Cherry Hinton Nursing Home is registered to provide accommodation, nursing, and personal care, for up to 59 people. At the time of our inspection there were 42 older people and people living with dementia at the service. There are a number of communal areas, including a hairdressing salon, lounges and dining areas, a conservatory and a secure garden for people and their visitors to use. The home is situated over three floors, with the ground floor and first floor providing accommodation. There are bedrooms on both floors which can be accessed by either the stairs or a lift. There were communal toileting and wash facilities for people who used the service.

This unannounced inspection was carried out on 18 September 2017. At the last comprehensive inspection on 28 October 2016, the service was rated as ‘requires improvement.’ This was because we found a breach of Regulation 12 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014; Safe care and treatment. This meant that we could not be assured that people would be given their medication safely.

We carried out a focussed inspection on 7 December 2016 due to further concerns raised with the Care Quality Commission. We found that the service had made improvements around the safe management of medicines but was now in breach of the following regulations:

• Regulation 18 Registration Regulations 2009; Notifications of other incidents.

• Regulation 12 HSCA RA Regulations 2014; Safe care and treatment.

• Regulation 13 HSCA RA Regulations 2014; Safeguarding service users from abuse and improper treatment.

• Regulation 17 HSCA RA Regulations 2014; Good governance.

We undertook another focused inspection on 7 April 2017 to check that the provider had followed their plan. During this inspection we were able to confirm that they now met legal requirements.

At this comprehensive inspection carried out on 18 September 2017, we found that the service had continued to make the necessary improvements.

There was no registered manager at the time of this inspection. However, provision had been made as there was an interim manager in post and deputy manager to oversee the day-to-day running of the service. This was until the new manager commenced their employment. A registered manager is a person who has registered with the Care Quality Commission (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.

Staff encouraged people to make their own choices. Staff assisted people in a way that promoted their safety and in the main; people were looked after by staff in a kind and caring manner. Staff were knowledgeable of how to report incidents of harm and poor care. Additional safeguarding training for all staff had been put in place as a result of a recent alleged incident.

People’s privacy and dignity was promoted and maintained by staff. Staff were trained to provide effective and safe care. People were supported to take their medicines as prescribed and safely.

People and their relatives or advocates were involved in the setting up and agreement of their or their family member’s care plans. People’s care records took account of people’s wishes and any assistance they required. Risks to people who lived at the service were identified and adequate plans were put into place by staff to minimise and monitor these risks. However, these plans were not always a detailed record.

People were looked after by enough, suitably qualified staff to support them safely with their individual needs. Where there was a shortfall in staffing numbers, agency staff were used. here was a documented process to determine safe staffing levels in conjunction with people’s assessed dependency needs.

People were supported to eat and drink sufficient amounts of food and fluids. Staff monitored

We carried out an unannounced focussed inspection of this service on 7 December 2016. During that inspection four breaches of the legal requirements were found.

One breach was because the provider had failed to notify the local authority of safeguarding incidents as per safeguarding protocols. Another breach was because people were placed at risk of avoidable harm. The provider had failed to report to relevant external authorities of incidents that affected the safety and welfare of people. The third breach was because there was a failure by the provider to have robust quality monitoring systems in place to enable them to identify where quality and safety was being compromised. The fourth breach was the failure of the provider to notify the Care Quality Commission (CQC) in a timely manner of all incidents that happened within the service that they were legally obliged to do so.

After the focused inspection in December 2016, the provider wrote and told us what they would do to meet legal requirements in relation to the breaches. They said they would meet these requirements by 14 February 2017. We undertook another focused inspection on 7 April 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Cherry Hinton Nursing Home’ on our website at www.cqc.org.uk.

Cherry Hinton Nursing Home is registered to provide accommodation, nursing and personal care for up to 60 people. At the time of our inspection there were 37 older adults, including adults living with dementia living, at the service.

