Cumberland

We found the following examples of good practice:

The provider was following best practice guidance to prevent visitors to the home spreading the Covid-19 infection. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home. There was a toilet next to the reception area where visitors were able to don and doff personal protective equipment (PPE). The home had a stock of PPE for visitors to use in the reception area and there were designated bins for PPE after use. The provider requested that visitors book visiting appointments. There were four slots available per day, two in the morning and two in the afternoon. Essential care givers were able to visit in the room of their friend or family member. Other visitors were able to visit residents in the visiting pod which had been set up in the grounds of the premises. Visitors were supported to wear the appropriate PPE when visiting. Visitors were required to undertake a lateral flow test, either on the premises or at home and provide the home with a negative result. There were multiple signs on the premises about infection prevention and control (IPC) and PPE.

The provider understood and was meeting Covid-19 vaccination requirements. The provider supported alternative forms of maintaining social contact for friends and relatives; for example, keeping in touch using video calls, window visits, visits in the communal garden and using a telephone to communicate. During a recent outbreak, the provider had minimised visiting. It had held a meeting with the families of residents who had tested positive for Covid-19 and explained the reasons for this. The provider had a process for the monitoring of residents for Covid-19 symptoms and lateral flow testing was completed if they had an outside visit or a hospital appointment. The provider had completed risk assessments for residents, which it had reviewed, where it considered the risks of Covid-19 and how risks could be mitigated.

The provider had a process in place for the isolation of residents in the case of positive Covid-19 cases and if staff tested positive for Covid-19. The home had a recent outbreak of Covid-19 and had completed a specific outbreak management plan to manage this outbreak. This reviewed the clinical action taken, staff allocation, laundry and housekeeping management, catering management and wellbeing. During the outbreak, the provider had increased the testing for both staff and residents.

The provider had no admissions during the Covid-19 pandemic, however, it had a process for admissions and there were clear procedures to be followed for people admitted to the home.

The manager had oversight of IPC and IPC lead, who both helped train staff internally. Audits were undertaken to ensure compliance with IPC responsibilities and there were also hand washing audits and spot checks of cleaning completed. Staff had completed IPC training and refresher training. Use of PPE at the home was in accordance with current government guidance.

The provide had supported staff wellbeing during the Covid-19 pandemic, and in particular during the recent outbreak. The provider had a staff member who ensured that residents were engaged and had activities available.

The provider ensured that the home was well ventilated, with windows and doors opened where appropriate to facilitate ventilation. The home had a separate laundry and good practice for linen and laundry guidance was followed.

Further information is in the detailed findings below.

We found the following examples of good practice.

The provider had robust measures in place to help prevent or minimise the risk of people who lived, worked and visited the care home catching or spreading COVID-19.

We observed managers and staff wearing personal protective equipment (PPE) correctly throughout our inspection. Staff had received up to date infection prevention and control (IPC) and COVID-19 training, which was being routinely refreshed. The service had adequate supplies of PPE that met current demand and foreseen outbreaks.

There were IPC and PPE policies and procedures in place, which were regularly updated to reflect ongoing changes to COVID-19 related guidance and were followed by staff. This included contingency plans for managing adverse events, such as COVID-19 outbreaks and staff shortages. The registered manager told us in response to a number of incidents where staff were found not wearing their PPE correctly they had increased the frequently of their walkabout tours of the care home to monitor staffs PPE wearing practices, which now included unannounced spot checks on staff working at night.

Access to the care home remained restricted, although five designated person could now visit their relative or friend in line with Government COVID-19 care home guidelines. All visitors to the care home had to follow the providers strict IPC guidance.

Alternative arrangements remained in place to help people maintain relationships with people that were important to them. For example, people were actively supported by staff to keep in touch with people that could not visit the care home in-person via telephone and video calls. People could also meet family members and friends in the wider community.

Any new admissions to the care home or people returning after a stay in hospital were required to have a negative COVID-19 test and self-isolate for at least ten days to minimise the risk of the virus spreading.

The provider continued to participate in a ‘whole home’ COVID-19 testing program. This ensured everyone living, working or visiting the care home were regularly tested for COVID-19. The provider knew how to apply for COVID-19 home testing kits and had adequate supplies.

The care home was kept hygienically clean. There were detailed records kept of staffs new cleaning schedules, which included a rolling program of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles. The registered manager told us they had employed additional cleaners during the pandemic to help with their increased cleaning responsibilities and demands.

The provider had thoroughly assessed infection risks to everyone living and working in the care home and where people were deemed to be disproportionately at risk from COVID-19, appropriate action had been taken to minimise the impact. For example, staff with underlying health care conditions or members of black, Asian and minority ethnic groups, had not been allowed to work on the floor where people who had tested positive for COVID-19 had been isolating.

