We carried out a review of the data available to us about Cambridge Court Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cambridge Court Care Home, you can give feedback on this service.
About the service
Cambridge Court is a care home in Waterloo in Liverpool. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The service can support up to 53 people and at the time of inspection, 49 people were living at the home.
People’s experience of using this service and what we found
Within the context of areas reviewed as part of this targeted inspection, people were supported with their pressure care needs and to maintain a balanced diet. Staff supported people in the home in the least restrictive way possible and in their best interests.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
CQC have introduced targeted inspections to follow up on specific concerns. We do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We undertook this targeted inspection to check on specific concerns we had relating to management of risks relating to pressure care, nutrition and hydration and oral care.
We found no evidence during this inspection that people were currently at risk of harm from this concern. We have made a recommendation about how the provider implements improvement in relating to oral care.
The overall rating for the service has not changed following this targeted inspection and remains good.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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 told us they felt safe at the home.
Staff had received appropriate training to provide them with the skills required to carry out their role.
Principles of the Mental Capacity Act (MCA) 2005 legislation were being followed and DoLS applications were completed correctly and in line with current legislation. Staff showed a basic knowledge and understanding of both MCA and DoLS.
People we spoke to during the inspection spoke positively about the food at Cambridge Court and were supported to maintain a healthy diet.
People had good access to health care where required.
Staff supervisions and appraisals had been completed regularly and were clearly documented. Staff told us they felt well supported by the management team and were able to request additional support through supervisions if required.
Staff that were spoken to showed good knowledge around maintaining the dignity and respect of people living within the home. During the inspection staff were observed to be kind, compassionate and respectful towards people and were seen to interact in a calm, respectful manner. People living in the home and their relatives spoke positively of staff and their care and treatment towards them.
Cambridge Court employs an activities coordinator several days a week. People living in the home spoke positively about the activities that were provided. We saw evidence of a wide range of both group and individual activities, themed activities and trips out. The activities folder provided further evidence of the positive reactions from people living in the home.
During the inspection we looked at six care files and found that people received personalised care that met their needs. Care records were person centred and produced with the involvement of the person and relatives and were reviewed regularly. In most files there was evidence of consent for care being obtained appropriately where people lacked the capacity. However it was also identified that where a person was known to have capacity, their consent was not obtained. This was discussed with the manager during the inspection who was responsive to the feedback provided and offered assurance that this would be addressed.
The home has a robust approach to complaints that is easily accessible to residents and family and provided evidence that they were reviewed and action taken where required.
During the last inspection it was identified that whilst systems and processes were in place to monitor the quality and safety of the service actions had not been taken to address all the concerns raised. During this inspection it was evidenced that this was now being carried out and actions were being completed where issues were identified.
The registered manager told us that their vision and values were to provide ‘better care, good practice’. Staff that were spoken to shared this vision and value and were able to clearly explain that this was achieved by delivering personalised care.
Staff told us that positive changes had taken place within the home since the last inspection.
Throughout the inspection the management team and staff were open and responsive. They were able to provide information on request and showed to improve on the quality of their service.
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 completed to show that any risks identified during the recruitment process had been addressed. During this inspection we found that improvements had been made as safe recruitment practices were evident and risk assessments had been completed. The provider was no longer in breach of this regulation.
In May 2016 we found that not all staff had received an annual appraisal, detailed induction or regular training to support them in their role. At this inspection we found that improvements had been made. Staff had received an induction and an appraisal and took part in regular supervision. Most staff had completed mandatory training, though we observed that best practice in relation to moving and handling was not always implemented.
At the last inspection we found that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA) and conditions applied to authorisations to legally deprive people of their liberty were not always followed. During this inspection we found that DoLS were applied for when needed, and consent was sought in line with the principles of the MCA and recorded in people’s care files.
In May 2016 we found that people’s confidential records were not always stored securely. At this inspection we found that records were stored securely, which meant that only people who needed to, could access this information.
At the last inspection we also observed that staff did not always interact with people when providing them with support. They did not explain the care or offer reassurances. During this inspection we observed a number of interactions between staff and people living in the home and they were all warm and caring. The provider was no longer in breach of this regulation.
At the previous inspection we found that people did not always receive person centred care. At this most recent inspection, people we spoke with told us they were given choices regarding their care, such as the gender of staff that supported them with personal care, how they spent their day and when to get up of a morning. Care plans reflected people’s preferences and contained information about them within a life history document. This helped to ensure that people were supported by staff that knew them well and could provide care based on their needs and preferences.
During the last inspection people told us they were bored and staff and relatives agreed that there was a lack of activities provided. During this inspection we found that an activity coordinator was in post five days per week and feedback regarding activities was more positive. An activity centre had also been developed within the grounds of the home, as well as a cinema room. The provider was no longer in breach of this regulation.
People living at the home spoke highly of the staff and told us they were kind and caring and relatives agreed. There were no restrictions on visiting the home and people told us their family members were made welcome when they visited.
People at the home were supported by both the staff and external health care professionals to maintain their health and wellbeing.
Feedback regarding meals was positive. The chef and staff we spoke with were aware of people’s dietary needs and preferences and these were recorded in care files.
Care files reflected that people or their families had been involved in discussions regarding care and this was evident through signed care plan agreement forms.
Most care plans we viewed were detailed and reflected the needs and preferences of the individual and had been reviewed regularly.
Records showed that quality assurance surveys were issued to people and their relatives at various times throughout the year in order to gather feedback from people. Records also showed that resident and relative meetings took place, though they did not appear to be regular. People had access to a complaints procedure within the home. The registered manager maintained a log of all complaints received and their outcomes.
People living in the home told us they felt safe living in Cambridge Court. We found the home to be clean and well maintained. Accidents and incidents were reported and recorded appropriately. Arrangements were in place for checking most of the environment and equipment to ensure it was safe. There was no evidence that bed rails or window restrictors were routinely checked.
Effective systems were in place to monitor the quality and safety of the service, however actions had not been taken to address all of the identified concerns. Both the registered manager and provider were involved in assessing the service. The provider was no longer in breach of this regulation.
We observed that the ratings from the last inspection were clearly displayed within the home in accordance with CQC guidance.
People living in the home and staff told us the registered manager; deputy managers and the provider were both approachable and supportive. Staff told us they enjoyed working at Cambridge Court and felt well supported. Staff we spoke with were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any concerns they had.
Staff told us positive changes had taken place within the home since the last inspection.
At the previous inspection of Cambridge Court the provider was found to be inadequate and the service was placed in 'special measures' by CQC. During this inspection we found that improvements had been made and breaches of regulations we identified in May 2016had been met. The rating of Cambridge Court has been revised and the service is no longer in special measures.
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 guidance on how best to meet people’s needs.
Systems were in place to gather feedback from people regarding their views of the service, through meetings and completion of quality assurance surveys.
Systems in place to monitor the quality and effectiveness of the service were not effective as they did not identify issues highlighted during the inspection. Recommendations made during the last inspection had not all been acted on.
People we spoke with were not aware who the manager of the home was. Staff however told us the new manager was approachable and they could raise any concerns with them.
CQC had not been notified of all relevant events which had occurred within the home.
We are considering our response and will report on any actions taken.
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.
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.
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.