This inspection took place on 9 and 10 January 2018 and was unannounced.

Cambridge Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cambridge Court Care Home is located in Waterloo in Liverpool. It has 54 bedrooms some of which have en-suite facilities. The home has been refurbished to a high standard but still requires additional refurbishments in some parts of the home. The home provides 24 hour long term care, respite residential care and care for residents with nursing and dementia care requirements. Accommodation is located over three floors with access to all areas of the home by a passenger lift. During the inspection there were 39 people living in the home.

When we carried out a previous inspection in December 2016 we found the service was rated ‘requires improvement’ in safe, effective and well-led with an overall rating of ‘requires improvement’. This inspection looked to see whether improvements had been made to ensure the provider was meeting the fundamental standards of 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.

During the inspection we observed the care home to be generally clean and free from odours. Whilst there were a few areas that required refurbishment the manager informed us that this was part of their business plan and changes were due to be made. People living in the home were observed to be well cared for, clean and happy.

During the last inspection the feedback we received about staffing levels was mixed, however during this inspection we found that appropriate staffing levels were in place and staff felt happy with the number of staff on duty. The registered manager had appointed new permanent care staff in order to ensure that adequate numbers of staff were provided on each shift.

The last inspection that was carried out in December 2016 found that arrangements were in place for checking the safety of the environment and equipment, however there was no evidence that bed rails or window restrictors were routinely checked. During this inspection we found that improvements had been made and there was evidence of regular safety checks being carried out.

During the previous inspection it was observed that best practice was not always implemented in relation to moving and handling. However during this inspection it was identified that most staff had received appropriate training both on-line and practical and during observations it was evidenced that safe procedures were being followed.

We observed a member of staff administering medications and checked records, stock, storage arrangements and audits and found that medicines were managed and stored safely.

Staff were aware of different types of abuse and how to report safeguarding incidents. Those that were reported had been done so appropriately. They were also aware of the whistleblowing policy. Staff were able to explain how to keep residents safe from abuse. People’s individual risks were appropriately assessed and reviewed in order to keep people safe.

Six staff recruitment files were checked and found to reflect safe recruitment processes. Each file contained an application form with detailed employment history, photographic identification, references and evidence of DBS checks.

The home had a robust approach to the recording and monitoring of incidents and accidents. The records that we saw detailed and showed evidence of review and analysis by the registered manager.

People t

This comprehensive inspection took place on 20 and 21 December 2016 and was unannounced.

Cambridge Court Care Home is located in Waterloo in Liverpool. It has 55 bedrooms some of which have en-suite facilities. The home has undergone a recent refurbishment. The home provides 24 hour long term care, respite residential care and care for residents with nursing and dementia care requirements. At the time of the inspection, there were 46 people living in the home.

When we carried out an unannounced comprehensive inspection of this service in May 2016, breaches of legal requirements were found and the service was rated as, “Inadequate.” After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches. We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they had made improvements and now met legal requirements.

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.

This service was last inspected in May 2016. During this inspection we found the provider was in breach of regulations relating to safeguarding, safe care and treatment, the safe management of medication, fit and proper persons employed, staffing, consent, dignity and respect, person centred care, governance of the service and submitting notifications. The overall rating for this service was ‘Inadequate’. The provider sent us an action plan to advise what actions they would take to improve the quality of the service and we reviewed this as part of this inspection. We found that improvements had been made and the provider was no longer in breach of these regulations.

In May 2016 we found the provider to be in breach of regulation regarding staffing levels within the home. During this inspection our observations showed there were adequate numbers of staff on duty; however the feedback received from people was mixed. The provider had reviewed staffing levels since the last inspection and created two supernumerary deputy manager roles and developed more structure as to how staff were deployed. We discussed this with the provider who told us they would continue to look at ways of improving people’s experiences. The provider was no longer in breach of this regulation.

At the previous inspection in May 2016, we found that not all incidents that should had been referred to the safeguarding team for investigation had been and not all staff had received training in relation to safeguarding. During this most recent inspection, we found that staff had a good knowledge of safeguarding and referrals had been made appropriately. The provider was no longer in breach in this regulation.

During the last inspection, we found that CQC had not been notified of all events and incidents that occurred in the home. At this inspection we found notifications had been made appropriately. The provider was no longer in breach of this regulation.

In May 2016 we found that risk assessments did not always contain sufficient information as to how risks would be managed. At this inspection we found that risk assessments were in place to assess specific risks to people and measures were put in place to minimise these risks. The provider was no longer in breach of this regulation.

We found that medicines were not always managed safely at our last inspection, however during our most recent inspection we found that this had improved and medicines were ordered, stored and administered in line with current guidance. The provider was no longer in breach of this regulation.

At the last inspection, we found that risk assessments had not been complet

This comprehensive inspection took place on 4, 10 and 11 May 2016 and was unannounced.

