Cambridge Park - Community Inpatient Unit (CIU)

Cambridge Park Inpatient Unit is a care home registered to provide accommodation, personal and nursing care for up to 52 people who need short term rehabilitation and reablement support to return home or prevent hospital admission across 2 adapted areas within the grounds. At the time of our inspection, 36 people were residing at the service.

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

Information about risks and safety was not always comprehensive or up to date and full information about risks to people's safety was not always communicated to the staff.

Care plans were not always person centred. People and their families were not always involved in decisions about their care and treatment.

A system was in place to monitor the quality and safety of the service, however, this was not always effective in identifying and addressing issues.

Medicines management was not always in line with best practice guidance; medicine administration records were not always fully completed and guidance for staff not always in place.

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 did not always support this practice.

People had support from safely recruited staff. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. The service had enough staff to keep people safe. We observed staff respecting people's privacy and dignity when providing care and support.

Staff had positive links with healthcare professionals which promoted people's wellbeing. Records confirmed the registered manager worked in partnership with stakeholders. We found the registered manager to be open and responsive to feedback. Visiting healthcare professionals told us that the management team and staff worked well with them.

Staff spoke positively about working for the provider. They felt well supported and could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

The home was clean and tidy. Staff have access to and followed clear policies and procedures on infection, prevention and control that met current and relevant national guidance.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 July 2021). 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.

At our last inspection we recommended that the provider reviewed their staffing levels and sought guidance to improve staff training and supervision systems. At this inspection we found the provider had made improvements in these areas.

Why we inspected

We carried out an unannounced inspection of this service on 29 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, medicine management, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cambridge Park Inpatient Unit on our website at www.cqc.org.uk.

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.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, risk management, person centred care and good governance at this inspection. We have also made a recommendation in relation care planning systems and the mental capacity records.

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.

Cambridge Park is a residential care home. The service provides nursing, personal and therapy care for up to 52 people who need short term rehabilitation and reablement support to return home or prevent hospital admission. There were 26 people using the service when we inspected. Accommodation is provided on two floors with en-suite bedrooms and communal areas on each floor.

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

There were shortfalls in how individual risk to people was assessed, managed and kept under review. There were also some shortfalls in the management of medicines and the management and recording of people’s changing care needs. The quality assurance system needed developing at service level so issues could be highlighted and addressed in a timely way.

People and staff gave mixed feedback about staffing levels. The service struggled to maintain a stable staff team. Overall, there were enough staff to meet people’s needs, although the deployment of staff needed review. We have made a recommendation about this. Recruitment systems were safe.

Staff training and supervision had slipped during the pandemic. Some staff said they would benefit from additional courses to develop their knowledge and skills. Staff morale was low, and staff did not feel supported. We have made a recommendation about this.

Staff knew how to protect people from the risk of abuse and harm. The management team monitored accidents and incidents, but analysis was not completed which made it difficult to learn from identifying patterns and trends.

People told us they liked the meals provided; menus offered choices and alternatives to ensure nutritional needs were met. People had access to a range of health professionals, which included dieticians, when required.

The environment was well maintained and clean. Safe infection prevention and control procedures were followed.

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.

People and relatives praised the staff for their kindness and compassion. Staff treated people with respect and maintained their privacy and dignity. People were supported to keep in touch with family and friends through video and phone calls and indoor visits. People had access to healthcare services. People were happy with the choice and quality of the food.

People and relatives knew how to raise concerns and were happy with the action taken in response.

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

Rating at last inspection

This service was registered with CQC on 27 April 2020 and this was the first rated inspection.

The last rating for the service at the previous premises was Good, published on 26 July 2018.

We carried out targeted infection prevention and control inspections on 11 November 2020 and 14 January 2021 to assess the service as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive COVID-19 status. The Local Authority withdrew their application. The service was not rated.

Why we inspected

This was a planned inspection based on the date of the provider’s registration.

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.

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.

We have identified breaches in relation to medicines and the management of risk, person-centred care and governance 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cambridge Park is a residential care home providing rehabilitation support for up to 52 people in one adapted building. The designated care unit on the ground floor has 12 single bedrooms intended for people discharged from hospital who have tested positive for Covid-19.

When we inspected this service on the 11 November 2020 the provider could not ensure a dedicated staff team was in place to provide support to people isolating in the designated unit. There is now a staff cohort assigned to work in the designated care unit.

We found the following examples of good practice

¿ The systems in place allowed people to be admitted to the service safely. Arrangements to provide a separate entrance for the unit and access via a key card system had been put in place.

¿ Staff supervised all essential visitors to ensure social distancing and infection control guidelines were followed.

¿ People could choose to use applications such as video calls to maintain contact with their families.

¿ The environment was very clean. Additional cleaning was taking place which included frequently touched surfaces.

¿ New changing facilities had been provided for staff on the unit. Staff had received appropriate infection prevention and control training. Additional designated PPE stations were in place and staff were wearing PPE in line with government guidance.

¿ Staff monitored people’s healthcare needs closely and were able to seek quick healthcare support when people needed this.

¿ The provider and senior management team had recognised the challenges staff faced during the pandemic. Staff could access counselling support to offload their feelings and support their wellbeing.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Cambridge Park is a residential care home providing rehabilitation support for up to 52 people in one adapted building. We inspected the designated care unit on the ground floor. This unit has 12 single bedrooms intended for people discharged from hospital who have tested positive for Covid-19. There were 10 people living on the unit at the time of our inspection.

We found the following example of poor practice

¿ In the longer term, the provider could not ensure a dedicated staff team was in place to provide support to people isolating in the designated unit.

We found the following examples of good practice

¿ The systems in place allowed people to be admitted to the service safely. Arrangements to provide a separate entrance for the unit and access via a key card system had been put in place.

¿ Staff supervised all essential visitors to ensure social distancing and infection control guidelines were followed.

¿ People could choose to use applications such as video calls to maintain contact with their families.

¿ The environment was very clean. Additional cleaning was taking place which included frequently touched surfaces.

¿ New changing facilities had been provided for staff on the unit. Staff had received appropriate infection prevention and control training. Additional designated PPE stations were in place and staff were wearing PPE in line with government guidance.

¿ Staff were able to seek quick healthcare support when people needed this. Staff monitored people’s healthcare needs closely and were able to seek quick healthcare support when people needed this.

¿ The provider and senior management team had recognised the challenges staff faced during the pandemic. Staff could access counselling support to offload their feelings and support their wellbeing.

We were not assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.