Archived: Cumnor Hill House

Cumnor Hill is a residential care home providing personal and nursing care to up to 75 people. The service provides support to older people some of whom living with dementia. At the time of our inspection there were 56 people using the service.

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

People living at Cumnor Hill received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had struggled to recruit permanent staff and were using a lot of agency staff which had impacted on the high standards of care people were used to. The provider had safe recruitment and selection processes in place.

People were supported with nutrition and hydration. However, the dining experience varied from unit to unit and could be improved. We saw staff deployment could be improved during mealtimes to ensure a better dining experience for people.

We found people’s records were not always up to date. The provider had already identified these shortfalls in their last audit and were working through an action plan. At the time of the inspection not all necessary actions identified had been completed so we could not be fully assured of the effectiveness of these actions.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs.

Medicines were managed safely, and people received their medicines as prescribed. The provider had an electronic self-auditing system which allowed safe management of all aspects of medicines.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to Covid-19 and other infection outbreaks effectively.

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.

The home was well-led by a newly registered experienced manager who was committed to improving people's quality of life. The home had gone through constant changes in leadership which had impacted on staff support, people’s care and general management of the service. People, staff and relatives were positive about the new management team. The provider had effective quality assurance processes which were used to improve people’s care. The provider and registered manager had created and were working through an improvement plan following the recent audits. The service had a clear management and staffing structure in place and staff worked well as a team. Staff worked well with external social and health care professionals.

Rating at last inspection

The last rating for this service was outstanding (Published 27 June 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing, recruitment, medicines management, records keeping, quality of care, staff knowledge of people’s needs and management of the home. A decision was made for us to inspect and examine those risks against all key questions.

We have found evidence that the provider needs to make improvements. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service was accessing regular testing for staff and people living at the service. This had enabled the prompt identification of the outbreak. The service was working with health professionals and the local public health to manage the outbreak effectively.

The registered manager and provider had ensured open and honest communication with staff, people and relatives regarding the outbreak which included daily email updates to relatives with details of the outbreak.

All staff in the home, regardless of their job role, received training to ensure they had the skills and knowledge to provide care and support to people. Staff from various departments within the home had been deployed to work as care staff which enabled people to continue to be supported by staff who knew them well.

The provider had purchased a specialist cleaning system to improve the cleanliness in the home. The registered manager had increased cleaning frequency to ensure the home was cleaned regularly. This included at least hourly cleaning of high risk areas.

Staff had received training in infection prevention and control and how to put on and take off their personal protective equipment (PPE). Staff demonstrated putting on and taking off of PPE and this was in line with government guidelines. There were designated areas allocated for this activity with pictorial and written guidance to prompt staff in the correct procedures.

Further information is in the detailed findings below

At our last inspection on 18 April 2017 we identified concerns about medicine management and we found the provider’s quality assurance systems for monitoring and improving the service were not always effective. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we asked the provider to submit an action plan telling us how they were going to address these concerns. We received the action plan within the timescales given that showed the improvements had been achieved and how these were going to be sustained.

At this inspection we found the provider addressed the above concerns and the service improved to Good in Safe and Effective domains. There was overwhelming evidence available that demonstrated further improvements to Outstanding in Caring and Responsive domains. The significant improvements of people’s experiences were achieved because of excellent leadership provided by the provider and service’s management. We therefore also rated the Well-led domain as Outstanding and the service was rated Outstanding overall.

The service was now very well-led. There was a registered manager running the service who started working at Cumnor Hill House a week after our last inspection in April 2017. 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.

Cumnor Hill House had a clear management and staffing structure in place. There were various departments such as care staff, nursing staff and ancillary staff and worked well as a wider team. The staff aimed to provide a high quality of service and they had a sense of pride working at the service. The provider’s quality assurance systems were effective and there was evidence available where an area for improvement had been identified, a prompt action was taken to address it. The registered manager monitored service delivery on ongoing basis and effectively used feedback from people, relatives and staff to improve the systems, practices and people’s experiences.