Cambridge Court Care Home is located in Waterloo in Liverpool. It has 55 bedrooms some of which have en-suite facilities. The home has undergone a recent refurbishment. The home provides 24 hour long term care, respite residential care and care for residents with nursing and dementia care requirements.

At the time of the inspection, there were 50 people living in the home.

We carried out an unannounced comprehensive inspection of this service on 7 September 2015 and breaches of legal requirements were found and the service was rated as, “Requires improvement.” After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches. We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements.

There was no 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 staff we spoke with had a good understanding of safeguarding processes. We found however, that not all incidents that should have been reported to safeguarding had been.

Risk assessment’s had been implemented for people who were unable to use their call bell, however we found that they, and other risk assessments, lacked detail as to how risks would be managed for people.

People told us they received their medicines when they needed them, but we found that medicines were not always managed safely within the home.

Safe recruitment practices were not always followed to ensure staff were suitable to work with vulnerable people. We found that there were not always sufficient numbers of staff on duty to meet people’s needs effectively. Some people told us they had to wait for support at times.

People told us they felt safe living in Cambridge Court. We found the home to be cleaned and well maintained.

As identified at the last inspection, not all staff had been supported in their role through induction, training and annual appraisals, however staff received supervision regularly and felt well supported.

Deprivation of Liberty Safeguards had been applied for appropriately but conditions within the authorisations were not always met. When people lacked capacity to consent, principles of the Mental Capacity Act 2005 were not always followed.

People living in the home were supported by staff and external health professionals in order to maintain their health and wellbeing.

Feedback regarding meals was mostly positive, though we were told food was not always hot.

The storage of people’s private records had improved since the last inspection, but we found that they were not always stored securely.

People told us they were treated with dignity and respect and that staff were kind and that their religious and cultural needs were met by staff.

We were told that independence was not always promoted and staff did not always communicate with people effectively when providing support.

We found people had choice with regards to their daily routine; however preferences regarding care and treatment were not always met.

There was a lack of activities available for people to participate in and an activity co-ordinator was being recruited.

There were people living with dementia in Cambridge Court and the environment had not been adapted to promote their independence or assist with orientation.

Records showed that most people and their family had been involved in the creation of their care plans and that plans were reviewed regularly. Not all care files however, provided sufficient detail to ensure staff had appropriate gui

This unannounced inspection of Cambridge Court took place on 7 September 2015.

Cambridge Court Care Home is located in Waterloo in Liverpool. It has 59 bedrooms some of which have en-suite facilities. The home has undergone a recent refurbishment. The home provides 24 hour long term care, respite residential care and care for residents with nursing and dementia care requirements.

A registered manager was not in post. A manager had been appointed and commenced in post and they had applied to Care Quality Commission (CQC) as the registered manager and this application was in process. 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 living in the home and relatives we spoke with told us they felt the home was a safe place to live. One person told us, “I’m safe yes, staff treat me well.”

Not all staff had received safeguarding training to enable them to identify and respond appropriately to potential allegations of abuse. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not always stored securely though procedures were in place to ensure safe administration of medicines. People we spoke with told us medicines were managed well.

Staff recruitment checks were completed prior to employment, to ensure staff were suitable to work with vulnerable people. Staff did not have the required photographic identification held within their personnel files.

Our observations showed people were supported by sufficient numbers of staff who completed regular checks to ensure people’s safety, comfort and wellbeing in accordance with individual need. People told us there were mostly sufficient numbers of staff available to support them.

We saw risk assessments in areas such as falls, nutrition, mobility, pressure relief and use of bed rails. However, risk assessments were not always in place to identify potential risks, such as not having access to a call bell. There was no guidance regarding what actions staff should take to minimise risks and protect people’s safety and wellbeing.

Systems were in place to maintain the safety of the home. This included health and safety checks of the equipment and building.

Staff felt well supported and able to carry out their role effectively; however personnel files did not reflect this. Staff did not receive an annual appraisal and had not received a comprehensive induction to ensure they had the skills and knowledge to fulfil their responsibilities.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing. People told us a doctor would be contacted if they were unwell.

We saw that procedures were not in place to ensure that people’s liberty could not be restricted unlawfully in line with the Deprivation of Liberty Safeguards (DoLS). It had not been assessed as to whether an application for DoLS was necessary.

People’s consent was not always sought regarding their care and treatment. Decisions made in line with the Mental Capacity Act (2005) were not always clearly recorded in people’s care files. We made a recommendation in the main body of the report regarding this.

People’s nutritional needs were assessed and monitored and referrals to appropriate healthcare professionals were made if necessary. People we spoke with gave positive feedback regarding meals and told us there was always a choice of meals available that met their nutritional needs and preferences.

The environment had not been adapted to promote independence for people living with dementia. We made a recommendation in the main body of the report regarding this.

We observed positive interactions between staff and people living at Cambridge Court. Staff were mainly warm, kind and caring when interacting with people and people told us staff looked after them well.

We observed that records containing people’s personal information were not always stored securely. We made a recommendation in the main body of the report regarding this.

