People could not be confident that important events that affect their welfare, health and safety had been reported to the Care Quality Commission (CQC) so that where needed action could be taken. People could not be confident that the provider makes notifications about management changes to the CQC as they are required to do by regulation.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Staff were trained in safer handling techniques and the use of equipment. A training session was underway during our visit.

The home used an electronic medicines management system. Nursing staff told us that they had received training in the system, and they were able to demonstrate how to use it correctly. Systems helped ensure people received their prescribed medicines on time. The electronic system prompted staff when to give medicines, so that no doses were missed, medicines were scanned to ensure that the correct medicines were given.

Staffing levels were appropriate and these were tailored to respond to the needs and number of people using the service. Recently hours were increased and provision was made to extend the activity programme. The home had two activity co-ordinators employed at the service, this ensured that suitable stimulation was provided over seven days at the home.

The majority of comments we received about the service were positive. People told us that staff were "wonderful", that the care was "good" and "they look after us well". Relatives told us that they are informed if there are any problems and they feel confident discussing their concerns with the manager and staff.

On the day we visited recruitment interviews were underway and we were told of plans to create a "bank" of staff who would be prepared to work at short notice. It was anticipated these actions would assist in ensuring a full staff team was available

People who lived at the service told us that they liked the staff who provided care: one person described staff as "so kind". However we also heard that the quality of care was sometimes adversely affected by low staffing levels. One relative said "they are sometimes a bit short of staff". Our observations and findings confirmed this view. We found that people had to wait longer than they would like for assistance with care tasks.

Appropriate arrangements were in place to manage medicines.

We heard that professionals had found errors in care records and this reflected our findings. We found some errors in record keeping including in an assessment of a person's nutritional needs.

We found that people who lived at the service were asked their views but we found that changes were not always made to reflect their wishes.