Cumberland Court

Cumberland Court is a residential care home providing accommodation and nursing care to up to 20 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 17 people using the service.

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

People’s care plans and records were not always well completed. The quality of the service was regularly monitored through audits. Where shortfalls were identified these were not always addressed in a timely way. We identified areas where further improvements were needed in relation to people receiving appropriate oral care and the general tidiness of the environment.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s risks were managed safely. Staff knew people well and understood the risks associated with their care and support. People were protected from the risk of infection. Staff understood safeguarding risks and procedures and knew what to do if concerns were raised. People were supported to receive their medicines when they needed them. There were enough staff, who had been safely recruited, working in the service.

People were supported to have enough to eat and drink throughout the day. Staff received regular training and supervision to ensure they had the knowledge and skills to support people. People were supported to maintain and improve their health with support from health care professionals.

There was a positive culture at the home. Feedback from people, visitors and staff was good. The provider and care manager were committed to improving and developing the service.

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 good (published 27 July 2019).

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. Please see the effective and well-led sections of this report.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We have identified breaches in relation to Need for Consent and Good Governance 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.

We found the following examples of good practice.

The home was clean and tidy throughout. Systems in place ensured areas of the home that were frequently touched, such as light switches and door handles were cleaned regularly.

People were supported to maintain contact with their family and friends. Visitors were welcomed to the home; they were able to meet with loved ones in their bedrooms which allowed them time together in private. There was an appointment system to ensure visits could be managed safely.

The testing program for people and staff was followed in line with government guidance. All visitors to the home, both family and professionals, were required to provide a negative test before entering.

PPE was available throughout the home and staff were seen to be using this appropriately. There was adequate stock available.

Cumberland Court is a care home providing accommodation and personal care for up to 20 older people, in one adapted building. At the time of the inspection there were 15 people living at the home. People living at the home had a range of needs. People's needs were frailties associated with old age. Some people were living with the early stages of dementia.

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

People received support from staff who knew them well, understood their needs, and were kind and caring. People’s care and support needs were assessed and reviewed. This meant people received care that was person-centred and reflected their needs and choices.

People were supported to maintain their own interests and friendships. They were able to take part in a variety of individual and group activities that were meaningful, and they enjoyed.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

Staff understood the risks associated with the people they supported. Risk assessments provided further guidance for staff about individual and environmental risks. People were supported to receive their medicines when they needed them.

Staff received training that helped them to deliver the care and support people needed. They received regular supervision. People's health and well-being needs were met. They were supported to receive healthcare services when they needed them. People's nutritional needs were assessed. They were supported to eat a wide range of healthy, freshly cooked meals, drinks and snacks each day.

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.

The provider and registered manager had good oversight of the service. They knew staff and people well and provided a supportive environment to live and work. There were a series of audits which helped the provider and registered manager to identify where improvements were needed to continue to develop the service.

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 10 July 2018) and there were two breaches of regulation. We issued a warning notice and met with the provider to discuss the improvements that were needed. The provider completed an action plan to show what they would do and by when to improve.

At this inspection we found improvements had been made, the warning notice had been met and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.

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

Follow up

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

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made improvements, and check that the service now met legal requirements. We found some improvements had been made, however the breach of regulation had not been met. We also identified a further breach of regulation. This is the second time the service has been rated 'Requires Improvement'.

Cumberland 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. Cumberland Court provides accommodation and personal care for up to 20 people in one adapted building. At the time of the inspection there were 17 people living there. People living at the home were older people who had a range of needs associated with old age and their health. Some people were living with the early stages of a dementia type illness.

There was a registered manager at the service. 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.

This inspection found risks to people were not always well managed. Although staff understood the risks associated with supporting people not all risks had been identified. Guidance was not always in place to inform staff. People’s records did not fully reflect the care and support they required and received. We found improvements were needed to ensure people were able to access a variety of meaningful activities throughout the day.

There was a training and supervision programme in place to help ensure staff had the appropriate knowledge and skills to meet people’s needs. Staff had received training in line with the provider’s policy.

There was a quality assurance system in place and this had improved since our previous inspection. However, it did not reflect all the shortfalls we found in relation to people’s risks, care records and activities.

There were enough staff working during the week. However, there were less staff working at the weekend. We identified this as an area that needs to be improved to ensure enough staff are working each shift. A safe recruitment system was being followed.