People’s preferences regarding their care were not always met.

There were a number of relatives visiting on the day of inspection. People told us visitors were always welcomed in the home, encouraging people to maintain relationships.

People’s care files had a personalised plan of care which contained detailed information regarding people’s care needs. Care documents showed regular reviews had been completed, with any changes in people’s needs being clearly recorded, to ensure staff had up to date information about the needs of everyone living at the home.

An activities co-ordinator was employed by the service and they regularly supported people to go out of the home in the mini bus, which people told us they enjoyed.

The home had a policy and procedure for managing complaints which was available to people within their service user guides. People we spoke with told us they felt able to speak to staff and were confident they would be listened to.

We received positive feedback regarding the management of the home. People told us communication was good between staff and relatives.

We saw that there were a range of audits (checks) completed, including areas such as medicines, care plans, fire safety, infection control, nurse call bells, mattresses and health and safety to ensure the quality and safety of the service provided. However, they were not always effective and had not picked up on some of the concerns we identified during this inspection.

Arrangements were in place to seek the opinions of people and their relatives, so they could provide feedback about the home. These included resident’s and relative’s meeting’s and quality assurance surveys.

We found some incidents had occurred which should have been reported to CQC as legally required but had not.

You can see what action we told the provider to take at the back of the full version of the report.

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?

This is a summary of what we found -

Is the service safe?

We observed people who lived at the care home being treated with respect and spoken to in a patient manner. All staff members had undergone comprehensive training in safeguarding procedures and those we spoke to were fully conversant with the needs of those people they were caring for.

The recruitment process at Cambridge Court was robust and thorough with all new employees required to undergo the required security checks before being allowed to commence work at the home. All agency staff had provided proof of their eligibility to work in a care environment and the provider insisted the same agency staff members were used when required, which provided a continuity of care to those people living in the home. These procedures ensured the safety of all people at the care home.

The care home was safe, clean and hygienic. Regular internal and external audits related to infection control, the handling, disposal and administration of medication and waste management ensured all people living at the care home were kept safe.

The care home had proper policies and procedures in place related to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards which become relevant when people living at the home may lose capacity to make informed decisions for themselves. No recent applications had been made but staff members were aware of when an application should be made and how to submit one which safeguarded all people at Cambridge Court.

Is the service effective?

All people at the care home had received a pre-admission assessment which was aimed at ensuring the provider could meet their required needs and wishes. We observed care plans and regular risk assessments were signed which showed the person and/or their relatives had been involved in producing their care plans. The provider informed us it had been planned to update the signage around the care home in the near future, which will better meet the needs of people. Colour coding of corridors and people`s room doors was being discussed which will `personalise` the care home and improve the needs of those people with cognitive problems, especially those people diagnosed with some form of dementia. Photo menus were also being produced to help people decide what they would like to eat at meal times.

Is the service caring?

We observed staff members being very patient with people living at the care home and, although they helped whenever asked, they also promoted and encouraged people`s independence. Within care plans, we observed evidence of people and their families being involved in their care planning which ensured their wishes and preferences were being met. We spoke to several visitors during our inspection and one said, `I am very happy with everything about this home - it is always spotlessly clean and the staff are lovely`.

Is the service responsive?

The provider was about to employ a new activities co-ordinator and had an adapted mini-bus for the use of people living at the home aimed at keeping people involved in activities around the local community. We were told people would decide on places they would like to visit during the regular meetings held at the care home. One visitor told us of a concern they had related to a dental and speech therapist appointment for one of the people at the care home but when we checked the provider had made all the necessary arrangements for the person to attend appointments. The provider had acted and responded to a concern in a positive manner.

Is the service well-led?

We observed evidence of regular internal and external audits that had been carried out by the provider which helped ensure the care being provided was both safe and of good quality. Meetings were held for both staff members and people living at the home and any wishes or suggestions made during these meetings had been acted on and implemented without delay. Within care plans, we saw evidence of a multi-agency approach to providing care and all staff members we spoke to were aware of their roles and responsibilities which ensured all people living at the home received good quality care that met their expressed needs and wishes.

Cambridge Court Care Home provides care for 59 people. At the time of the inspection there were 39 residents. The home had recently had a change in ownership and the new owners were investing in a refurbishment programme so to limit the disruption to the residents they did not take on new admissions. The refurbishment programme will be completed by the end of May 2013.

We spoke with people who lived at the home and asked them to share with us their views and experience of the care support they received.

One person told us “The decoration is lovely and we are having a cinema.” Another person told us “The food is lovely and we get a choice so we can’t complain.”

We spoke with 3 people who lived at the home and they told us that staff were considerate towards them showing dignity and respect at all times.

We viewed care files and found them to be person centre and a process was in place to support scheduled reviews on a monthly basis.

We spoke with staff who told us that they felt well supported by the management and peers. They (the staff) said they worked well as a team and welcomed the new owners support.