The Good Companions (Cumbria) Limited

The Good Companions (Cumbria) Ltd is a residential care home providing personal care for up to 39 people. The service provides support to older people, some of whom may have dementia-related needs. At the time of our inspection there were 31 people using the service.

The care home is a large, adapted building. The accommodation is over three floors. People living with a dementia-related condition were accommodated on a lower ground floor unit with access to a sheltered, secure courtyard and gardens.

People’s experience of using this service and what we found

People and relatives had many positive comments about the caring, welcoming and warm atmosphere in the home. People said staff were kind, friendly and helpful. Relatives said the Good Companions was homely and provided personalised care for each person.

People and relatives said it was a safe place to live and they felt supported and encouraged by staff to lead fulfilling lives. Risks to people were now assessed and managed in a safe way. The home was clean, bright and well-maintained.

People got appropriate support with their medicines, but records were not always completed correctly. We have made a recommendation about this.

There were enough staff to support people. New staff were appropriately vetted before they started to work at the home. People said staff were “always on hand” and relatives commented, “Staff respond to the call buttons quickly.”

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.

People and relatives described the provider and registered manager as open and amenable. Staff said they felt supported by the new registered manager and enjoyed working at the home.

The registered manager carried out checks of the quality and safety of the service and acted on any issues. The provider and registered manager were committed to improvements. Shortfalls from the last inspection had been addressed and a refurbishment programme was taking place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published on 25 January 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an unannounced inspection of this service on 25 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Good Companions (Cumbria) Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Good Companions (Cumbria) Ltd is a residential care home providing personal care for up to 40 older people, including people living with dementia. There were 26 people living there at the time of this inspection.

The care home is a large adapted building. The accommodation is over three floors. People living with a dementia- related condition were accommodated on a lower ground floor unit with access to a sheltered, secure courtyard.

People’s experience of using this service and what we found

The provider's quality assurance systems were not fully effective and did not always identify gaps in records and checks. Risk assessments were not always in place to show staff how to manage potential risks to people’s well-being. There had been no organisational oversight of incidents.

Medicines were not always managed in line with good practice. We have made a recommendation about this.

There were enough staff to supervise people, although the rota needed to be prepared far longer in advance to make sure there was the right skill mix of staff on duty.

The home was clean and comfortable. The provider had sufficient equipment and screening to reduce the spread of COVID-19. Infection control practices had improved recently with guidance from an infection prevention and control nurse.

Relatives praised the “jolly” atmosphere in the home and described staff as caring and kind. The home had a welcoming and friendly culture. Staff were engaging with people.

The provider and management team were open and approachable. Relatives said staff had kept them well-informed throughout the pandemic and recent outbreak.

The home had good working relationships with local health and social care agencies to support the needs and well-being of the people who live there.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 May 2018).

Why we inspected

We received concerns about infection control during a recent outbreak of COVID-19 and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and quality assurance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice:

All staff and essential visitors used appropriate personal protective equipment (PPE).

The home had sufficient supplies of appropriate PPE which was stored hygienically and kept safe.

Staff were provided with separate areas to put on, take off and dispose of PPE safely.

Staff supported people's social and emotional wellbeing. Where people required additional support, they were referred to appropriate services.

The provider explained the quality systems they had in place to check the service was providing safe care.

Deep cleaning of all areas of the home was completed and recorded. The home was decorated to a high standard and care had been taken to ensure all areas were easy to clean.

All staff, including catering and housekeeping staff had completed training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

The provider supported the well-being of their workforce.

Further information is in the detailed findings below.

The Good Companions (Cumbria) Limited (known as Good Companions) is situated in the Victorian seaside town of Silloth overlooking the Solway Firth.

Good Companions 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. When we last inspected this service in January 2016 we rated it as 'Good'.

The home accommodates up to 39 people in a large adapted period property. At the time of our visit there were 39 people living there.

The home had a suitably qualified and experienced registered manager. 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 service focused on people enjoying a meaningful day. Activities were plentiful and varied. People were encouraged and supported to access their local community. The home was very much part of the community and took part in local competitions and charitable events. The people who lived there told us they were extremely happy with their lives within the home. We were told about multiple examples of person-centred activities and events which had been tailored to meet people’s individual wishes and aspirations.

Risk assessments and care plans provided guidance for staff in the home. People in the service were involved in the creating of support plans and were able to influence the content. The management team had ensured the plans reflected the person centred care that was being delivered.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and talked to us about how they would identify any issues and how they would report them appropriately. Risk assessments and risk management plans supported people well. Arrangements were in place to ensure that new members of staff had been suitably checked before commencing employment. Any accidents or incidents had been reported to the Care Quality Commission as nesessary and suitable action taken to lessen the risk of further issues.

The registered manager ensured that there were sufficient staff to meet people's needs in a timely manner. Our findings corroborated this. Staff were suitably inducted, trained and developed to give the best care possible. We met experienced and kind team members who understood people's needs as well as new staff who were keen to learn.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. They accessed hospital appointments as a matter of routine.

We saw that an assessment of needs was in place and that the staff team analysed the outcomes of care for effectiveness. People were very happy with the food provided and we saw well prepared healthy meals that staff supported and encouraged people to eat.

The home itself was warm, clean and comfortable on the day we visited. Suitable equipment was in place to support people with their mobility.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have 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.

We observed kind, patient and suitable support being provided. Staff knew people and their families very well. They made sure that confidentiality, privacy and dignity were maintained. No one was receiving end of life care when we visited but staff were suitably skilled in this.

The registered manager demonstrated good vision and values. Staff were able to discuss good practice, issues around equality and diversity and people's rights.

The service had a quality monitoring system in place which was used to support future planning.

Complaints and concerns were suitably investigated and dealt with and good records management was in place in the service.

The Good Companions (Cumbria) Limited provides personal care to 39 older people some of whom may have complex needs. It is situated in the town of Silloth overlooking the Solway Firth.

Accommodation is provided in single rooms all but one have en-suite facilities. There is a passenger lift and stair lifts giving access to the upper floors. There are three lounges and a dining room allowing freedom of movement about the home. There is a garden area for residents to use

and car parking facilities.

The service had a registered manager. 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 knew how to identify abuse and protect people from it.

The service had carried out risk assessments to ensure that they protected people from harm.

Medicines were ordered, stored, administered and disposed of correctly.

The registered manager had recently reviewed and revamped the training at the home.

People enjoyed the food provided and were supported to take a good diet that was based on an assessment of their nutritional needs.

Staff had developed caring relationships with people who used the service.

Support plans were based on thorough assessments and were written using a person centred approach.

The registered manager provided good leadership. The provider had systems in place to ensure the delivery of good quality care.

On the day of our inspection the service had sufficient staff to meet people’s needs. However we recommended that the service reviewed its deployment of staffing to ensure that people were appropriately supported at night.

Relatives and those who lived in the home told us they were happy with the care and support provided. Comments included'

'I am very happy living here and the staff look after me very well'.

'I enjoyed the chair exercises this morning'.

"I really enjoy my meals especially the cake".

Medication and health care were well managed and people got the right levels of support to keep well and comfortable.

Staffing levels met the needs of the people living in the home. The staff team were skilled, knowledgeable and understood the care of older people with diverse needs.