Cubbington Mill

Cubbington Mill is registered to provide accommodation, nursing and personal care for up to 56 older people, including people living with dementia. At the time of our inspection visit there were 44 people living at the home. The home has two floors with numerous communal areas and a main dining area on the ground floor. People had their own bedrooms and had access to a garden.

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

We found some improvements were still needed to improve the quality of risk management through better and clear recording. This included more effective monitoring of people who required support to maintain skin integrity through repositioning and pressure relieving equipment. This was a concern at the last inspection and although no one had any pressure areas this time, we would expect a robust process to be in place. We raised our concerns to the manager and deputy manager. Following our visit, the regional director sent us an immediate action plan which would address these concerns.

People told us they felt safe living at the home. Staff knew how to protect people from poor and abusive practice. Not everyone felt staffing levels met their needs, however staff and our observations during our visit showed staff met people’s needs and requests for assistance. Staff followed safe principles for infection control and their knowledge, training and practice meant the potential of cross infections was minimised.

Staff were confident in their abilities to support people. Staff training included refresher training alongside an induction for new staff. One to one supervision meetings and regular staff meetings gave staff the opportunity to discuss any developmental opportunities.

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

People told us staff were respectful, kind and caring with their choices being respected. Care plans provided staff with the information and guidance they needed but in some examples, clearer recording would ensure staff support remained consistent. People were supported by other health professionals and agencies.

People were involved in pursing their interests and hobbies. People’s life history information was used to inform staff about their interests. Regular activity sessions were planned and further work was planned to increase people and family’s engagement.

Staff supported people who required end of life care and people’s advanced wishes and preferences were respected. Our planning identified a higher than average number of expected deaths at this home. The deputy manager was confident this was because of the high number of admissions in the last 12 months for people who needed palliative and end of life care.

There were opportunities for people and relatives to give their feedback on the service. The provider’s complaints policy was recently updated and displayed so people had the information they needed. The new manager had plans to improve the service and although not every person or staff member had chance to meet the manager, those who had, gave us positive comments.

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 22 January 2019). 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 enough improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

Cubbington Mill is registered to provide personal care to older people including people living with dementia. Cubbington Mill is a nursing home, which provides care for up to 56 people across two floors. At the time of our inspection there were 47 people living at Cubbington Mill. People had their own bedroom and all the bedrooms had en-suite facilities, plus people had the use of shared communal lounges, dining rooms and bathrooms. To aid people’s movement around the home, a passenger lift and stairs helped people move between floors.

People in care homes receive accommodation and nursing and/or 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.

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.

At our last inspection we rated the service Good overall. However, at this inspection we found standards in how safe wounds were risk assessed and how responsive the service was to meet people’s needs had not been maintained. In Well Led, we found this had changed to requires improvement because there were limited and effective quality assurance checks recorded that assured the provider, people received good care outcomes. Overall, the rating had changed to Requires Improvement and we found a breach of the Health and Social Care Regulations.

People were pleased and satisfied with the quality of care provided by a consistent, kind and caring staff team. People and relatives were complimentary of the service and were supported by enough staff to provide them with the care and support they needed, at the times they preferred.

People said the service was well managed and people and relatives were complimentary of the registered manager. Staff said the registered manager was effective and supportive to them.

Care plans and risk assessments needed more specific information for staff to provide consistent and individualised care. For people assessed as being at risk, care records did not always include sufficient information for staff to help minimise those risks. Staff records were not always completed consistently and in line with the providers expectations.

Staff knew how to keep people safe from the risk of abuse. Staff and the management team understood what actions they needed to take if they had any concerns for people's wellbeing or safety. People told us they felt safe, comfortable and at ease when staff provided their support.

Training records showed staff training was up to date and staff were equipped with the skills and knowledge to look after those in their care. Recent improvements to address staff training had meant staff training exceeded the provider’s expectations.

Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent before any care and support was provided. Staff recognised this was an important part of their role in promoting choice and continuing to promote people’s independence.

People received regular support from district nurses and other health care professionals. People were registered with a GP practice who visited people when needed. If people required healthcare support in an emergency, staff were available 24 hours a day to seek that help.

