This was an unannounced comprehensive inspection which took place on 10 October 2018. The service was last inspected on 14 April 2015, where we found the provider to be in breach of the regulation in relation to safe care and treatment. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe to at least Good. At the focused inspection on 24 August 2016, we found that the provider had made improvements and were no longer in breach of the regulation and hence, overall rated Good.

Cambridge Nursing Home is a care home with nursing provided on three floors. The service is registered to accommodate a maximum of 49 people. The service specialises in supporting people living with dementia, physical disability, older people and younger adults. Cambridge Nursing 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. At the time of our inspection, 46 people were living at the service.

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 provider did not ensure staff were deployed appropriately to meet people’s needs safely. There was lack of appropriate hand wash facilities in the communal toilets and bathrooms. People were at risk as the window restrictors were not safe.

The provider did not always work in line with the Mental Capacity Act 2005 principles and Deprivation of Liberty Safeguards to ensure people’s consent was sought in relation to care and treatment. The service's décor was not dementia friendly.

People told us some staff were not caring and did not always treat them with dignity and respect. Relatives felt unwelcomed as visiting times were restricted and did not always suit them.

There was lack of structured stimulating activities for people living with and without dementia.

The provider did not have efficient and effective auditing, monitoring and evaluating systems to ensure the quality and safety of the care delivery.

Risks to people were appropriately assessed and mitigated so that staff could provide safe care. Staff understood their responsibilities in safeguarding people against harm and abuse. People’s medicines were managed safely. Staff were recruited appropriately to ensure they were safe to support people.

People’s needs were assessed before they moved to the service. Staff told us they received appropriate, regular training and supervision to provide effective care. People’s individual dietary needs were met. Staff worked well with healthcare professionals to ensure people’s individualised needs were met effectively.

People’s cultural and spiritual needs were identified, recorded and met by staff. The provider had effective systems and processes to support people at end of life.

Care plans were individualised and detailed people’s likes and dislikes. Staff knew how to meet people’s personalised needs. Staff were trained in equality and diversity. The provider encouraged lesbian, gay, bisexual and transgender people to use the service. People knew how to raise concerns and the provider maintained clear and accurate complaints records.

Staff told us they found the management approachable and felt well supported and valued. Healthcare professionals told us the service was well managed. The registered manager submitted a detailed action plan to address issues raised during our inspection.

We found the registered provider was not meeting legal requirements and was in breach of four regulations. These were in relation to safe care

This inspection took place on 24 August 2016 and was unannounced. At the last inspection on 14 April 2015, we found people who used the service were not protected against the risks associated with unsafe management or administration of medicines. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the comprehensive inspection, the provider wrote to us in July 2015 to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection 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 those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cambridge Nursing Home on our website at www.cqc.org.uk.

Cambridge Nursing Home is a care home with nursing provided on three floors. The service is registered to accommodate a maximum of 49 people. At the time of the inspection, there were 49 people using the service.

There was a registered manager in place. 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.

At this inspection we found the registered provider had taken sufficient action to ensure people received their medicines as prescribed and medicines were managed safely.

This unannounced inspection took place on 14 April 2015. The service did not meet three regulations we inspected against at our last inspection on 8 September 2014. During this inspection we found that the service was now compliant with these regulations.

The service had a registered manager in place. 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.

In September 2014, our inspection found that the nursing home provider breached regulations relating to Care and welfare of people who use services, cleanliness and infection control and Assessing and monitoring the quality of service provision. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made.

Cambridge Nursing Home is a care home with nursing provided on three floors. The service is registered to accommodate a maximum of 49 people. At the time of the inspection there were 48 people using the service.

Medicines were not always safely managed. We saw the balance of medicines for five people did not match with the records. We noted there was not always a system in place to account for medicine and to check to ensure people had the right quantity of medication required, which left people at risk because medicines were not properly managed.

People and relatives told us they liked the home. They said the home was clean and staff were pleasant. People told us they felt safe in the home because staff quickly responded to their calls. Relatives felt that the home had enough number of staff deployed to support people. They said staff were kind and welcomed them when they visited the home.

Each person had a care plan which contained information about their needs including any allergies, nutrition, falls risk, wellbeing, manual handling and instruction for staff how to support people. People's healthcare needs such as their weight, blood pressure, and blood sugar level were monitored and recorded in their files. People were referred to dieticians, speech and language therapists, district nurses, and GPs as and when needed. This ensured that people received treatment healthcare intervention when they needed.

People talked positively about different aspects of the service. They told us the food provided was good and they had choices of what they wanted to have at breakfast, lunch and dinner. We saw staff provided assistance for those who needed support with meals. We observed staff sat by people and talked to them when helping them with their food. This showed staff treated people with respect.