The care home had reduced the number of temporary agency staff they used and ensured bank staff worked exclusively in the one care home to reduce the risk of spreading infection.

The Cumberland is a care home that can provide nursing and personal care for up to 56 older people. At the time of our inspection 33 people were living at the Cumberland. The building is purpose built and is divided into two separate wings, each with their own adapted facilities. Most people using the service were living with dementia.

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

People were positive about the service. Most people using the service, their relatives and staff all spoke positively about the new management team and felt the service had definitely begun to improve in the last six months under their leadership.

At this inspection we found the provider had made good progress against all the outstanding breaches of regulations in relation to the way they managed medicines on behalf of people using the service and ensuring staff who worked at the care home were well trained and supported. This meant people received their medicines as prescribed and the right levels of care and support from competent staff.

People continued to be supported by staff who knew how to prevent and manage risks they might face and keep them safe from avoidable harm. The provider was less reliant on temporary agency staff, which meant people received continuity of care and support from staff who were familiar with their care needs, wishes and daily routines. Staff who worked at the care home had now received the right levels of up to date training and support they required to effectively meet the needs of people they supported. All new staff continued to undergo all the relevant pre-employment checks to ensure their suitability and fitness for the role. The provider had effective systems in place to assess and respond to risks regarding infection prevention and control, including those associated with Covid-19.

People, their relatives and staff all spoke positively about the way the care home was now managed. Since our last inspection the service had appointed a new suitably fit, experienced and competent person to run the care home who was registered with us in June 2020. Furthermore, the service has a new deputy manager, regional director and regional quality development manager.

The provider’s governance systems were now effectively operated, ensuring the quality and safety of the service people received was routinely monitored and assessed. The provider continued to consult people, their relatives and staff as part of their on-going programme of improving the service. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver positive outcomes for people using the service.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 3 February 2020). This was because we found multiple breaches of legal requirements in relation to the safe management of medicines and the way staff were deployed throughout the care home. The provider completed an action plan setting how they could improve.

At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations. This report only covers our findings in relation to the Key Questions; Is the service Safe, Effective and Well-led? The overall rating for the service has now improved to good.

Why we inspected

This inspection was prompted in part due to ongoing concerns we received about the service’s continued high turnover of managers and the safe management of medicines. A decision was made for us to inspect and examine the risks associated with these issues.

Care Quality Commission (CQC) has introduced focused/targeted inspections to follow up on previous breaches and to check specific concerns.

We used the targeted inspection approach to look at a specific concern we had about staff support associated with the key question, Is the service effective? As we only looked at part of this key question, we cannot change the rating from the previous inspection. Therefore, the key question for is the service effective remains rated as requires improvement.

We undertook a focused inspection approach to review the key questions of Safe and Well-led where we had specific concerns about medicines management, staffing levels, staff training and support, fire safety and quality assurance governance.

As no concerns were identified in relation to the key questions is the service Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The Cumberland is a care home providing accommodation and nursing and/or personal care for up to 56 people. At the time of our inspection 45 older people lived at the care home, which is a single building divided into two separate wings, each with their own adapted facilities. Most people using the service were living with dementia, while some had mental ill health, behaviours that might be considered challenging and complex health care needs.

People’s experience of using this service

People remained positive about the way staff treated them, with most people stating staff were caring.

However, other comments we received were mixed about staff not always being visibly present in the care home and the high turnover of managers they had experienced in the last year. At this inspection, we found the service was not always safe, effective or well-led. People were placed at risk of harm because the provider did not always follow relevant national guidelines regarding the safe management of medicines and fire safety, staffing levels were not always adequately deployed throughout the care home, staff training and support was not always sufficient and their governance systems had failed to pick up all the aforementioned issues.

We found the service remained caring and responsive.

We also saw people were still cared for by staff who knew how to protect them from avoidable harm. Staff continued to undergo all the relevant pre-employment checks to ensure their suitability and fitness for the role. The premises remained clean and staff followed relevant national guidelines regarding the prevention and control of infection.

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 were still offered well-balanced meals that meet their dietary needs and wishes and were supported to stay healthy and well. Since our last inspection the services main communal areas had all been refurbished.

People continued to be treated equally and had their human rights, diversity and privacy respected. People were encouraged to make decisions about the care and support they received. People were supported to be as independent as they could and wanted to be.

People had their own individualised care plan for staff to follow. People’s communication needs and preferences continued to be respected and met. People were aware of the providers’ complaints policy and how to raise any concerns or complaints they may have. When people were nearing the end of their life, they continued to receive compassionate and supportive palliative care.

