The Cambridge Care Home

The Cambridge Care Home provides accommodation, nursing and personal care to up to 90 older people, some of whom are living with dementia. The service is set over two floors and has various communal rooms and a secure garden available for people to use. At the time of our inspection there were 36 people living at the service.

People’s experience of using this service and what we found

At the previous inspection we found that care was task led rather than focussing on the person. During this inspection we found that not enough improvement had been made. We saw that there was very little staff interaction with people other than when care and support tasks needed completing. People told us that staff did not have time to chat with them and they sometimes had to wait considerable times for assistance. Staff did not always treat people with respect and dignity.

Action had not always been taken to mitigate risks to people. However, a lack of action meant that there was an increased risk to people living at the home. We found no evidence that people had been harmed but further action was needed to ensure people were safe. Procedures were in place to assess if people were at risk of dehydration and/or malnutrition. However, these procedures were not always followed by staff to encourage people to eat/drink more when they had not met their food and drink intake targets.

Not enough improvements had been made since the previous inspection to ensure that people received a good service. The issues we found during this inspection had not been identified by the homes quality monitoring systems. The regional director, registered manager and deputy manager at The Cambridge Care Home had all changed since the previous inspection. The current management team acknowledged the feedback given during the inspection and put plans in place to make the necessary improvements. However, it was too soon for these actions to be embedded.

There was a high use of agency staff in the home however permanent staff were being recruited

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was requires improvement (report published 02 March 2022). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing, safety and the quality of care provided to people. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only. We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Cambridge Care Home on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to reducing risks to people’s safety, treating people with dignity and respect and identifying areas for improvement and making the necessary improvements at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Cambridge Care Home provides accommodation, nursing and personal care to up to 90 older people, some of whom are living with dementia. The service is set over two floors and has various communal rooms and a secure garden available for people to use. At the time of our inspection there were 53 people living at the service.

People’s experience of using this service and what we found

Due to a shortage of permanent staff there was a large proportion of temporary agency staff. This meant there was a risk that agency staff would not understand, or respond to, people’s needs well.

People were not always safe when being supported to transfer with the support of staff. Staff had received training in moving and handling, however safe practices were not always followed. The provider had arranged for all staff to be retrained in moving and handling, and competency assessments to take place by senior staff.

People were not always treated with dignity and respect. There was limited interaction and communication between people and staff.

Concerns had been raised regarding the cleanliness of the service. During our inspection we found the service to be clean and free from clutter. There was an unpleasant odour present in one of the units, however new floors had been arranged to be fitted to address this.

At the time of our inspection a new management team had been appointed and put in place. This was to address the concerns raised and make improvements in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 November 2017).

Why we inspected

We received concerns in relation to the cleanliness of the service, the care provided, and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Cambridge Care Home on our website at www.cqc.org.uk

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• The staff at the service booked in visitors for socially distanced ‘window visits’ and 'garden chats' with people living at the service. The times were spread out and the number of visitors at one time was monitored to avoid potential infection transmission with other visitors. All professional visitors to the home had their temperature checked and had to complete a questionnaire before entering the building. PPE had to be worn.

• Social distancing was difficult for people living with dementia to understand and remember. As such, the registered manager and staff team had looked at different ways to try to keep people as safe as practicable. They said activities had increased to provide distractions and there had been increased cleaning of ‘frequently touched’ surfaces such has door handles and handrails.

• The registered manager also showed us photographs used which showed staff members and how they can be identified with and without a face mask. This was put in place to reassure people who may become anxious due to staffs face masks.

• End of Life ‘compassionate visits’ continued during lockdown. One family member at a time could spend up to twenty minutes [each visit] with their relative in their room. The visitor would be given PPE and access to a ‘comfort basket/box’ designed by the deputy manager that included toiletries and tissues for the visiting relative to use, if needed, during their visit.

Further information is in the detailed findings below.

This comprehensive inspection took place on 24 October 2017 and was unannounced. At the time of this inspection care and support was provided to 84 people. This was the first inspection since the provider Bupa Care Homes Registered as the provider in January 2017.

The provider is required to have a registered manager as one of their conditions of registration.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the CQC 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.

People told us they felt safe and secure living at The Cambridge Care Home. We found that staff were knowledgeable in recognising signs of potential abuse and knew how to report concerns both within the organisation and externally.

Assessments were undertaken to identify any risks to people who received a service and to the staff who supported them. There were enough members of staff available to meet people's individual support and care needs at all times. Care plans were clear and gave staff enough information to meet people's needs

People were supported to maintain good health and had access to health and social care professionals when necessary. People received appropriate support from staff to enable them to take their medicines.

People and their relatives knew how to raise concerns.

People received care and support from a staff team that fully understood people's health and care needs and who had the skills and experience to meet them.

We found that people who used the service were treated with dignity and respect and their privacy was maintained. They were provided with a healthy balanced diet that met their individual needs.

People were involved in the planning of their care and we found that people had access to independent advocacy services. There was an activities programme in place which covered seven days a week.

Safe and effective recruitment practices were followed to make sure that all staff were of good character, and were suitable to work in a care home environment as well as being fit for the roles they were being employed to carry out. Staff records confirmed checks had been made which ensured it was safe for them to work with vulnerable adults before a position was offered to them.

Staff were well supported by the management team and received an induction from senior staff when they first started working at the service. They received on-going training and support to enable them to perform their roles effectively. Staff had regular individual supervision meetings, team meetings and had an annual appraisal to review their development and performance.

There was an effective quality assurance system in place to identify any areas for improvement. Staff and people living in the service were encouraged to be involved in the running of the service and to give their views on any improvements needed.