Records showed staff had various training opportunities relevant to their roles. Staff told us they felt supported and enjoyed their work. They informed us they worked as a team; they had regular supervision and attended team meetings. Staff told us they shared experience with colleagues and supported each other.

There was a system in place for checking health and safety. Staff checked fire safety, emergency lights and the cleanliness of the home. Relatives, visitors and people were consulted about the quality of the service. This ensured that people's views were taken into account in provision and improvement of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe? is the service effective? is the service caring? is the service responsive? and is the service well-led? Below is a summary of what we found. The summary is based on our observations during our inspection, speaking with people using the service, their relatives, and staff, and looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe ?

People and their visitors told us they felt safe. There were effective arrangements in place for staff to identify the possibility of abuse, prevent it from happening, and respond appropriately to any allegation of abuse. We observed that appropriate arrangements were in place to manage medicines safely and effectively.

Recruitment practice was safe and thorough. There was, however, limited evidence that people's care needs were taken into account when making decisions about the number, skills and experience of staff required when setting duty rotas.

There were some arrangements in place to deal with foreseeable emergencies, however these did not ensure that equipment and emergency medicines were readily accessible or that there were on-going equipment checks and systems to replace used items.

There were ineffective arrangements in place to protect people from the risk and spread of infection.

Is the service effective ?

People's health and care needs were assessed and there were care plans in place. There was limited evidence of people being involved in assessments of their needs and planning their care, or that specialist and expert advice was sought and acted upon. Some of the care plans had not been reviewed or updated regularly. It was therefore not possible to confirm all people's needs were being met. Staff did not have the opportunity to participate in on-going learning and development activities in some relevant topics, although they had regular supervision and appraisal.

Is the service caring?

People and their relatives told us that they were generally satisfied with the care provided within the home, that staff were kind, approachable, and kept them informed. We found staff acted in accordance with the wishes of people who used the service. Where people were able, they gave give valid consent to examination, treatment, care and support. Staff knocked on people's doors, explained care to people, gained their permission to provide care and treatment, and to receive visitors.

There was no designated person to co-ordinate activities for people using the service within the home, and no evidence that planned activities were available on a daily basis, or that they were evaluated.

Is the service responsive?

We found staff understood people's individual communication methods, enabling choice in their daily lives. We saw some examples of where staff worked collaboratively with other health and social care professionals and agencies, ensuring people received care in a co-ordinated way. People, their relatives and staff were all familiar with the processes to feedback comments and concerns about the service. However, we saw limited evidence that learning from feedback had taken place or that it had been acted upon.

Is the service well-led?

People, visitors and staff told us that they felt supported by managers, that managers were approachable and accessible, that communication was good, and that they felt listened to. There was limited evidence of an effective quality assurance system to identify, assess and address risks relating to the health, welfare and safety of service users and others who may be at risk. The quality assurance systems did not make sure that the knowledge and experience of people, or staff, was properly taken into account and acted upon or that shortfalls were appropriately addressed.

People told us that they were treated with dignity and respect and that they were able to make choices over their daily care. Comments included "I am treated very well here" and "I can get my own space in my room when I want to." People told us that the service was meeting their care needs and that they were happy with the staff. Comments included "the staff are lovely, all of them" and "the staff are fantastic."

People were provided with a choice of suitable and nutritious food and drink. People said that they enjoyed the food and were given choices of food and drink. Measures were put in place where a risk of poor nutrition was identified. People said they felt safe at the home. One person said "I've never had any trouble" when asked if they felt safe there. Records showed that all staff had received training in safeguarding vulnerable adults within the last year. The home had a safeguarding policy in place.

Staff received appropriate professional development. They felt well supported by the management. One member of staff said "the manager is usually here so if there are any issues we can always tell them" and another said "I've learned a lot of things since I've been (working) here, I've grown a lot in this company."

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector who was joined by an Expert by Experience people who have experience of using services and who can provide that perspective.

We used a number of different methods to help us understand the experiences of people using the service. A number of the people who lived at this care home had complex needs, which meant they were not always able to communicate verbally with us in a meaningful way. During the morning and at lunch we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

The people who live in the home and their relatives all commented on the kindness of staff. People felt reassured in the knowledge that their care is provided by long established staff with whom they have a positive relationship. One relative told us they “felt at peace” with their relative being in the home. However, at times some people did not always feel safe living in the home because other people had uninvited access to their rooms.

We received a variety of comments on the food provided to people in the home. Some said there was a lack of variety. When we asked one person to tell us about how they had a choice in the foods provided they said they had “no real choice, but you know when it comes you can eat it”.

We did not have the opportunity to speak with any relatives or visitors to the home on the day of the inspection so we spoke to some on the phone following our visit.