We inspected Cumberland Court on 8 and 9 May 2018. The first day of the inspection was unannounced. The home has been inspected twice under the current provider. We undertook an inspection in September 2016 to look at the key question 'safe.' This was in response to concerns raised about the safety of the service. We found the provider was in breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and this key question was rated inadequate. We inspected the service again in March 2017 where we found improvements had been made and the provider was meeting the regulation. However, further improvements were required to ensure these improvements were fully embedded into practice. At this inspection we also found people’s records did not reflect their care and support needs and were not well completed. This had not been identified through the audit system and this was a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was rated requires improvement. The provider sent us an action plan and told us how they would address these issues.

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.

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Cumberland Court provides care and support for up to 20 older people with care needs associated with older age. The needs of people varied, some people were mainly independent others had low physical and health needs. The care home provided respite care with some people coming back to the home for short stays on a regular basis when they or people looking after them needed a break. There were 18 people living at the home at the time of the inspection.

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.

Cumberland Court provides care and support for up to 20 older people with care needs associated with older age. The needs of people varied, some people were mainly independent others had low physical and health needs and others had a mild dementia and memory loss. The care home provided respite care with some people coming back to the home for short stays on a regular basis when they or people looking after them needed a break.

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.