Cumbria House Care Home

Cumbria House Care Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cumbria House Care Home provides accommodation and support for up to 32 older people. There were 24 people living at the service at the time of our inspection. People had varying care needs. Some people were living with dementia, some people had diabetes or had Parkinson’s disease, some people required support with their mobility around the home and others were able to walk around independently.

A registered manager was employed at the service by the provider. 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 our last inspection on 5 July 2017, the service was rated as ‘Requires Improvement’. We found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Peoples preferences and requirements around their food and how this was delivered was not always person centred. We also made a recommendation to the provider that they provide better evidence of their oversight of all aspects of service delivery. At this inspection we found the provider and registered manager had made the necessary improvements to meet the regulations and achieve a rating of ‘Good’.

People were now complimentary about the food and snacks available. There was variety and choice at mealtimes. People told us they had access to plenty of drinks throughout the day. People’s specific dietary needs were known about and catered for.

Staff were now careful to make sure they recorded the food and fluids people had, where this was required, to ensure people maintained their health.

A comprehensive range of quality auditing processes were in place to check the safety and quality of the service provided. Action was taken where improvements were needed. The provider now held a governance meeting once a month to ensure their clear oversight of the service they provided.

Staff were aware of their responsibilities in keeping people safe and reporting any suspicions of abuse. Staff knew what the reporting procedures were and were confident their concerns would be listened to by the registered manager.

Individual risks were identified and steps were taken to reduce and control risk. Staff had the guidance they needed to support people to maintain and improve their independence while at the same time preventing harm. Accidents and incidents were appropriately recorded by staff; action was taken and followed up by the registered manager.

The procedures for the administration of people’s prescribed medicines were managed and recorded appropriately so people received their medicines in a safe way. Regular audits of medicines were undertaken to ensure safe procedures continued to be followed and action was taken when errors were made.

The registered manager and deputy manager carried out a comprehensive initial assessment with people before they moved in to the service. People were fully involved in the assessment, together with their relatives where appropriate. Care plans were developed and regularly updated and reviewed to consider people’s changing needs. People’s specific needs were taken account of and addressed in care planning to ensure equality of access to services.

People had access to a range of activities to choose from. Some people preferred their own company and wished to spend time in their room reading or watching TV and this was respected by staff. People were asked their views of the service and action was taken to make improvements where necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible according to the basic principles of the Mental Capacity Act 2005. The policies and systems in the service supported this practice.

People were supported to access healthcare professionals when they needed advice or treatment. The registered manager had developed good relationships with local health care professionals and referred people when they needed.

There was clear evidence of the caring approach of staff. People and their relatives were happy about the staff who supported them, describing them as caring, saying they were confident in the care they received. Staff knew people well and were able to respond to their needs on an individual basis.

Suitable numbers of staff were available to provide the individualised care and support people were assessed as requiring. The provider used safe recruitment practices so only suitable staff were employed to work with people who required care and support.

Staff were supported well by the registered manager and the deputy manager. Staff told us they were approachable and listened to their views and suggestions. Training was up to date and staff were encouraged to pursue their personal development. Staff had the opportunity to take part in one to one supervision meetings to support their success in their role. Regular staff meetings were held to aid communication within the team and to provide updates and feedback.

All the appropriate maintenance of the premises and servicing of equipment was carried out at suitable intervals.

People and their relatives thought the service was well run. People knew the registered manager and the deputy manager well and were very happy with the service provided.

Further information is in the detailed findings below.

Accommodation is provided over three floors; although there are some double rooms all people currently accommodated have single occupancy accommodation. Some people have ensuite washing and toilet facilities in their rooms. People have access to two lounges and a dining room. A pleasant garden provides good accessible outside space. We last inspected this service in July 2016 when we found the provider was not meeting all the regulations in regard to assessment of environmental risks, medicines management and the implementation of an effective quality monitoring system. We asked the provider to tell us how and in what timescale they intended to address these issues. This inspection showed that previous requirements had been addressed.

There was a registered manager in post who was present at inspection. A registered manager is a person who is 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.

There had been improvements in the range of quality audits and monitoring of the service provided to people. However, the range and depth of provider visits needed improvement to ensure all aspects of service quality were looked at, highlighted shortfalls and gave clear timescales for addressing these. Quality audits needed to maintain the upward trend to provide the registered manager and provider with the information and assurance they needed about service quality.

