Archived: Cunningham House

Cunningham House is a residential care home providing personal care for older people. Younger adults and people living with dementia. The service can support up to 54 people, at this inspection 20 people were living at Cunningham House

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

People did not always receive personalised care and support. People were not always supported to have maximum choice and control of their lives and staff did not always support them in their preferred way and in their best interests. People’s personal preferences were not always respected and their independence was not always promoted.

The provider had arrangements in place to assess and monitor the quality of the service provided. However, these processes had not been effective in addressing shortfalls in relation to personalised care and promoting people’s independence.

The provider had made suitable arrangements to help keep people safe. Staff had received training about safeguarding people and understood how to report any concerns. Risks to people were identified and managed to help prevent them from receiving unsafe care and support. The provider’s arrangements for medicine administration helped to ensure people received their medication in accordance with the prescriber’s instructions and staff’s practice was safe.

Staffing levels were appropriate to meet people’s care and support needs. Robust recruitment procedures were followed to help ensure the right staff were employed to care for people. People were protected by the provider’s arrangements for the prevention and control of infection.

Feedback about the management was overall positive. Staff felt there was more support available to them now after a period of instability in the home’s leadership, which had negatively impacted on morale and culture in the home.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 05 November 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safe care and treatment, staffing, personalised care and overall management oversight.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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 remains Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cunningham House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to personalised care and management oversight. 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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cunningham House is a residential care home providing personal care for to up to 54 people. The service provides support to older people. At the time of our inspection there were 40 people using the service, one of whom has a learning disability. Accommodation is provided across two connected areas, one of which specialises in providing care to people living with dementia.

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

People were not always supported by enough staff and their care plans and risk assessments were not always up to date. Oral hygiene was poor, and food and fluid intake were not always documented accurately. People received their medicines safely.

People and their families were not always involved in their support plans. Care plans included people’s likes and dislikes, but care provided did not always reflect people’s preferences. There was little evidence of personalised activities for people.

There were issues with relationships among the staff teams. The manager was aware of this and had identified various other areas of improvement required. At the time of the inspection action taken had not yet been effective.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 29 December 2017).

Why we inspected

We received concerns in relation to staffing levels, people being woken up from 3am for personal care and left without food or fluids and medication errors. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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. We have found evidence that the provider needs to make improvements.

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 Cunningham House 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 risk assessments, poor oral hygiene and food and fluid documentation, staffing levels, people not receiving personalised care and the culture within the service at this inspection.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People and relatives told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

Medicines were stored, administered and managed safely and we saw evidence of recent improvements. The provider regularly checked the premises and equipment were safe for people to use.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Care plans were written in a very person centred style and were regularly reviewed to reflect peoples' individual care and support requirements. People were given safe care because risks had been identified and managed.

Staff were well motivated, proud of the service and felt listened to. Staff had regular opportunities to reflect on their practice and to request any additional support or training.

The provider was actively looking at ways to improve the quality of the food to meet people’s preferences. People were supported to eat and drink enough to maintain a balanced diet and referred to other healthcare professionals when their health needs changed.

People and their relatives were encouraged to share their opinions about the quality of the service, through meetings. Staff were supported in their practice by a manager they liked and respected.

The provider's quality monitoring system included regular reviews of people's care plans, checks on medicines management and staff's practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Further information is in the detailed findings below.

We inspected the home again on 07 November 2013 to check whether improvements had been made. We found that records relating to food and hydration were accurate and detailed. We found that the provider had begun a review of care plans to ensure that they accurately reflected people's needs, we noted that this area was 'work in progress' at this inspection.

People who used the service were not involved in developing the menu at Cunningham House and gave us varied feedback about the food provision. For example, some people said they liked the food, comments included, 'It's lovely but too much, I wouldn't normally eat this much.' Other people told us they were less pleased with the food provision with comments including, 'I would like better food, the menu is monotonous with cheap cuts of meat.' People were recorded in residents' meetings as saying, 'Some days the food is good, other days it is not good.'

On the day of our inspection the home appeared clean and well maintained. We saw that personal protective equipment such as gloves was available to staff members. Records showed that staff had completed annual training in infection control.

We spoke with relatives of people who used the service about complaints. They told us they were confident to raise concerns with the management team.