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 an

The inspection took place on 5 and 10 November 2017. The first day of our inspection was unannounced. Following this we informed the provider we would return to the service within two weeks.

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 effectivel

The inspection took place on 1 and 14 June 2017. The first day of our inspection was unannounced. Following this we informed the provider we would return to the service within two weeks.

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

The inspection took place on 19 October 2016 and was unannounced. This was the first inspection of the service since it had registered with the Care Quality Commission (CQC). Camberley Manor provides accommodation, nursing and personal for up to 60 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 45 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 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 suppo