CQC report explained · a nursing home
What the CQC found at Cambridge Park - Community Inpatient Unit (CIU)
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, March 2023
Rated Requires Improvement; inspectors found kind staff and enough staff on duty, but serious gaps in medicines, risk assessments, care planning and oversight.
This was an unannounced focused inspection on 21 February 2023. Inspectors spoke with people, relatives and staff, reviewed care and medicines records, checked staff files, and observed the home and infection control practices.
The home was rated Requires Improvement overall. Inspectors found that medicines were not always managed safely, risks were not always properly recorded or shared, and care plans did not always explain people's needs or involve them and their families.
There were also positive findings. People said they felt safe, there were enough staff, staff were supported, and the home worked well with health and social care professionals. The home was clean and infection control arrangements were mostly assured.
The rating remained Requires Improvement, as it had been at the previous inspection. The provider had improved staffing and staff training, but remained in breach of regulations. CQC asked for an action plan and said it would monitor progress.
Enough staff
Inspectors found enough staff on each shift to support people safely. Recruitment checks were also completed before staff started work.
“There were enough staff on duty each shift to safely support people.” from the report
Staff training and support
Staff received induction, ongoing training, supervision and appraisals. Staff and relatives said the team had the skills to support people.
“Staff received an induction, ongoing training and regular opportunities to discuss their work, training, and development needs.” from the report
Links with professionals
The home worked with health and social care professionals to support rehabilitation, reablement and discharge planning.
“The registered manager and staff had effective working relationships with other organisations and professionals to ensure people received the right support.” from the report
Respectful atmosphere
Inspectors observed positive interactions. People were treated with respect, and the atmosphere was described as warm and supportive.
“Cambridge Park Inpatient Unit was welcoming, and the atmosphere was warm and supportive.” from the report
Activities and relationships
People were offered social activities and support to maintain relationships with family and friends.
“Staff supported people to maintain relationships with family and friends.” from the report
Medicines management
seriousGuidance for medicines given as required was missing. Records for prescribed thickeners, medicine temperatures and stock levels were not always reliable.
“Where people had medicines prescribed 'as required', there were no protocols in place to give staff guidance to administer this type of medicine.” from the report
Care plans not personal enough
seriousCare plans did not always describe people's needs, preferences and life history in enough detail. People and relatives were not always involved in decisions.
“Care plans did not consistently contain detailed information about people's likes, dislikes, interests and personal histories.” from the report
Weak oversight
seriousAudits did not consistently find problems or show whether actions had been completed. The home also made little use of accidents, incidents and falls to learn lessons.
“Systems designed to monitor the safety and quality of the service and take action to mitigate risk, were not robust.” from the report
Incomplete food and fluid records
needs fixingFood and fluid monitoring records were not always completed in line with people's assessed needs. The provider said it was reviewing its recording system.
“However, food and fluid monitoring records were not always completed in line with people's assessed needs.” from the report
- 01What has changed since the inspection to make sure medicines given as required have clear written guidance?
- 02How do you identify and update risks such as falls, diabetes, catheters and weight loss?
- 03How will you involve the person and their family in care planning and decisions about treatment?
- 04How do your audits now check that medicines, care plans and risk records are complete and accurate?
- 05How do you record and review accidents, incidents and falls so that lessons are shared with staff?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not inspected and the previous rating was used in calculating the overall rating. This explanation was written from the published report of 14 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2021
Rated Requires Improvement; inspectors found kind care and good infection control, but medicines, risk management and care records were not always safe or reliable.
This was the home’s first rated inspection since it registered at these premises. It provides short-term nursing, personal and therapy care for up to 52 people. There were 26 people living there when inspectors visited.
Two inspectors visited without advance notice on 29 and 30 June 2021. They spoke with eight people, five relatives and 22 staff. They reviewed care records, medicine records, recruitment files and management information.
Inspectors found that people were treated with kindness and respect. The home was clean, well maintained and followed infection control procedures. However, there were important shortfalls in medicines, risk assessments, changing care needs, staff support and quality monitoring.
The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. Caring was rated Good. The provider was asked for an action plan, and CQC said it would monitor progress and return for another inspection.
Kind and respectful staff
People and relatives described staff as kind, compassionate and respectful. Inspectors saw staff supporting privacy, dignity and independence.
“People and relatives praised the staff for their kindness and compassion.” from the report
Infection control
Inspectors were assured that the home had suitable infection prevention arrangements, including safe visiting, protective equipment and outbreak procedures.
“We were assured the provider was meeting shielding and social distancing rules.” from the report
Rehabilitation support
People had access to nursing, therapy and other health professionals. People and relatives reported positive progress and well-coordinated discharge support.
“A range of health and social care professionals were employed at the service to meet people's individual care, rehabilitation and reablement needs” from the report
Clean and maintained environment
The home was purpose-built, clean and well maintained. Equipment and premises were checked to keep them safe.
“The environment was well maintained and clean.” from the report
Medicines safety
seriousThere had been several medicines errors, and some people had not received medicines as prescribed. Records for some controlled medicines did not explain where they had gone.
“Medicines were not always managed safely. There had been several medicines errors and people had not received their medicines as prescribed.” from the report
Risk management
seriousRisk assessments did not always explain the level of risk or the actions staff should take. Inspectors found one person using bed rails despite an assessment saying they should not be used.
“During the inspection, one person's bed rails were in use despite their risk assessment identifying bed rails were not be used due to the high risk of the person climbing over.” from the report
Personalised care records
seriousCare plans were not always present or detailed enough, and records were spread across different systems. Inspectors found shortfalls in several areas of changing care needs, including wound care and pressure relief.
“Care plans were not always in place or sufficiently detailed to guide staff on aspects of care delivery to meet people's needs.” from the report
Staff training and morale
needs fixingEssential training and supervision had fallen behind during the pandemic. Staff described low morale and said they needed more support and training.
“Staff training and supervision had slipped during the pandemic. Some staff said they would benefit from additional courses to develop their knowledge and skills.” from the report
Weak quality monitoring
seriousThe home’s checks did not identify important problems found by inspectors. There was also limited evidence that incidents were being used to prevent similar problems happening again.
“The governance systems in the service were limited and had failed to pick up the issues we identified during our inspection.” from the report
- 01What changes have been made to prevent medicines errors and to account for all controlled medicines?
- 02How are individual risks, including bed rails, skin damage and falls, now assessed and communicated to staff?
- 03Are all care plans now held in one system and detailed enough to cover changing needs such as wound care, bowel care, pressure relief and continence?
- 04How do you calculate staffing levels and make sure staff are deployed according to people's needs?
- 05What has been done to improve staff training, supervision, morale and communication between teams?
This was the first rated inspection at these premises and covered all five key questions, including infection prevention and control under Safe; earlier targeted infection control visits were not rated. This explanation was written from the published report of 30 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Cambridge Park - Community Inpatient Unit (CIU)
2 rated inspections over 2 years: the service has held its Requires improvement rating throughout.
- March 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Cambridge Park - Community Inpatient Unit (CIU) →
- July 2021Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Cambridge Park - Community Inpatient Unit (CIU) →
- February 2021Inspected but not ratedSafe: Inspected but not rated
- December 2020Inspected but not ratedSafe: Inspected but not rated
- April 2020
Registered with the Care Quality Commission on 27 April 2020.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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12 live-in carers within about an hour of North East Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,350 a week. 10 can care for a couple. 7 years' experience on average.
“What truly stands out is how mindful and attentive she is to all of my medical needs, always going above and beyond to ensure I’m comfortable and well cared for.”
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.