People were given choices in the food they ate but there were mixed views about overall food quality and this remains an area for improvement. People deemed at risk of poor nutrition or hydration had fluid and food intake monitoring in place. Those who were a source of concern because of poor intake were referred to dieticians for support and guidance to staff, peoples weights were taken regularly. Peoples health needs were monitored and staff ensured people were referred to health professionals as needed.

People told us that they were happy living in the service and felt safe; they got on well with staff and found them kind and caring. People relatives and staff found the registered manager approachable and felt she listened to them. Health and social care professionals said staff communicated well with them.

The premises provided a comfortable clean and well maintained environment, equipment was routinely serviced. Staff understood how to keep people safe from harm and abuse and to evacuate them safely from the service in an emergency.

Required recruitment checks and procedures ensured that only suitable staff were employed to support people. There were enough staff available to meet people’s needs. Medicines were managed safely. Risks were appropriately assessed and accident and incidents reported and acted on appropriately; the registered manager analysed these for trends and patterns and ensured people who experienced accidents were referred to medical professionals for investigation as to possible causes.

New staff received an induction into their role; they were provided with basic knowledge and skills to support people safely. A programme of regular training updates and access to specialist training courses was provided. Staff said they felt supported and listened to and that there were always opportunities to discuss things with the Registered or deputy manager in relation to work issues. Handovers were held at the beginning of each shift so that incoming staff were made aware of changes to people’s wellbeing and also changes in operational practices. Staff had formal supervision of their training, development and practice, with competency assessments of their care delivery and medicine practice undertaken annually. Appraisals to assess annual work performance were undertaken by the registered manager of all staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff sought consent and people were supported by staff to make their own daily choices and decisions. The least restrictive measures were in place for two people who required additional support to keep them safe or for staff to make decisions on their behalf. Deprivation of Liberty Safeguarding (DoLS) authorisations were in place for those people and the service was meeting the requirements of the Deprivation of Liberty Safeguards. Staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves.

People were supported to maintain links with the important people in their lives and relatives told us they were always consulted and kept informed of important changes. Visitors were made welcome and visiting times were flexible. Observations showed staff behaved in a kind patient manner with people, treating them with dignity and respect.

People referred to the service were assessed by the registered manager prior to admission to ensure their needs could be met and their impact on other people I the service considered. Individualised care plans were developed with the involvement of the person and or their relatives. Care plans reflected people’s assessed needs and how they preferred these to be supported by staff. Daily reports by staff recorded people’s wellbeing and mood on a daily basis.

A complaints procedure was displayed, people were provided with their own copies. Complaints were rare but people told us how minor concerns they had raised as informal complaints had been addressed immediately. People felt confident of using the complaints procedure if they needed to and of approaching the registered manager or other staff with any concerns.

People were routinely asked to share their views through surveys and resident/relative meetings. Survey feedback was analysed by the registered manager and individual comments addressed with the people concerned to ensure these were addressed to their satisfaction. Analysis of survey information was published for people to read and gave them confidence that their views were listened to.

We have made two recommendations:

We recommend that a competent person monitors that all staff attend fire drills at least twice annually and all staff can demonstrate they know how to use evacuation equipment safely.

We have recommended more in depth checks by the provider.

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

Cumbria House is a large detached house in a residential area of the town of Folkestone, it is close to public transport but off street parking is limited and there are parking restrictions in the surrounding roads. It provides accommodation and personal care for up to 32 older people and there were 27 people in residence at the time of the inspection. The accommodation is provided over three floors with each person having their own room. People have access to a large communal lounge, dining room and a quiet room. There is a large accessible garden to the rear of the premises.

The home was run by a registered manager who was present on the day of our visit. 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.

People and relatives told us that they were satisfied with the quality and delivery of care provided in the service and no concerns were raised.

Our inspection found that improvements were needed to the way in which medicines were managed to ensure this was accordance with current best practice and guidance and ensured medicines were safely stored. Some risks that could impact on people’s safety had not been assessed and the procedures for assessing and monitoring service quality needed further development to be more effective in identifying shortfalls.

The premises were well maintained. All areas viewed were visibly clean and cleaning staff told us about their cleaning schedules each day. Despite carpets being shampooed there remained an underlying odour in some areas of the ground floor but this had already been identified and arrangements for industrial carpet cleaning were in hand. People were provided with the equipment they needed to mobilise or bathe, and grab rails were visible in communal bathrooms and ensuites. All necessary equipment servicing, checks and tests were carried out. The registered manager also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order.

Staff had received training in safeguarding adults and knew what action to take if there was any suspicion of abuse. They understood how to keep people safe in emergencies and what they needed to do in the event the service needed to be evacuated.

