The Cumberland

The Cumberland is a residential care home providing the regulated activity of personal care to up to 29 people. The service provides support to people living with dementia. At the time of our inspection there were 16 people using the service. The service is a large, converted property and accommodation is arranged over three floors.

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

People told us they felt safe living at The Cumberland. Relatives told us their loved ones were well cared for. Long standing staff knew people well and supported them in the way they preferred. However, some risks to people had not been assessed and mitigated. Guidance had not been consistently provided about people’s needs and the support they required. This was important as the provider used agency staff to cover staff vacancies and there was a risk they would not know how to provide people’s care. People’s medicines were not stored safely or managed consistently.

There were not always enough staff to meet people’s needs. The manager supported staff to care for people at times and this took them away from managerial tasks. The provider had not developed the environment to support people living with dementia to remain independent, including the use of signs to help people move around without support. However, staff supported people to continue to look after themselves as much as they wished. We have made a recommendation about best practice in dementia environments.

The provider’s checks and audits had not identified all the shortfalls at the service. Actions planned to address shortfalls the provider identified had not always been completed in the timescales they set out. The manager was realistic about the improvements needed and the action required to achieve them. The service was clean, however action had not been taken to protect people from all infection risks.

The manager had been working at the service for several months and had not applied to be registered with CQC. Staff told us they manager had made positives changes to the culture of the service and to people’s lives. They had worked with mental health professionals to reduce people’s anxiety and agitation and this had improved the quality of people’s lives.

Relatives and staff had shared their views, and these had been acted on to develop the service. Lessons had been learnt when things went wrong and action had been taken to reduce the risk of incidents occurring again. Staff had been recruited safely and checks had been completed on staff’s conduct in previous roles. Staff had the skills they needed to meet people’s needs.

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.

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 24 May 2018).

Why we inspected

This inspection was triggered in part by potential risks around 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 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. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 The Cumberland 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 the management of risks and medicines, staff deployment, care records and the effectiveness of the provider’s checks and audits at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

The Cumberland is a ‘care home’. People in care homes receive accommodation and nursing 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 Cumberland accommodates up to 29 people living with dementia in one adapted building. There were 25 people using the service at the time of our inspection. The Cumberland exclusively offers a service to women.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated Good

The registered provider had oversight of the service. The registered manager and management team checked that the service met the standards they required and worked to continually improve the care people received.

Staff felt supported by the management team, they were motivated and enthusiastic about their roles. A member of the management team was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be. All the staff and community professionals we spoke with told us they would be happy for their relatives to live at The Cumberland. Records in respect of each person were accurate and complete.

Staff were kind and caring and treated people with dignity and respect. One relative told us the care the staff provided had “Allowed me to go back to being a daughter again”. Staff had taken time to get to know each person well and provide the care they wanted in the way they preferred. People received the care and support they wanted at the end of their life. Since our last inspection the provider had begun to implement the Gold Standards Framework (GSF) for end of life care. The GSF is a recognised approach to ensuring that everyone receives appropriate and individualised care which takes account of their wishes and preferences at the end of their life.

Staff knew the signs of abuse and were confident to raise any concerns they had with the management team. People were not discriminated against and received care tailored to them. People and their relatives were confident to raise any concerns they had. A process was in place to investigate and resolve any complaints or concerns received. People had enough to do during the day, including taking part in activities they had enjoyed.

Assessments of people’s needs and any risks had been completed and care had been planned with them and their relatives, to meet their needs and preferences and keep them safe. One person’s relative had commented, ‘It was a lovely experience seeing her so happy’.

Changes in people’s health were identified quickly and staff contacted their health care professionals for support. People were encouraged to stay as physically and mentally active as possible. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet of food they liked and that met their cultural needs and preferences.

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. The registered manager knew when assessments of people’s capacity to make decisions were needed.

There were enough staff to provide the care and support people needed when they wanted it. Staff were recruited safely and Disclosure and Barring Service criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The service and equipment were clean and well maintained. The building had been adapted to meet people’s needs and make them feel comfortable. People were able to use all areas of the building and grounds and were encouraged to make their bedroom feel homely.

The registered manager had informed CQC of significant events that had happened at the service, so we could check that appropriate action had been taken.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall and on their website.

Further information is in the detailed findings below.

We spoke with some visiting relatives who said “They are really nice here, the staff are lovely. My (relative) was ‘difficult’ when she moved in because of her anxiety, the staff coped with this well and managed to settle her down” and “ They phone me all the time to update and reassure me. I trust the staff.”

People’s needs were assessed and detailed in care plans that provided staff with clear guidance. Staff understood people’s needs especially relating to dementia. Records were available and up to date and were stored securely protecting people’s confidentiality.

People maintained good physical and mental health because the service worked closely with health and social care professionals. The home was safe, well maintained and suited people’s needs. Each bedroom was personalised with people’s own photographs and pictures. One visitor said “The home is always immaculately clean. I cannot fault it.”

There was enough skilled and experienced staff to meet peoples’ needs. Staff were thoroughly vetted before they started working at the service. Staff worked together as a team with each shift planned in advance so that staff knew their roles and responsibilities. Staff engaged with people in a calm, respectful and reassuring manner. Staff acted quickly and appropriately in response to people who looked upset, uncomfortable or anxious.

The service recently took part in a research project by the University of Kent looking at people’s well-being. For more information please contact the provider.