Cambridge 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.

Cambridge Manor accommodates up to 88 people in one adapted building over three floors. The ground floor cared for people that require residential and some nursing needs. The first floor care for people who were living with dementia. The top floor is for people who require nursing care.

We inspected the home on 14 November 2017. The inspection was unannounced. There were 82 people living in the service on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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.

In November 2015 we conducted a first comprehensive inspection of the home. We rated the service as ‘good’. At this inspection we found the service remained ‘good’.

There were sufficient staff to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.

Good infection control procedures were in place. Staff understood their responsibility in ensuring the home was clean and were using the correct equipment.

There was a friendly, relaxed atmosphere and staff were kind and attentive in their approach. People were provided with food and drink of good quality that met their individual needs and preferences.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

Staff supported people to make everyday decisions in the least restrictive way possible. The policies and systems in the service supported this practice. Staff respected people's privacy and dignity and encouraged people to be as independent as they could be.

People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.

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

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. We found that people who lived at the service and their visitors/relatives were encouraged to share their views and give feedback about the quality of the care and support provided.

Cambridge Manor Care Home provides nursing and personal care for up to 88 people, some of whom are living with dementia. The home is over three floors. There are a number of communal areas for people and their visitors to use. There were 71 people living at the home on the day of our inspection.

There was a manager in place. Although they are registered with CQC, they are not registered at this location. 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.

During the previous comprehensive inspection on 30 May 2015, we found the provider was not meeting all the regulations that we looked at. We found that there were breaches of five of the regulations and these were in relation to consent, respecting and involving people who use the service, staffing, assessing and monitoring of the quality of the service and records. The provider wrote and told us of the actions that they would take to ensure that the regulations were met. During this inspection we found that all these regulations had been complied with.

This unannounced inspection took place on 3 November 2015.

.

Systems were in place to meet people’s needs effectively and safely. Staff were aware of the procedures for reporting concerns and protecting people from harm. Staff were only employed after the provider had carried out satisfactory pre-employment checks. Staff were trained and were well supported by their managers. There were sufficient staff to meet people’s assessed needs.

The CQC monitors the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We found people’s rights to make decisions about their care were respected. Where people were assessed as not having the mental capacity to make decisions, they had been supported in the decision making process. DoLS applications were in progress and had been submitted to the authorising body.

People’s health, care and nutritional needs were effectively met. People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines appropriately and medicines were stored in a safe way.

People received care and support from staff who were kind, caring and respectful. Staff respected people’s privacy and dignity. People, their relatives, staff and other professionals were encouraged to express their views on the service provided.

People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People, and their relatives, were involved in their care assessments and reviews. Care records were detailed and provided staff with specific and detailed guidance to provide consistent care to each person, that met their individual needs. Changes to people’s care was kept under review to ensure the change was effective. Staff supported people to take part in hobbies, interests and activities of daily living. There was a varied programme of group and one to one activities available to people.

The manager was supported by senior staff, including qualified nurses, care workers and ancillary staff. People, relatives and staff told us the home was very well run and that staff in all positions, including the manager, were approachable. People’s views were listened to and acted on.

People told us that they were happy living in the home and that they felt safe there. We were told that the staff are wonderful and there needs were met and their independence was promoted.

The care records we looked at included detailed information on how people’s needs were to be met. Risk assessments were appropriately included for areas such as use of bed rails, moving and handling and falls.

Staff understood how to protect people from abuse and what to do if they suspected any abuse had occurred.

Staff received appropriate training and the recruitment procedures were comprehensive. Appropriate checks had been conducted prior to a person commencing employment.

During our inspection on 18 January 2013, we spoke with 12 people who lived in the home, the manager, the deputy and six staff. People told us they were involved in the planning of their care and the reviews of their care plans. We saw that staff encouraged and supported people to be independent. One person told us, "It’s a marvellous place here." Another said “I will give it ten out of ten.”

We observed staff supporting people in a kind and calm manner. Communication was positive and staff spoke respectfully with people. Staff told us they very much enjoyed working at the home and felt well supported and were offered lots of training to carry out their roles in supporting people to meet their health and care needs. The provider may find it useful to note that we saw one member of staff who did not knock on one persons bedroom door and another who carried out an incorrect handling technique. However the nurse on the unit dealt with this immediately.

The organisation had systems in place to monitor the quality of the service provided and action had been taken to address any issues that were highlighted as needing improvement.

The Registered Manager noted in this report is no longer at this service.

People who we spoke with during our visit on 19 July 2012 expressed their satisfaction with the care they were being given.

We spoke with the relatives of five people, who told us that, “The home has improved and got much better recently, thanks to the new manager who has an open door policy and who I feel I can speak to at any time. This has made a great difference and I feel my relative is better cared for now." Two other relatives said, "We are very pleased with the care. I know that the care staff are busy but they seem to manage and provide good care”.

When we visited on 14 June 2011 we spoke with people living at the home. People were generally satisfied with the care provided and said that most care staff knew what care to provide and we received positive comments about the care provided to them and comments made included, ”I have nothing to complain about and the care workers all know what they are supposed to do."

