This inspection was carried out on 18 April 2018 and was unannounced.

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 recruite

This inspection was carried out on 17 November 2015 and was unannounced.

The Cumberland provides accommodation for up to 29 older ladies who are living with dementia or Alzheimer’s and need support with their personal care. The service is a converted domestic property. Accommodation is arranged over three floors. Stair lifts are available to assist the ladies to get to the upper floors. The service has 15 single bedrooms, and 7 double bedrooms, which ladies can choose to share. Nine of the bedrooms have ensuite toilets. There were 28 ladies living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Cumberland provides a service to ladies only and the manager employed only female care staff to meet their needs. Ladies were treated with dignity and respect at all times. For example, staff explained the care and support ladies would receive before they received it and asked them what they would like staff to do and when.

The manager provided strong leadership to the staff team and had oversight of all areas of the service. Staff were highly motivated and felt supported by the manager and other senior staff. The staff team shared the manager’s philosophy of care and worked to make sure that care was always provided to a good standard. Staff told us the manager was approachable and they were confident to raise any concerns they had with them. The manager had taken action to continually improve the service. They had employed consultants to review and make recommendations to make sure the service was the best it could be.

There were enough staff, who knew the ladies well, to meet their needs at all times. The needs of the ladies had been considered when deciding how many staff were required on each shift. Staff had the time and skills to provide the care and support ladies needed. Staff were clear about their roles and responsibilities and worked as a team to meet the ladies’ needs.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff were supported to provide good quality care and support. The manager had a very good knowledge of dementia and Alzheimer’s and its impact on the ladies at the service, they shared this with staff to develop their skills. A plan was in place to keep staff skills up to date. Most staff held recognised qualifications in care. Staff spoke to senior staff whenever they had concerns about the ladies. Plans were in place to hold more regular meetings to give staff the opportunity to discuss their role and practice.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the manager, senior staff or the local authority safeguarding team. Plans were in place to keep ladies safe in an emergency. Equipment was in place to evacuate ladies safely and plans were in place to make sure staff were confident to use it safely.

Ladies’ needs had been assessed to identify the physical and mental care and support they required. Care and support was planned with ladies and their representatives to keep them safe and support them to be as independent as possible. Detailed guidance had not been provided to staff in some ladies care plans about how to provide all areas of the care and support they needed. However ladies received consistent care as staff knew them well. An independent social worker had reviewed the ladies care plans and was working with the manager and staff to make improvements in line with best practice recommendations.

The ladies received the medicines they needed to keep them safe and well. Action was taken to identify changes in ladies’ physical and mental health, including regular health checks and GP clinics. Ladies were supported by staff to receive the care they needed to keep them as safe and well as possible.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Arrangements were in place to check if ladies at risk of being deprived of their liberty and applications had been made to the supervisory body where they were necessary.

Consent to care had been obtained from the ladies or those legally able to make decisions in their best interests. Ladies who had capacity were supported to make decisions and choices. The manager had recognised that processes were not in operation to assess if ladies were able to make decisions. This had been discussed with the independent social worker and action was being taken to put system into operation that met the requirements of the Mental Capacity Act 2005 (MCA).

The ladies were supported to participate in a wide variety of activities that they enjoyed. Possible risks to them had been identified and were managed to keep them as safe as possible, without restricting them.

Ladies told us they liked the food at The Cumberland. They were offered a balanced diet that met their individual needs, including low calorie diets for ladies who wanted to lose weight. A wide range of foods were on offer to the ladies each day and they were provided with frequent drinks to make sure they were hydrated.

The ladies and their representatives were confident to raise concerns and complaints they had about the service with the manager and senior staff and had received a satisfactory response.

The manager frequently worked on the floor with ladies and staff to check that the quality of the service was to the standard they required. Any shortfalls found were addressed quickly to prevent them from happening again. Ladies and their relatives were asked about their experiences of the care and these were used to improve and develop the service.

The environment was safe, clean and homely. Maintenance and refurbishment plans were in place and flooring throughout the service had recently been replaced. Appropriate equipment was provided to support the ladies to remain independent and keep them safe. Safety checks were completed regularly.

Accurate records were kept about the care and support ladies received and about the day to day running of the service and provided staff with the information they needed to provide safe and consistent care and support to the ladies.

There were 28 people using the service and we met, spent time with or spoke with most of them. People said or indicated that they were happy with the service. People looked relaxed and comfortable. One person said that they had felt anxious about moving into the home, then they said “However, I felt straight away that I was at home. The care staff are very good and the food is absolutely wonderful.”

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.

We made an unannounced visit to the service and spoke to people who use the service, a visitor, the manager and to staff members. There were twenty five people using the service. We spoke to most of them and everyone we spoke to said or expressed that they were very happy living at The Cumberland.

People told us or expressed that they felt safe and well looked after. Everyone said that the food was ‘good’ or ‘very good’. People said “It is all very nice, the best place I’ve ever been in” and “The girls (staff) could not be kinder, they are real carers”. People described the service as ‘lovely’, ‘wonderful’ and ‘very good’.

People told us that there were enough activities going on and we were told, “Activities? I am happy with things as they are”.

People told us “I like it here; they (the staff) are wonderful “and “We love it here; it is the best place I have ever been in".

People said “The staff are very kind and they are around when you need them. The laundry is very well done, they take your clothes every day and bring them back clean and my room is clean”. People told us that the home and their bedrooms were clean.

We observed staff interacting and engaging with people in a warm positive way. Staff worked together to calm a person down when they became anxious and upset.

A visitor told us that they were made welcome when they visited and that they felt their relative had the care and supported they needed. They told us that when their relative had to go to hospital “Staff put themselves out to make sure (Their relative) was well looked after there”. They said “The staff are very kind, they always say hello and they are always close by when you need them”.

A few days after our visit, a relative raised some concerns to us about some aspects of the service. We looked into the concerns, reviewed our evidence and spoke to the manager. We could not corroborate the issues and were satisfied that the service was compliant with the essential standards .