Camberwell Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection in December 2022, we identified breaches in relation to the management of risks and medicines. The provider had made improvements and was no longer in breach of regulations. The rating of this key question has improved from requires improvement to good during this assessment. Risks to people's safety and well-being had been assessed and plans were in place to mitigate the risks. People lived in a safe environment. Systems and processes were in place to investigate accidents, incidents, complaints, and safeguarding incidents. Staff communicated with and worked in partnership other agencies to help keep people safe. There were systems to help prevent and control infection. People’s medicines were managed safely and they received these as prescribed. There were effective systems in place to safely recruit staff and there were enough well-trained staff on duty to care for people safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives of people receiving care knew how to make a complaint and said that they wouldn’t hesitate to raise concerns with management if the need arose. Most people told us concerns about safety were listened to and the provider was learning lessons from previous incidents to improve the quality of care people received. One person told us, “The management have made themselves available to any concerns I have.” Despite mainly positive feedback, some people did not feel things improved when they raised concerns. One person told us, “I did get quick action when I complained. They acknowledged it and acted. But it falls back a lot.”

Staff told us the manager and their colleagues helped them learn and improve practice when things went wrong. Comments from staff included, “As a team we are trying our best to avoid safety concerns” and “The staff meetings are used to discuss safety issues that have happened so we can all improve.”

Processes were in place for investigating, analysing, and responding to accidents, incidents, complaints, and safeguarding alerts. Staff recorded accidents and incidents when these occurred. The registered manager reviewed incidents to ensure appropriate actions were taken. They also used team meetings to discuss emerging themes with the safety and quality of care.

People and their relatives told us the service worked closely with other agencies and health professionals to ensure ongoing safe care. Comments included, “It is definitely safe. It’s lovely” and “I spoke to the admiral nurses, [registered] manager and assistant manager about the care plan. They are very good on health issues.”

Staff told us there were effective systems in pace to manage risks to people. Comments from staff included, “We read care plans and update them regularly, every month” and “Every care plan is updated as part of resident of the day program. If any changes occur, we will update the care plans so they are reflective of people’s needs.”

We received mixed feedback from partners about systems in place to manage risks. Many professionals felt the provider had made substantial improvements and was operating safe systems. Positive comments included, “The registered manager has worked very hard to ensure her staff and in particular the nursing team have appropriate skills including the ability to escalate unwell residents appropriately” and “We work as an MDT to support the care home and I find that I have a good working relationship with the care team, including the [registered] manager.” Although the overall feedback from professionals was positive some professionals felt there was still room for improvement around managing pressure ulcers and staff understanding of the eating and drinking guidelines from speech and language therapists. One professional told us, “I have raised concerns regarding care plans not being followed and delays in escalation when deterioration of wounds is noticed.”

At the last inspection in December 2022 people were not always protected from the risk of harm as we identified several risks that had not been assessed and/or mitigated by the provider and staff did not always follow guidelines. The provider had made improvements. Risks to people’s health and wellbeing were being assessed and information about guidelines for staff were clear. At the last inspection we found there were persistent issues with pressure relieving mattresses being on the wrong setting which meant people were exposed to the risk of skin breakdown. The provider had made improvements and there were effective systems in place to ensure people’s mattresses remained on the correct setting. At this assessment we also found guidelines from the tissue viability nurse were being followed correctly.

People and their relatives were satisfied staff were keeping them safe from neglect or abuse. We received comments such as, “Yes, they guard us well” and “They definitely keep us safe.”

Staff we spoke with felt confident about reporting concerns. They were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice. Comments from staff included, “Safeguarding is protecting the residents’ health and wellbeing, ensuring they are free from harm or abuse” and “I would report straight away if I thought someone had been harmed.”

We observed people were safe in the home. Staff knew exactly what to do to protect people from harm and abuse. Staff upheld people’s rights.

There were procedures in place to protect people from avoidable harm, abuse or neglect. These provided guidance about the action to take if staff had concerns about the welfare of people. Training records showed staff had completed safeguarding training. The provider was making necessary safeguarding referrals and conducting investigations when required.

Most people and their relatives’ felt risks were well managed in the home, and they were kept informed of safety incidents or significant changes. Positive comments included, “Thankfully there hasn’t been any accidents or falls. No skin issues either. It’s a fabulous place” and “[Family member] had a fall recently and went to hospital. They’re back at the home now. It was reported to me within 15 minutes and documented.” Despite generally positive feedback some relatives did not feel fully consulted about risks and changing needs. One person told us, “I normally speak to the floor manager about any concerns. I’m not always notified, about changes.”

Staff assessed risks to people's health and safety and were able to describe how they supported people to reduce the risk of harm. Comments from staff included, “We read care plans and update them regularly. Every month the care plan is reviewed. If any changes occur, we will update the care plan to ensure they are reflective of people’s needs.” Staff also told us how they helped people if they became distressed. One member of staff told us, “I know when [person] is agitated because they make noises. I sing to them to distract them and do painting and drawing with them which they like.”

We saw staff support distressed people in a calm and empathetic manner which helped reduce their anxiety and distress. Staff explained what they were doing, encouraged people to make choices in their preferred communication method and did not rush them.

At the last inspection in December 2022, we found risks to people’s safety and wellbeing were not always managed well. At this assessment we found the provider had made improvements. Risks to people's safety and wellbeing had been assessed. Risk assessments included a good level of detail about how to reduce the risks. They included personalised information and had been regularly updated and reviewed. Despite evidence of overall improvement we identified 2 people who required an epilepsy care plan/risk assessment. We raised this with the registered manager and they have ensured epilepsy risk assessments and care plans are in place for people who need them.

