Cumberland is a care home which provides nursing and personal care for up to 56 adults. The service specialises in supporting older people living with dementia. The service is divided into two distinct units called Turner and Reynolds. At the time of our inspection there were 48 people using the service.

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.

The inspection took place on 24 March 2015 and was unannounced. The last inspection of this service was on 10 May 2014 and we found no breaches of legislation.

Cumberland is a care home providing personal and nursing care for people living with dementia. It provides accommodation for up to 56 people on two separate units. There were 54 people living at the home at the time of the inspection.

The service has a registered manager 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.

There were procedures for safeguarding adults at risk. Staff were knowledgeable about what they needed to do if they suspected abuse. People received their medicines as prescribed because the provider had appropriate arrangements for the management of medicines.

There were enough staff on duty to ensure people’s needs were met. Staff received appropriate training which was regularly refreshed to make sure they understood standards of best practice.

People had access to healthcare professionals as and when they needed them. People were provided with a diet that met their needs. Their nutritional needs were assessed and monitored, and if it became necessary people were referred to specialists. Professionals told us the service worked with them in the best interests of people.

People were asked their consent before care was provided. If people were not able to give consent, the provider worked within the framework of the Mental Capacity Act 2005. The Act aims to empower and protect people who may not be able to make decisions for themselves. It also enable people to plan ahead in case they are unable to make important decisions for themselves in the future.

People could move freely around the home. The environment was suitable for people living with dementia, although planned works would enhance it further.

Most staff were kind and caring. They helped people to be as independent as possible and to take part in activities of daily living. However, we observed some staff who did not act in a caring way and we received some comments from relatives who said staff were sometimes abrupt.

Care that people received was individualised to meet their needs. There was a range of social activities people could choose to participate. Relatives were free to visit their family members whenever they wished.

The service had measures in place to monitor the quality of the home. Incidents and accidents records were analysed so that the risks of re-occurrences were minimised. Relatives’ views about the service provision were sought and people felt their views were important and would be acted upon.

This visit was completed by two inspectors at the weekend. We spoke with four relatives and people who use the service and observed staff interactions with them. We looked at care records for six people across the two units and spoke with three members of staff. After the inspection we had telephone contact with the manager. There were 45 people using the service on the day of our inspection.

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.

There had been a planned major refurbishment at Cumberland Lodge with the start date initially a year ago. To minimise disruption to people who used the service, the home had purposefully not been at full capacity. On the day of our inspection the home had 42 people resident, even though it was registered for 56. Whilst awaiting the major refurbishment some minor works had been undertaken by the home.

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.

We visited Cumberland Lodge with an Expert by Experience colleague. The experts are chosen as they have personal experience of older peoples services.

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.

Comments from relatives or carers of people using the service were positive about the care and support being provided. These included ‘the overall care is excellent’, ‘I’m very happy with the care – it’s quite a nice home’, I’m happy’ and ‘I’m very satisfied’.

One family member said that ‘they weren’t frightened anymore’ now that their relative was living in the Cumberland and stated that they ‘were always pleased with the care’.

Feedback about the staff was again positive. Comments included ‘nothing’s too much trouble’, ‘very helpful’ and ‘I’ve never met with any hostility – always helpful’.

All of the people we spoke to felt able to raise any concerns or complaints with the home.

To help us to understand the experiences people have at the Cumberland we spent time watching what was going on and how people were spending their time.

Activities were taking place during our first unannounced visit and these included a relaxation session along with art and crafts. A meeting of people who use the service took place on the second day we visited and included creative discussion around meals people enjoyed and the television programmes they watched in the past.

We saw some very positive interactions between staff and the people who use the service. One example of a person centred approach was one person who we saw helping a domestic staff member clean the rooms. Their relative told us that the person always liked to be occupied and the service now allowed them to help which was very important to their wellbeing.

We received feedback from relatives of people using the service either during or after our visits. Comments were generally positive and included ‘I’m very happy with the service’, ‘I think it’s very good’ and ‘very satisfied’.

Improvements have clearly taken place in the service since our 2011 visit and these need to be sustained in the longer term. Concerns have however been raised by commissioners about the number of reported incidents between people who use the service in recent months. We saw that the home was developing plans to try to address these issues and was consulting with stakeholders at the time of our visits.