• Care Home
  • Care home

Archived: Cunningham House

Overall: Requires improvement read more about inspection ratings

Pike Way, North Weald, Epping, Essex, CM16 6BL (01992) 524160

Provided and run by:
Abbeyfield Society (The)

All Inspections

22 November 2023

During an inspection looking at part of the service

About the service

Cunningham House is a residential care home providing personal care for older people. Younger adults and people living with dementia. The service can support up to 54 people, at this inspection 20 people were living at Cunningham House

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

People did not always receive personalised care and support. People were not always supported to have maximum choice and control of their lives and staff did not always support them in their preferred way and in their best interests. People’s personal preferences were not always respected and their independence was not always promoted.

The provider had arrangements in place to assess and monitor the quality of the service provided. However, these processes had not been effective in addressing shortfalls in relation to personalised care and promoting people’s independence.

The provider had made suitable arrangements to help keep people safe. Staff had received training about safeguarding people and understood how to report any concerns. Risks to people were identified and managed to help prevent them from receiving unsafe care and support. The provider’s arrangements for medicine administration helped to ensure people received their medication in accordance with the prescriber’s instructions and staff’s practice was safe.

Staffing levels were appropriate to meet people’s care and support needs. Robust recruitment procedures were followed to help ensure the right staff were employed to care for people. People were protected by the provider’s arrangements for the prevention and control of infection.

Feedback about the management was overall positive. Staff felt there was more support available to them now after a period of instability in the home’s leadership, which had negatively impacted on morale and culture in the home.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 05 November 2022). 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 the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 September 2022. 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 the safe care and treatment, staffing, personalised care and overall management oversight.

We undertook this focused inspection to check the provider 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, Responsive 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 remains Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cunningham House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to personalised care and management oversight. 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

21 September 2022

During an inspection looking at part of the service

About the service

Cunningham House is a residential care home providing personal care for to up to 54 people. The service provides support to older people. At the time of our inspection there were 40 people using the service, one of whom has a learning disability. Accommodation is provided across two connected areas, one of which specialises in providing care to people living with dementia.

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

People were not always supported by enough staff and their care plans and risk assessments were not always up to date. Oral hygiene was poor, and food and fluid intake were not always documented accurately. People received their medicines safely.

People and their families were not always involved in their support plans. Care plans included people’s likes and dislikes, but care provided did not always reflect people’s preferences. There was little evidence of personalised activities for people.

There were issues with relationships among the staff teams. The manager was aware of this and had identified various other areas of improvement required. At the time of the inspection action taken had not yet been effective.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 29 December 2017).

Why we inspected

We received concerns in relation to staffing levels, people being woken up from 3am for personal care and left without food or fluids and medication errors. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 good to requires improvement based on the findings of this inspection. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cunningham House on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk assessments, poor oral hygiene and food and fluid documentation, staffing levels, people not receiving personalised care and the culture within the service at this inspection.

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

8 November 2017

During a routine inspection

Cunningham House 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. Cunningham House accommodates 54 people across two separate areas, each of which has separate adapted facilities. One of the areas specialised in providing care to people living with dementia.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People and relatives told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

Medicines were stored, administered and managed safely and we saw evidence of recent improvements. The provider regularly checked the premises and equipment were safe for people to use.

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

Care plans were written in a very person centred style and were regularly reviewed to reflect peoples' individual care and support requirements. People were given safe care because risks had been identified and managed.

Staff were well motivated, proud of the service and felt listened to. Staff had regular opportunities to reflect on their practice and to request any additional support or training.

The provider was actively looking at ways to improve the quality of the food to meet people’s preferences. People were supported to eat and drink enough to maintain a balanced diet and referred to other healthcare professionals when their health needs changed.

People and their relatives were encouraged to share their opinions about the quality of the service, through meetings. Staff were supported in their practice by a manager they liked and respected.

The provider's quality monitoring system included regular reviews of people's care plans, checks on medicines management and staff's practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Further information is in the detailed findings below.