The majority of individual and environmental risks to people’s safety were assessed and managed appropriately. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People’s needs and dependency had been assessed to make sure that there was enough staff on duty during the day and night to meet people’s individual needs.

People’s health needs were assessed and monitored. A health care professional said that the staff were good at seeking professional advice when it was needed. People were provided with a varied diet that reflected their personal likes and dislikes, and dietary needs.

New staff received an induction that included completion of the care certificate. All staff however experienced had completed the care certificate and were trained in areas necessary to their roles; additional training in some specific areas was provided where necessary to make sure that they had the right knowledge and skills to meet people’s needs effectively.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent on a daily basis. A DoLS application had been authorised for one person who lived in the home to ensure that they were not deprived of their liberty unnecessarily.

Staff spoke kindly to people and treated them with respect. People were able to make decisions and choices for themselves about what they did, and where they ate their meals and with whom, people were encouraged where possible to maintain their independence seeking support when needed.

People’s care, treatment and support needs were clearly identified in their plans of care and included people’s choices and preferences. Staff knew people well and understood their likes and dislikes.

People were offered an appropriate range of activities and were consulted about changes to this at residents meetings. Relatives and friends were made welcome and people were supported to keep in contact with people who were important to them.

We have made two recommendations:

We recommend that the provider seek guidance from a competent source on the best system of measurement to use in fluid monitoring to aid consistency.

We recommend that the provider seeks advice from a reliable source to ensure that the personal evacuation plans in place and the frequency and recording of fire drills for care staff meet the requirements of current fire legislation.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We asked our five questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

Is the service safe?

The service was safe. People we spoke with told us they felt safe living in the home and the staff supported them well.

Risks associated with people's care delivery were identified during assessments, and care plans contained sufficient guidance for staff to follow, to make sure they took a consistent approach to reduce the risks, so that people remained safe.

People were being cared for by trained and sufficient staff to make sure they were safe and receiving the care they needed.

Systems were in place to make sure that managers and staff learnt from events, such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded when required.

Is the service effective?

The service was effective. People told us that they were happy with the care that had been delivered and that their care needs were met. We saw that staff were attentive to people using the service and responded promptly when needed.

Care plans detailed people's personal routines. Staff knew the people well and demonstrated they knew how to care for the people in line with their preferences and choices.

People were supported to maintain a healthy diet. Nutritional assessments had been carried out for each person. We saw that health professionals had been involved in these assessments and clear guidance about how to meet people's nutritional needs were recorded in people's care plans.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People were given care and support by staff in a way that suited them best.

People were treated with dignity and had their privacy respected. We observed people making decisions as to what they wanted to do and staff respected this.

Is the service responsive?

Staff were responsive to people's needs and people told us that there was always someone around when they needed them. People's care and support plans were reviewed with their relatives and updated regularly to make sure they were receiving the care they needed.

There were systems in place to support people when they were unable to make complex decision to ensure decisions were made in people's best interest.

People had opportunities to undertake a range of activities and were being supported to maximise their independence and lead an active life.

People, staff and relatives were aware of the complaints procedure and told us they would contact the registered manager or deputy if they had any concerns.

Is the service well-led?

The service was well- led. There was a clear management structure in place. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service.

Where investigations had been required, for example in response to accidents and incidents, the service had completed a detailed investigation. This included what actions had been taken to resolve the issues so that risks to people of future occurrences were minimised.

People were treated with respect. Records and our observations showed that people were supported to make decisions about their day to day lives and things that were important to them. People could choose what to do and what to eat each day and staff respected their choices.

People liked the staff and told us that staff were kind towards them. Staff understood people's needs and personal preferences. People were supported to be as independent as they could.

The service had a safeguarding policy and financial procedures in place to ensure people were protected and that their money was safe.

There were enough staff on duty to support people safely and in the way they preferred.

The provider had processes and procedures to regularly check on the quality of the service people received and to keep them safe.

The people we spoke with told us that they enjoyed living at the service. They spoke positively about the environment, the staff and the care provided. Comments people made included 'I am glad to be here, I feel very lucky'. Speaking of the care and support afforded to their relative, another person told us 'I don't have to worry. I know they are safe and well looked after here'.

When we looked around the service we saw that it was recently decorated, comfortable and well furnished. People commented that they liked their bedrooms, they felt staff were caring and helpful and that the atmosphere was relaxed. People were complimentary about the quality and choice of meals and spoke positively about activities arranged by the service which included visiting musicians.

We saw positive interactions between staff and the people who lived at the service, they were offered choices and we saw that their dignity and independence was respected. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.