At the time of this inspection there was no registered manager in post. A new manager was working at the service and they were currently applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

At this focused inspection on 7 April 2017 we found that the provider had followed their plan, and legal requirements had been met.

The provider had notified the local authority of any safeguarding concerns as per safeguarding protocols. Staff had received training and refresher training in safeguarding and had an understanding that they had a duty to report concerns around suspicions of harm and poor care.

Applications had been made to the local authority (supervisory body) to lawfully restrict a person’s liberty when the person had been assessed as lacking capacity to make their own decisions.

Risks to people’s health and safety had been assessed and actions identified to mitigate such risks. Incidents that affected the health, safety and welfare of people living at the service were, where appropriate, referred to external healthcare agencies such as the falls team for additional and specialised guidance and support.

There were robust systems in place to monitor and identify areas where the quality and safety of the service provided may be compromised. Actions were in place to respond appropriately to any areas of improvement required in a timely manner.

The CQC had been notified by the provider of all incidents, including safeguarding incidents that they were legally obliged to inform us about.

Although we found that improvements had been made we have not revised the rating for the four key questions: to improve the rating to 'good' would require a longer term track record of consistently monitoring the quality of the service and delivery of high quality care.

We will review our ratings at the next comprehensive inspection.

We carried out an unannounced comprehensive inspection of this home on 19 August 2016. At this inspection we found a breach of the legal requirements. This was because the provider could not assure us that people’s prescribed medicines were being safely managed. We found that detailed records to prompt staff about how, and when, to administer people’s ‘as required’ medicine were not always in place. Staff did not always follow the provider’s policy of recording people’s medicine administration at the time of the person taking it. The reason why covert medicines (medicines disguised in food or drinks) were to be given was not always formally documented within people’s care records.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the management of medicines. We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This inspection was also prompted in part by notification of an incident following which a person who lived at the home died. Information shared with the Care Quality Commission (CQC) about the incident indicated potential concerns about the management of falls. This inspection examined those risks.

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

Cherry Hinton Nursing Home is registered to provide accommodation, nursing, and personal care, for up to 60 people. At the time of our inspection there were 42 older adults, including adults living with dementia living at the home. At this inspection there was an embargo from the local authority in regards to new placements. This embargo was in place due to on-going concerns found at the home.

At the time of this inspection there was no registered manager in post. A new manager was working at the home and they were currently applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

At our focused inspection on 7 December 2016, we found the provider had followed their plan, and was now meeting the legal requirement around the safe management of people’s medicines.

Whilst improvements had been made we have not revised the rating for the key question ‘is the service safe?’ To improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating at the next comprehensive inspection.

We looked at how risks to people’s safety and welfare were managed and found people who lived at the home were not protected from harm. This was because the local authority had not been made aware of all safeguarding incidents and medicine errors that had taken place within the home as per safeguarding protocols.

People were not always safeguarded against the risk of having their freedom restricted in an unlawful manner. The provider had not made sure that applications to the local authority to lawfully restrict a person’s liberty had been made when they had been assessed as lacking capacity.

The Care Quality Commission had not been notified by the provider of all safeguarding and medicine errors that they were legally obliged to inform us about.

The provider did not have systems in place to assess and monitor the quality of the service provided at the home. They had had failed to review and investigate incidents that had occurred at the home which had compromised people’s safety. The provider had not made sure prompt action was taken to remedy incidents such as, recurrent falls and behavioural issues. Referrals to external specialist hea

Cherry Hinton Nursing Home is registered to provide accommodation, nursing, and personal care, for up to 59 people. At the time of our inspection there were 57 older adults and adults living with dementia living at the home. There are a number of communal areas, including a hairdressing salon, lounges and dining areas, a conservatory and a garden for people and their visitors to use. The home is situated over three floors, with the ground floor and first floor providing accommodation. There are accessible bedrooms on both floors by either the stairs or a lift. There were communal toileting and wash facilities for people who used the service.