30 November 2015 & 1 December 2015

During a routine inspection

The inspection was completed on 30 November 2015 and 1 December 2015 and there were 48 people living at the service when we inspected.

Cunningham House provides accommodation and personal care for up to 54 older people and people living with dementia.

A registered manager was 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. At the time of the inspection we were advised that the registered manager was providing additional support to another service belonging to the registered provider. However, the Head of Care was deputising for them in their absence. Both the registered manager and Head of Care confirmed that they communicated with each other on a daily basis and there was no negative impact on the day-to-day running of Cunningham House.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided. People who used the service and their relatives were involved in making decisions about their care and support.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

Care plans accurately reflect people’s care and support needs. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

7 November 2013

During an inspection looking at part of the service

When we previously inspected Cunningham House in May 2013 we found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate records were not maintained. We required the provider to make improvements.

We inspected the home again on 07 November 2013 to check whether improvements had been made. We found that records relating to food and hydration were accurate and detailed. We found that the provider had begun a review of care plans to ensure that they accurately reflected people's needs, we noted that this area was 'work in progress' at this inspection.

8, 14 May 2013

During a routine inspection

We saw staff supporting people living with dementia meet their daily living needs by communicating with them in a quiet and patient manner. This helped to ensure that people's agitation and distress were kept to a minimum and enabled people to participate in activities and live their lives as fully as possible in the home.

People who used the service were not involved in developing the menu at Cunningham House and gave us varied feedback about the food provision. For example, some people said they liked the food, comments included, 'It's lovely but too much, I wouldn't normally eat this much.' Other people told us they were less pleased with the food provision with comments including, 'I would like better food, the menu is monotonous with cheap cuts of meat.' People were recorded in residents' meetings as saying, 'Some days the food is good, other days it is not good.'

On the day of our inspection the home appeared clean and well maintained. We saw that personal protective equipment such as gloves was available to staff members. Records showed that staff had completed annual training in infection control.

We spoke with relatives of people who used the service about complaints. They told us they were confident to raise concerns with the management team.

4 April 2012

During an inspection in response to concerns

We spoke with two relatives and two people who use the service who told us that people at Cunningham House, including those who have difficulty with verbal communication, were supported in promoting their independence and community involvement where possible. They said that people were treated with dignity and respect and that people were encouraged to express their views and were involved in making decisions about their care and treatment.

People and relatives we spoke with told us that care and treatment was planned and delivered in a way that ensured people's safety and welfare. One person said 'They will listen and get things right' another said 'The staff are lovely, I like it here, they care about me.'

12 December 2011

During an inspection looking at part of the service

People we spoke with said that they were happy that the home manages their medicines on their behalf. One person said "I don't think I could remember them all myself now so it's best they do it for me."

17 June 2011

During a routine inspection

People living at Cunningham House told us that they were treated with dignity and respect and their independence was supported and encouraged. People with whom we spoke told us they were satisfied overall with the care and support they received at the home. This included in relation to healthcare matters.

People using the service told us they felt safe at Cunningham House. One person with whom we spoke told us that they could say if they were unhappy or concerned about anything, they felt safe there and said 'I know who people are so that feels better.'

People told us that they were comfortable at the home and were able to bring some of their own possessions to make it more homely and personalised. 'I brought my own furniture, my bed, chair and other things, it's nice.' Another person said 'My room is very pleasant and comfortable.'

People were complimentary about the staff working at the home. One person said 'The staff are very good, they are polite and friendly and they respond to the buzzer when I call.' Some people said there were enough staff on duty to meet their needs. Other people found that staffing levels did not fully meet their needs at times and they had to wait a long time for a drink in the morning.

People using the service told us that they felt able to express their views and had opportunity to do so at Cunningham House. One person with whom we spoke said 'We are very happy but could certainly say if we were not happy with something.' Another person said 'The manager is very good, anything you do not like, they will come and shut the door, sit and listen and sort it out.'

A healthcare professional with whom we spoke said that, in their opinion, this is one of the best care homes in the area and that 'People are cared for and about.' They also told us that staff are competent and available and report matters promptly to ensure people's wellbeing.