Carmel Care & Support Limited Camborne was rated Requires Improvement following a focused inspection of Safe, Effective and Well-led, with breaches of Regulation 12 identified in relation to unsafe medicines management and inadequate risk documentation. Significant management instability, failure to operate settings as true supported living environments, and lack of compliance with the Mental Capacity Act compounded the concerns, though the newly appointed manager showed early promise and staff were caring and committed.
Concerns (10)
criticalMedication management: “Medicine administration records had not been accurately completed and staff had not been provided with clear guidance on the use of 'as required' and emergency medicines.”
criticalMedication management: “We found multiple examples in all 3 settings where there were unexplained gaps in MAR charts.”
criticalConsent / capacity: “Staff and managers did not fully understand their roles in assessing people's capacity to make specific decisions.”
criticalConsent / capacity: “Where people lacked capacity...restrictions to people's freedoms were in place...this information had not been appropriately reported to the local authority.”
moderateCare planning: “People's care plans were incomplete and missing information on how to manage risks, including in relation to mobility needs and specific medical conditions.”
moderateGovernance: “The service is required to have a registered manager but there was no registered manager in post at the time of this inspection.”
moderateLeadership: “"We've had an insane high management turnover", "Management has been a mess" and "There has been a lot of management change, I think I am on my 4th or 5th manager".”
moderatePerson-centred care: “2 of the 3 settings inspected were operating as if they were care homes as opposed to supported living settings...Rolling staff rotas...restricted people freedoms and choices.”
moderateRecord keeping: “Handwritten amendments and changes to MAR had not been countersigned to ensure the accuracy of the information transcribed.”
minorSupervision / appraisal: “"I have had supervisions" and "[The new manager] has done supervisions, I had not had one before".”
Strengths
· Staff were dedicated, caring and kind, with relatives confirming confidence in people's safety and wellbeing.
· Staffing levels had recently improved with safe staffing levels consistently achieved across all 3 settings.
· Staff training was regularly refreshed and updated, and induction procedures including the Care Certificate were in place.
· Accidents and incidents were accurately documented, reviewed by managers, and learning shared with staff.
· Infection prevention and control procedures were appropriate with PPE used in accordance with current guidance.