People received their medicines safely by trained and competent staff but improvements to certain types of medicines was needed so we could be assured, people received their medicines as prescribed.

There were examples of completed audits and checks that gave the registered manager and the provider confidence people received a safe, responsive and effective service. However, some of the issues we found around food and fluid monitoring, record quality and person centred care plans had not been identified in the registered manager’s audits. We did however see; provider level audits had identified some of these concerns but timely actions had not been taken. Changes with senior staff within the home had not always checked and evidenced good care outcomes for people were being provided. This lack of understanding between roles and responsibilities had destabilised the quality of clinical care some people received.

Further information is in the detailed findings below.

Cubbington Mill House is divided into two separate floors and provides personal and nursing care for up to 56 older people, including people living with dementia. There were 50 people living at the home when we inspected the service, supported by 40 care and nursing staff.

At our last inspection in July 2014, the provider was meeting the requirements of the HSCA 2008 (Regulated Activities) Regulations.

A requirement of the service’s registration is that they have 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection. We refer to the registered manager as the manager in the body of this report.

People were protected against the risk of abuse as the provider took appropriate steps to recruit staff of good character, and staff knew how to protect people from harm. Safeguarding concerns were investigated and responded to in a timely way to ensure people were supported safely.

Care and nursing staff knew people well and could describe people’s care and support needs. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people that were important to them.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.

People were supported to access healthcare from a range of professionals inside and outside the home and received support with their nutritional needs. This assisted them to maintain their health. Medicines were stored and managed safely.

People had interests and hobbies offered to them that met their needs and their personal preferences. People were involved in deciding how they wanted their care and support to be delivered and care records reflected the support people received.

People knew how to make a complaint if they needed to. Complaints received were fully investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run. Quality assurance procedures identified where the service needed to make changes, and where issues had been identified the manager took action to continuously improve the service.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they were happy living in the home. They said, "Mum's been here 13 years, I'm very happy with it", "He feels very safe here" and "I do actually."

People were cared for in an environment that was well maintained and fit for purpose. We found it was clean and tidy with no unpleasant odours.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing and a call bell system that people could use to call for assistance.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The manager understood their responsibilities in relation to this legislation.

Is the service effective?

People and visiting relatives and friends told us they were satisfied with the service provided. They told us, "The staff are very attentive here", "I couldn't be more satisfied to be honest" and "She's never looked better, she always looks well cared for."

People had assessments of need in place from which care plans and risk assessments had been completed. Care plans were evaluated monthly, and people or their relatives were involved the formal reviews which took place on a six monthly basis.

Is the service caring?

People were cared for by staff who were friendly, kind and attentive. Interactions we observed between staff and people who lived in the home were positive and respectful.

People and visiting relatives told us, "It's wonderful here, the staff are very good" and "They check on you regularly."

Is the service responsive?

Systems and processes were in place to monitor and manage complaints, accidents and incidents.

People and relatives we spoke with told us they were able to approach the manager and staff freely to discuss any concerns or worries they had.

Is the service well led?

There were processes and systems in place to monitor the service provided. The manager used the information gathered through these processes to assess and improve the quality of service for people.

Staff were well supported and received training to enable them to carry out their role efficiently.

We looked at a whether people were involved with their care following concerns from our previous inspection on 30 May 2013 to see whether any improvements had been made to the service.

We found overall there had been improvements made since our last inspection.

People and relatives we spoke with told us that the care planning was discussed with them regularly. We saw that people or relatives were involved with the reviews of people's care.

We saw that staff listened to people about their care needs and their wishes. We saw people's independence was promoted within their care plans and on the day of our inspection.

People and relatives we spoke with told us that the care planning was not discussed with them. We saw that people or relatives were not involved with the reviews of people's care.

We saw that staff listened to people about their care needs and their wishes. We saw people's independence was promoted within their care plans and on the day of our inspection.

We found that the care plans were person centred and reflected people's individual needs. We saw the members of staff supported people as detailed within their care plans. We observed that staff were compassionate and caring when supporting people.

People we spoke with told us that staff were friendly and supported their needs well. We saw staff knew what people's care needs were and how they needed to be supported.

We spoke with four staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

We found that people were involved with the service and systems were in place to monitor the quality of service being provided.