We were also informed that some people were not being provided with care by two care workers, when they had expected two care workers to assist them, although this was not the same for everyone. Some people said that there were not enough staff available and that they had to wait a long time for care staff to assist them. Comments made included: "There are so few care staff and I have to wait a long time"; " My care is mostly good. The care staff are all different. I need two carers to get me up and there are always two carers".

A visiting relative said," I would give the home eight out of ten." One person showed us that the electric call alarm system in their room, was not within their reach and showed us that they were also unable to operate their hand held buzzer that is used to call for the attention of care staff.

People told us they felt safe but had not been provided with any information about safeguarding by the service and knew nothing about a system being in place to protect them from harm.

During the two days of this inspection we spoke at length with six people who lived at Cambridge Manor and with five relatives. We spent time observing the way staff cared for people who could not talk with us about their experiences.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found.

Is the service safe?

People told us they felt safe at Cambridge Manor Care Home. One person said, “No-one will hurt me or shout at me. I feel safe.” The provider had a system in place to protect people from abuse. Staff had undergone training in protecting vulnerable adults from abuse (safeguarding) and they were able to demonstrate that they would recognise if abuse was taking place. All the staff said they would report any safeguarding concerns to the nurses, senior staff or the manager. Most of the senior staff were aware of external agencies to report any allegations to, such as the local authority’s safeguarding team and CQC.

People we spoke with liked the staff and said they felt safe with them. One person told us that nursing students worked at the home during their course. They said, “They’re very good. They handle you with confidence and you feel safe in their hands.” Assessments of any potential risks to people had been carried out and guidance had been written for staff so that they would know how to minimise any identified risks.

Prior to the inspection we had had concerns raised with us, from three different sources, which included that the home was short of staff. Some of the staff we spoke with said there were enough staff, but some staff and the majority of people and their relatives told us that the home was often short staffed. One person said, “Staff are wonderful but there’s not always enough staff.” This could put people at risk of not receiving the care they needed.

We found that some of the record keeping was poor. Charts, put in place to record the care people received, had not been fully completed by staff. This meant we did not know whether or not people had received care according to their care plans.

Assessments of people’s capacity to make decisions, as required by the Mental Capacity Act 2005, had not been recorded correctly. We saw that some decisions had been made on people’s behalf, by their GP, staff at the home and/or their relatives, with no record of whether each person had capacity to make those decisions themselves. This meant that people’s rights were not always protected.

Is the service effective?

People we spoke with told us they liked living at Cambridge Manor Care Home. One person said, “I’m happy, I’m comfortable, they’re very good to me.”

Some relatives were also very enthusiastic about the service provided. One relative told us, “It’s an amazing place. My dad got wonderful care so my mum wouldn’t go anywhere else” and another said, “It’s a brilliant place. I love it. I’ve recommended it to quite a few people”.

However, some of the people and relatives we met told us there were some aspects of the service provided that they were less happy with. For example, one relative was waiting for a response to a number of issues they had raised about the care of their family member. The manager told us she was aware of this and was dealing with the complaint within the relevant timescales.

Care plans we read gave detailed guidance to staff about the care that each person needed, and the way in which they preferred their care to be delivered by the staff. However, staff told us they did not get time to read people's care plans and relied on verbal handovers from the nursing staff. This presented a risk that staff could be inappropriately supporting people because handovers would not cover every aspect of each person’s needs. Although electronic records had been reviewed and updated, paper copies of the care plans, which a senior member of staff told us were available for people, their relatives and staff, had not been updated, in some cases for 10 months.

Is the service caring?

We saw that the staff spoke very kindly to people and showed compassion and empathy. People told us they liked the staff and made comments including, “The permanent staff are very very good” and “The staff are not too bad at all. They allow me to be independent.” Another person said, “Staff are caring but they’re rushed off their feet.” One relative said, “My [family member] always looks comfortable and well cared for.”

On the first day of our inspection we observed one member of staff trying to assist seven people, all of whom were living with dementia, with their meal. This was not a pleasant, comfortable or dignified experience for the people involved.

Is the service responsive?

People’s needs were assessed before they were admitted to the home, and a care plan developed to meet each person’s individual needs. The care plans were reviewed monthly, or more frequently if required, to make sure that the planned care and support was meeting the person’s changing needs.

We saw that people’s health needs were monitored, as staff ensured that people had access to other healthcare professionals such as their GP, dietician, optician and chiropodist.

People and their relatives were given opportunities to express their views about the running of the home.

Is the service well-led?

Some people we spoke with spoke highly of the manager and told us they would talk to the manager if they wanted to raise any concerns. One person said, “The manager is extremely good and efficient.” However, a number of other people told us they did not know who the manager was.

The provider had a system in place to make sure that the service delivered to people by the staff was of a high standard. This included a number of audits of different aspects of the service, carried out by employees of the provider who were independent of the home, and by the home’s own staff. However, although the quality audit had identified some of the shortfalls we found on the days of the inspection, such as the lack of sufficient staff in one area of the home, and the poor quality of some of the records, the improvement plan that had been put in place had not resolved the issues. This meant that the quality assurance system was not effective.

We found that the provider was not compliant with some of the regulations in the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.