This inspection took place on 8 and 9 August 2018 and was unannounced on the first day.

At the last inspection in July 2017, the service was rated Requires Improvement and the provider was in breach of three regulations. These related to risk management and safeguarding adults in the key question safe, person-centred care in responsive and governance in well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress in some areas but further improvements were required in others. We identified new concerns. This was the second Requires Improvement rating for the service.

Cambridge Park Care Home accommodates up to 60 people across two floors. Evergreen Suite on the first floor provides residential support and Courtyard Suite on the ground floor specialises in providing care to people living with dementia. The building is purpose built with lift and stair access to the first floor. All the bedrooms are for single occupancy and the majority have en-suite facilities. At the time of our inspection there were 35 people using the service.

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

The service had a new registered manager in post. 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.

Although we found some improvements had been made at this inspection, concerns remained in several areas. We found continued regulatory breaches in relation to safe care and treatment and good governance. We also identified a new breach in relation to staffing. You can see what action we told the provider to take regarding the above areas at the back of the full version of the report.

The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection or consistently driving improvements in line with their own action plans.

Sufficient staff were not on duty to meet people’s needs at all times. Staff were not visible in communal areas on the Courtyard Suite for long periods of time and inspectors had to seek staff support to manage incidents on two occasions, where people’s behaviour challenged the service.

We found shortfalls with the standards of hygiene and cleaning in areas of the home. There were mal odours and we found items of furniture, fittings and equipment which were damaged and could not be cleaned effectively. The shortfalls in staffing and hygiene standards had also impacted on some people’s dignity.

People were supported to make their own decisions and choices. They had maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had assessments of capacity and best interest decisions made on their behalf if they lacked capacity; documentation regarding best interest decisions showed all relevant persons were involved.

Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager was aware of their responsibility to liaise with the local authority where safeguarding concerns were raised and such incidents were managed well.

Staff had a good understanding of people’s needs and r

Cambridge Park Care Home is registered to provide residential and personal care for up to 60 older people who may be living with dementia. Accommodation is provided over two floors with both stairs and lift access to the first floor. Accommodation for people who may be living with dementia is located on the ground floor. There is an enclosed garden area, adequate parking and the service is close to local amenities. At the time of this inspection, 41 people were using the service.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found people were not always safeguarded from abuse and improper treatment. When safeguarding concerns were raised they were not investigated and responded to in a timely manner. Staff used unauthorised low level interventions to provide care to a small number of people without appropriate training to do so safely.

People did not always receive safe care and treatment. Appropriate actions were not taken to reduce the possibility of people suffering from avoidable harm. People’s care plans failed to include relevant information and sufficient information to ensure staff could meet their needs safely and consistently.

Effective governance systems were not established and operated within the service. Shortfalls in care and support were not always highlighted through internal auditing and quality assurance systems failed to ensure required improvements occurred.

Staff, who had been recruited safely, were deployed in sufficient numbers to meet people's individual need. People received their medicines as prescribed. Staff who were responsible for administering medicines had completed relevant training and their competency assessed regularly.

Staff had completed a range of training, which enabled them to feel confident in the roles. Staff received one to one support and annual appraisals in line with the provider’s policies. Staff understood how to gain consent from people but we found the principles of the Mental Capacity Act had not always been followed. People ate a varied and balanced diet and when concerns with their nutritional intake were identified appropriate action was taken. A range of healthcare professionals were involved in the on-going care and treatment of the people who used the service.

People received their care and support from an established team which, ensured continuity and consistency. People were not always treated in a dignified way and some aspects of their care showed they were not treated as individuals. Private and sensitive information was treated confidentially and managed accordingly.

People who used the service or their appointed representative were involved in the initial planning and on-going delivery of their care. We found that some people’s care plans and risk assessments were not updated as their needs changed or after incidents had occurred. People’s care plans did not always contain accurate and up to date guidance to enable staff to meet their needs consistently and effectively. People took part in a range of activities in groups or on a one to one basis. The provider’s complaints policy was displayed at the within the service to ensure it was accessible to people. When complaints were received, appropriate action was taken as required.

The service had a registered manager who was aware of their responsibilities to report notifiable events to the Commission; despite this we found evidence that on a two separate occasions they had not reported specific incidents. People who used the service and their relatives were asked to provide regular feedback on the service and their opinions were used to improve the service when possibl