We found the service was exceptionally responsive to people’s needs. There was a positive culture that reflected people were put first. Staff told us they would do anything for the people living there, and not because they had to but because they wanted to. The team at Cumnor Hill House had a clear vision about how they wished to improve people’s lives and well-being. Staff talked about recognising people's individual wishes how they want to live their lives and enabled people to live their lives to the full. People’s, relatives, and external professionals’ feedback reflected this approach was successfully demonstrated. The team ensured people had exceptional opportunities to enhance their social inclusion and they were supported to participate in activities that met their needs and took account of their preferences. We identified that the provision of activities enhanced people’s well-being and gave them a sense of purpose.

People's care plans were up to date, current and gave clear guidance to staff on how people wished to be supported. Staff knew people's needs well and they used this knowledge to provide people with personalised support that put their well-being first.

People knew how to complain and evidence showed the complaints and concerns were managed appropriately. The registered manager demonstrated an innovative and proactive approach to the management of complaints and they demonstrated they successfully had made improvements to the service as a result of this.

People were supported to have a comfortable, dignified and pain free end of life. People’s relatives and professionals were equally extremely positive about end of life support provided to people and emotional support provided to families during that difficult time. The registered manager ensured emotional support was also provided to the team and held reflective meetings that staff were very complimentary about.

There was an exceptionally strong ethos within the service of treating people with dignity and respect. People, and meeting people’s needs were at the forefront of the service delivery. The team was very caring and we found people’s individual wishes and preferences including equality and diversity needs were considered and respected. People’s confidentiality was maintained and the registered manager explored innovative approaches to ensure where the information needed to be shared this was done in a secure and safe way.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. 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. People’s rights to make own decisions were respected and we found the records surrounding people’s capacity improved and were in line with the Act.

People were supported by trained and competent staff to take their medicines safely and as prescribed. People were supported to meet their health needs. The team worked closely with external health and social care professionals where needed. People were supported to maintain a good nutrition and were offered suitable diet that met their needs and likes.

People told us they were safe living at the service. Staff knew how to report and escalate safeguarding concerns. People’s care files contained risk assessments surrounding people’s well-being and any individual health conditions. Where people had been identified as at risk, management plans guided staff on how to keep the person safe respecting people’s rights to positive risk taking. People were supported by sufficient number of suitable skilled staff and received support in an unhurried way. Staff received good support and complimented the provision of training.

There was no 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. However, there was an interim home manager in post and the provider had recruited a new manager who had applied to register with the Care Quality Commission as the registered manager.

Medicines were not always managed safely. People did not always receive their medicines as prescribed and medicines were not always administered in line with the provider's policy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, care records did not support this practice. We have made a recommendation in relation to the Mental Capacity Act 2005.

Systems for monitoring and improving the service were not always effective. Auditing systems had not identified the issues we found during the inspection. Incidents were not always investigated to identify actions needed to reduce the risk of further events.

There was a relaxed, cheerful atmosphere throughout the inspection. People and staff laughed together and clearly enjoyed each other's company. There was a person-centred culture that valued people as individuals and involved them in the running of the service. The provider took opportunities to obtain feedback about the service to guide improvements.

During the inspection people's requests for support were met in a timely manner However, people and relatives were not confident there were always enough staff to meet people's needs.

The provider had recruitment processes in place that ensure people were supported by staff who were suitable to work with vulnerable adults. Staff were supported through regular supervisions and had access to development opportunities. Staff completed training to ensure they had the skills and knowledge to meet people's needs. Staff were clear about their responsibilities to report any concerns to senior staff and were confident to do so.

Risks to people were identified and where necessary management plans were in place to manage risks. Staff understood the importance of promoting people's independence. The service responded to people's changing needs and where needed were supported to access health professionals.

People were supported by caring staff who treated them with dignity and respect. People were involved in developing their care plans to ensure their needs were met in a way they chose.

Nutritional needs were met and people were complimentary about the quality of the food they received. Friends and relatives were able to join people for meals at any time and received a warm welcome. The provider promoted the engagement of relatives and friends to encourage a sense of belonging for everyone.

There was a programme of activities available for people. The home manager had identified that improvements were still needed and had a plan in place to achieve the improvements.

We found two breaches 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 the report.