People spoke highly of the staff and were positive about the care provided. Staff knew people well and had developed good relationships with them. They had a good understanding of the care and support people needed. This helped to ensure people received care that met their individual needs and choices.

Systems were in place to ensure accidents and incidents were well managed. Action was taken to prevent a reoccurrence. Staff understood the procedures to safeguard people from the risk of abuse. Staff knew what steps to take if they believed someone was at risk of harm or discrimination

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Nobody living at the home was subject to a DoLS. Systems were in place to ensure medicines were ordered, stored, administered and disposed of safely. Where possible people were supported to manage their own medicines.

People were supported to eat and drink a variety of food that met their individual needs and preferences. Their health and well-being needs were met. People were enabled to have access to healthcare services, such as the doctor, when they needed them.

A complaints procedure was in place and complaints were responded to appropriately. The provider, registered manager and staff were working to improve and develop the service.

We found breaches 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.

The service did not have a registered manager however there was an appointed manager working at the home and had day to day responsibility. 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.

We previously undertook an inspection in September 2016 to look at the question 'is the service safe.' This had been in response to concerns raised with us about the safety of the service. We found there was a breach in regulation because the provider was not always ensuring care was provided in a safe way to people. The provider sent us an action plan and told us they would address these issues by the end of December 2016. We undertook an inspection on 7 and 9 March 2017 where we found the provider was meeting the legal requirements that were previously in breach. However, these improvements were not, as yet, fully embedded in practice and need further time to be fully established in to everyday care delivery.

There were systems in place to ensure medicines were safely managed. However, there was a lack of guidance for people who had been prescribed ‘as required’ (PRN) medicines.

There was an audit system in place however this had not identified all the shortfalls we found. People’s records did not reflect the care they required and received. However, this had a limited impact on people because staff had a good understanding of their needs and were able to tell us about the care people needed and received.

People were supported by staff who were kind and caring. Staff knew people well and had a good understanding of their needs. People received care that was person-centred and reflected their individual choices and preferences. Staff had the knowledge and skills they needed to look after people.

There were enough staff to support people and meet their needs. Recruitment records demonstrated staff had been appropriately employed and were suitable to work with people who used the service. Staff received appropriate training and support to enable them to look after people and had the skills to perform their roles.

Staff knew how to recognise different types of abuse and were clear on how to respond to any allegation or suspicion of abuse. Environmental risk assessments had been completed and actions taken to ensure people's safety.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to maintain a healthy diet of their choice. They were supported to maintain good health and they had access to relevant healthcare professionals when required.

People were involved in the day to day running of the home. They were asked for their feedback which was listened to and used to improve and develop the home.

There was an open and positive culture at Cumberland Court. This was focussed on ensuring people received good person-centred care that met their needs. People and staff spoke highly of the provider and manager and told us they would always address their concerns.

We found a breach of the Regulations 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 this report.

At the time of this inspection 17 people were living in the service. This inspection took place on

16 September 2016 and was unannounced. The inspection only covered the question ‘is the service safe.’ This was in response to contact from whistle blowers who raised concern about the safety of the service.

The service did not have a registered manager a recently appointed manager had taken up post on the day of this inspection. 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.

Cumberland Court was registered under new ownership in January 2016. A registered manager was in post at this registration. Since registration there has been three changes in the manager. The provider has recognised the need for an established leadership for the service. They have contracted an external professional consultant to establish this.

The staffing arrangement which included one staff member working at night did not ensure the safety of people living in the home in the event of an emergency situation. The Personal Emergency Evacuation Plans (PEEPs) completed identified many of the people needed support and guidance to move to a place of safety if there was a fire in the home.

The provider had not taken account of all possible environmental risks and taken action to minimise them. This included completing an infection control risk assessment and addressing any areas to minimise the risk of infection.

The provider had not ensured staff administering medicines followed clear guidance that maintained safe storage and administration of medicines. Systems to assess people’s individual risks were not followed for all people and guidelines for staff to follow to minimise any risk were not in place for all people. Therefore the provider could not be assured people received safe and effective care.

People said they were happy and well looked after. We found people were comfortable and happy moving around the home and spending time where they wanted to. The provider ensured a thorough recruitment procedure was followed when new staff were employed. Staff understood how to recognise any possible abuse and how to respond to any suspicion or allegation of abuse to safeguard people.

We found a 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 this report.