A previous inspection took place on 2 February 2015 and the service was rated overall as ‘good’. There were no breaches of the Health and Social Act 2008 (regulated Activities) Regulations 2014. However, we found that the provider ‘required improvement’ under the question. Is the service effective? During this inspection we found that the provider had made some of the improvements required.

This unannounced inspection took place on 19 August 2016.

There was no registered manager in place during this inspection. A new manager was working in the home and they were currently applying to become the registered manager. 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Applications were still in the process of being made to the local authorising agencies to lawfully restrict people’s liberty where appropriate. Staff were able to demonstrate a basic understanding of the MCA and DoLS to reduce the risk that people would not have their freedom restricted in an unlawful manner.

Plans were in place to minimise people’s identified risks and to assist people to live as independent and safe a life as possible. We found that records were in place for staff to monitor people’s assessed risks. However, we noted that that records were not always completed accurately by staff.

Most people were supported by staff in a respectful and kind way. We saw that there were lots of positive interactions between staff and people. However, there were missed opportunities for staff to fully engage with the people they were assisting and not all staff were caring to the people they were supporting.

Arrangements were in place to support people with their prescribed medicines. However, we could not be confident that people received their medicines as prescribed. Information on why a person’s medicine could be administered covertly was not always recorded and ‘as required medicines’ did not have robust protocols in place as guidance for staff. People’s medicines were stored and disposed of appropriately.

When required, people were referred to and assisted to access a range of external healthcare professionals. People were supported to maintain their health and well-being.

People’s support and care plans gave prompts and guidance to staff on any individual assistance a person may require. They included the person’s wishes on how they were to be supported and their likes and dislikes. An activities co-ordinator and staff assisted people with their interests and activities and promoted social inclusion. People’s family and friends were encouraged to visit the home and staff made them welcome.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, competency checks and appraisals. This was to make sure that staff were deemed comp

This unannounced inspection was carried out on 02 February 2015. The previous inspection took place on 16 July 2014, during which we found no breach of the regulations that we looked at.

Cherry Hinton Nursing Home is registered to provide accommodation and personal care, including nursing care, for up to 59 older adults and adults living with dementia. There were 53 people living at the home at the time of this visit. There are a number of communal areas, including lounges and dining areas, conservatory and a garden for people and their visitors to use. The home is situated over three floors, with the ground floor and first floor providing accommodation and communal rooms for people who used the service. Two guest rooms with en-suites were set aside to enable relatives to spend extended periods of time with their family members receiving end of life care.

There was a registered manager in post. 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Staff were not always aware of the key requirements of the MCA 2005 and DoLS.

People who lived in the home were assisted by staff in a kind way that also supported their safety. People had individual personalised care and support plans in place which gave prompts to staff about people’s preferences, choices, needs and wishes.

Risks to people were identified by staff and plans put into place to minimise these risks and enable people to live as safe life as possible.

There were arrangements in place for the safe storage, management and administration of people’s prescribed medication.

Staff supported people in a caring way. People were supported to maintain a nutritional diet. People’s nutritional health and well-being was monitored by staff and any concerns acted on.

There were a sufficient number of staff on duty during this inspection. Staff were trained to provide effective care which met people’s individual support needs. They understood their role and responsibilities and were supported by the registered manager to maintain their knowledge and skills by supervision, appraisals and training.

People were able to raise any suggestions or concerns that they might have with staff members or the registered manager.

Staff told us that there was an open culture within the home and they were aware of the services ‘values’.

There was a quality monitoring system in place to identify areas of improvement required within the home. Where improvements had been identified there were action plans in place which documented the action taken.

An adult social care inspector carried out this inspection on 16 July 2014. The focus of the inspection was to answer the five key questions we always ask; Is the service effective ? Is the service caring ? Is the service caring? Is the service responsive? Is the service well led?