People lived in a safe environment. People’s rooms were personalised. The lighting, ventilation and temperature were appropriate and met people's needs. People spoke positively about the home environment. Comments included, “The rooms are bright and there are lots of other areas to go to. Also, it’s great that you can personalise their room” and “It is very smart, more like a hotel. They have a separate library, bar area and roof top garden.”

Staff told us they knew how to ensure the environment was safe. One member of staff told us, “The building is new and well-designed. We have a lot of checks in place to make sure anything that goes wrong is identified and resolved quickly.”

There was enough suitable furniture and equipment to meet people's needs and to ensure they were comfortable. The environment was free from clutter or hazards. People had their own bedrooms which were light, personalised and well equipped. There were spacious and welcoming garden and outside terrace areas.

Processes were in place to ensure risks within the environment were assessed and monitored. Management and staff carried out regular checks of the environment and the equipment being used. Fire drills and regular fire alarm tests had been carried out and were recorded appropriately however, all recent fire drills had been conducted during day shifts. We raised this with the provider as it is best practice to conduct fire drills at different times including at night. The registered manager told us they had plans to carry out fire alarm drills at different times to ensure evacuation procedures would be thoroughly tested.

At the last inspection in December 2022 people told us they did not feel there were always sufficient staff on duty to meet people’s needs. People’s experience had improved. We received comments such as, “There always seems to be plenty of staff.” People were generally satisfied with how quickly staff came when people needed them. Comments included, “They come quickly” and “Yes in the main they arrive quickly, sometimes a little wait if they are busy.” People were also confident about the skills and abilities of staff. One relative told us, “The carers are very good, very helpful and knowledgeable on dementia. I can’t fault them.”

Staff told us there were sufficient numbers of staff on duty to safely meet people’s needs. We received comments such as, “The staffing is enough on my shifts at all times” and “If someone calls sick our managers will take effort to make sure enough staff are on duty to cover all residents’ needs.” Staff also told us they received appropriate training and ongoing support to ensure they had skills and knowledge to care for people safely. Comments from staff included, “All the training is useful and interesting because they are what I need to provide the appropriate care for my residents” and “Our home provides every training that is relevant for our job roles.”

We observed that staffing levels seemed sufficient to meet people’s needs. Staff were not rushed and people were not waiting long periods for staff to respond to them.

At the last inspection in December 2022 we found the provider did not always have sufficient staff and the process for assessing staffing needs was not robust. Call bell records also showed people often waited a long time for staff to respond. This was a breach of Regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this assessment we found the provider had made improvements to the process of assessing staffing needs and was no longer in breach of this regulation. The rotas showed there were more staff on duty than the minimum stipulated in the dependency tool. People were supported by staff who had the knowledge and skills required to effectively meet their needs. Records showed that staff had received training in areas relevant to their roles. The provider was following safe recruitment procedures to ensure staff were suitable to work with people who used the service. Checks included obtaining a full employment history, appropriate references, right to work documents and proof of identity and DBS checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff received regular supervision.

Family members told us the environment was kept clean and staff followed good hygiene practices, such as hand washing and wearing protective clothing when needed. One person told us, “They always wear aprons and gloves when attending to people.” A relative said, “My [family member] has been in the home for over a year and it has always been clean and hygienic.”

Staff completed infection prevention and control training and were given the information and guidance they needed to ensure they understood how to maintain safe hygiene. Staff told us they had adequate supplies of personal protective equipment (PPE), and they knew their responsibilities in relation to infection control. One member of staff told us, “Yes we have adequate supply of PPE. Before every shift starts, we will get a new supply of PPE, we all are following our home COVID-19 policy.”

The environment was clean and free from clutter. On the day of the assessment, we saw cleaning staff cleaning communal areas in the home to a high standard.

There were procedures in place for managing and preventing infections. Cleaning staff followed cleaning schedules to ensure all areas were covered. Staff and the manager carried out regular audits of cleanliness to identify any shortfalls.

Most people and their relatives told us staff managed people’s medicines well. Comments included, “The nurse comes around to give the medicines with water. There’s no problems.” People also told us they were consulted about their medicines and kept up to date with any changes. One relative told us, “I had a meeting with the doctor last week to agree the pain relief medication so there’s no problems with pain. I am told about any changes in medication or any health issues.” Despite this a minority of relatives felt they had they were not always informed about changes. One person told us, “I was not informed about any changes in medication.”

Staff spoke positively about the medicines training they had completed. Comments included, “We get regular training and competency assessments.” The registered manager told us they had been working with the senior staff to build on their skills in the oversight and management of medicines.

At the last inspection in December 2022, we found medicines were not always managed safely and there was insufficient staff on duty to give people their medicines in a timely manner. Improvements have been made to the management of medicines and we found good procedures in place to ensure medicines were received, stored and administered safely. This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this assessment we found the provider had made improvements to the management of medicines and was no longer in breach of this regulation. We saw people were given their medicines in a dignified way and were not rushed. There were sufficient staff on duty to ensure staff were not rushed when administering medicines. The medicine administration records (MARs) we sampled were completed correctly. However, we identified that information about allergies was incorrect on some people’s records. There were regular audits of the MARS but these had not identified the incorrect information about allergies. We raised this with the registered manager, and they have resolved the issues we found and incorporated this into the regular audit to ensure this will be regularly checked. There were guidelines in place for when required (PRN) medicines. Stock levels of medicines was also checked as part of the regular audit. The dispensing pharmacy also supported the service by carrying out medicine audits and making recommendations to improve systems and processes with the home.