People, their relatives and staff all spoke positively about the leadership approach of the temporary interim manager. The manager involved people and staff in the running of the care home and worked in close partnership with community professionals and groups.

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

Rating at the last inspection

The last rating for this service was good (published 27 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches of regulation that relate to the unsafe management of medicines and inadequate staffing levels.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last Care Quality Commission (CQC) inspection in March 2015, the overall rating for this service was ‘Good’. At this inspection we found the service remained ‘Good’. The service demonstrated they continued to meet regulations and fundamental standards.

People continued to be safe at Cumberland. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. The premises and equipment were safe for people to use because staff routinely carried out health and safety checks. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs. They also received the support they needed to stay healthy and to access community healthcare services.

Staff were caring and treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. Staff encouraged people to actively participate in leisure activities, pursue their social interests and to maintain relationships with people that mattered to them.

The registered manager continued to provide good leadership and the management team led by example. The service had an open and transparent culture. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.

Further information is in the detailed findings below.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see evidence supporting our summary please read the full report.

Is the service safe?

People using the service told us they felt safe. Assessments were carried out by staff to make sure that people's needs were identified and met. Risks were assessed and reviewed regularly to make sure people's changing needs were met. People were supported to take their medicines in a safe way.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had undertaken training in DoLS and in the Mental Capacity Act (2005) and they were aware of their responsibilities. Relevant staff had been trained to understand when an application should be made and how to submit one. We saw that applications under the Mental Capacity Act had been done so appropriately.

Policies and procedures for safe working practices were in place to monitor that the service was prioritising people's safety. There were systems in place to ensure management and staff learnt from incidents and accidents and other untoward events.

Is the service effective?

Staff encouraged and supported people to make choices and decisions about how they lived. People's wishes were respected and we saw staff obtaining people's agreement before any care was provided. This meant that people had choice and dignity in the care provided to them.

People's specific needs were taken into account and there was guidance and instructions for staff on how these should be met. People's care plans were reviewed regularly and any necessary changes made. In this way people were receiving care that was appropriate to their needs.

Staff encouraged and supported people to keep healthy and well through regular monitoring of people's general health and making sure they attended scheduled medical and healthcare appointments.

Is the service caring?

People were supported by attentive and patient staff. We saw them give encouragement to people and these interactions were caring and compassionate. Staff respected peoples' privacy, dignity and their right to be involved in making decisions and in making choices about their care and treatment.

All the people we spoke with gave us positive feedback on the care and support they received in the home.

Is the service responsive?

We found staff continually monitored people's condition and where necessary sought advice and assistance from other community based health and social care professionals.

The views of the people using the service and their relatives were routinely sought by the provider who regularly had contact with them and also used annual questionnaires to ascertain their views. People we spoke with knew how they could make a complaint if they were dissatisfied or unhappy with the service they received.

Is the service well led?

The service had a registered manager who was experienced and knew the service well.

The provider carried out regular checks to assess and monitor the quality of the service provided. In this way the provider could ensure that the quality of the service was maintained.

Staff told us they were clear about their roles and responsibilities. Staff felt able to raise concerns and said that their manager was approachable and would act upon any concerns they raised.

On the day of our inspection we were able to speak to five people who used the service who told us that they felt safe living at Cumberland Lodge and that they liked the staff and food. We were also able to speak to two relatives/representatives of people who used the service. They were positive about the care at Cumberland Lodge, one person told us 'I'm happy, he's happy' and someone else said 'I can't fault the home, they really look after (name of resident).'

Cumberland Lodge had a warm, friendly atmosphere with a number of people visiting the home. There were also a large number of support staff who in undertaking their work freed up care staff to undertake work directly with people. In addition, the support staff were generally aware of the needs of people who used the service and were therefore able to engage with them in an understanding and meaningful way.

Cumberland Lodge was in the process of a planned refurbishment which was yet to start. To minimise disruption to people who use the service, the home had not been at full capacity. On the day of our inspection the home had 40 people resident, even though it was registered for 56.

On the day of our inspection we were able to speak to eight sets of relatives about the care provided at Cumberland Lodge. All were positive and comments included, 'my wife is very well looked here and I am happy' and 'satisfied with it, they're very kind and gentle'.

We did talk to four people who use the service and received some comments, however, because of people's needs we also completed a Short Observational Framework Inspection (SOFI) which is an observational tool to look at people's well being.

Cumberland Lodge had many positive aspects. There was a warm, friendly atmosphere with a number of relatives visiting the home. Staff had a good understanding of people's needs and were able to respond appropriately. The home also employed a full time activities co-ordinator for each unit.

There were some minor areas that could improve the home, these have been commented on within the body of the report.