As part of this inspection we spoke with six people who used the service, eight relatives, a range of healthcare professionals who had regular contact with the home including: contracts monitoring officers from the Local Authority, Cambridgeshire County Council care managers and safeguarding leads, two GPs, a psychologist, discharge planning staff from Addenbrookes Hospital and a local hospice, Tissue Viability nurses and a manager from the Complex Care Placements team. We also spoke with the manager, deputy manager, operations director and six members of care staff. We reviewed records relating to the management of the service which included five people’s care plans, daily records, medication records, safeguarding procedures, training records and quality assurance monitoring records and the service’s complaints’ procedures.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

Is the service safe?

Risk assessments regarding people’s individual care and support needs were carried out and arrangements were in place to minimise any potential dangers as much as possible. People’s medicines were safely stored and administered. Staff understood their roles and responsibilities in making sure people were protected from the risk of abuse and were up to date with safeguarding training and accompanying reporting procedures. The premises were well maintained and met the personal preferences and needs of people living in the home.

Is the service effective?

We saw that people’s needs had been assessed and their preferences regarding how they wished their care to be delivered had been recorded. Observations we made during our inspection confirmed that the people using the service were assisted to make choices regarding how they wished to spend time during the day. People’s complaints were effectively responded to and in a timely manner. The care staff we met were knowledgeable about people’s individual care and support needs and they had also received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) so that appropriate arrangements were in place so that people who could not make decisions for themselves were protected.

Is the service caring?

Observations made during our inspection showed that people received warm, consistent and respectful support from care staff and they were enabled to make choices and changes when required. One person told us, “I am happy living here and the staff are kind and help me with what I need.” Staff told us that they were well supported and supervised by the manager and senior staff so that they could provide safe care and support to people.

Is the service responsive?

We saw that people’s personal care and social support needs were assessed and met. This also included people’s individual choices and preferences as to how they liked to be supported. We observed and saw from the records that people could make changes to their support and had been involved in the regular reviews of their support plans as much as possible.

Is the service well led?

The home was effectively managed and staff told us that they felt well supported and were regularly trained to safely provide care and support. Observations made during our inspection showed that staff were friendly and attentive so that people were supported consistently and safely. Health and safety checks were in place to monitor the services provided. The service gathered opinions from people who used the service, healthcare professionals and staff to identify any improvements that could be made.

We found that the provider was compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

People that we spoke with during our inspection visit on 3 April 2013 were positive and satisfied with the care and support they received whilst living in the home. They made comments such as, “The staff are very kind and help me with what I need during the day.” People felt that they could talk to the manager and staff whenever they wanted to sort out any concerns.

Care and support had been regularly reviewed to ensure that people’s needs were met. There was evidence of people’s involvement in the planning of their care and support.

There were safeguarding policies and processes in place. It was noted that improvements had been made to ensure that the Local Authority’s safeguarding policies and contact information were available to people living in the home, their relatives and all staff.

There were appropriate arrangements in place for the safe administration and storage of medication.

There were thorough recruitment procedures in place to ensure that only staff who were suitable to work with vulnerable people were employed.

The home had an effective system to deal with complaints from people who used the service. People and their relatives regularly had access to the manager and staff to resolve any concerns that they had.

People that we spoke with were satisfied with the care and support they received and commented that, “The staff are kind and helpful”. Relatives that we spoke with were positive about the care provided. However, one relative did raise a concern about their relative’s dietary needs which they had raised with the manager of the home. Care and support was well delivered to people but some improvements were needed to the care planning documentation to ensure people’s needs were accurately recorded.

Staff received training regarding safeguarding people but improvements were needed regarding safeguarding procedures and information to ensure that any incidents were reported accurately,

Staff received ongoing training during the year but arrangements regarding formal supervision needed improvement to ensure that staff received support for their role

Quality assurance procedures were in place to monitor the standard of the service and ensure people’s safety and one person commented that, “I can speak to the staff if I am not happy and they are very helpful”.