Cumberland

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People and those important to them were supported to understand safeguarding and how to raise concerns when they did not feel safe. People were protected from the risk of harm and abuse. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers and staff. When concerns had been raised, managers reported these promptly to the relevant external agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. People were supported to understand and manage risk. Managers and staff assessed and reviewed safety risks to people regularly and made sure people and those important to them, were involved in making decisions about how they wished to be supported to stay safe. Care plans were sufficiently detailed and clear, and provided sufficient guidance to staff to keep people safe. There were enough staff to support people with their care and support needs. Managers reviewed staffing levels regularly to make sure there were enough suitably skilled and experienced staff deployed throughout the care home at all times. There were appropriately trained staff in place to support people and keep them safe. They were well supported through individual and group supervision meetings and annual appraisals of their overall work performance to continuously learn and improve their working practice. Managers made sure thorough pre-employment recruitment checks were undertaken on all staff to make sure only those that were deemed suitable and fit, would be employed to support people at the service. People lived in a suitably adapted, comfortable and safe environment. The provider ensured medicines systems were well-organised, and people received their prescribed medicines safely

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We observed staff supporting in a a dignified and caring manner. they used people's preferred names and sought their consent when supporting and encouraging them to take part in activities and other aspects of living in the home. Where people called for help or assistance, satff were quick to respond to their needs showing empathy.

People using the service told us they felt safe. Comments included, “Staff are fair, I feel safe,” “Staff are nice” and “Yes, I am safe here. Carers are good.” Relatives were equally satisfied and told us staff who supported their family members knew how to keep them safe. One relative said, “From what I have noticed yes, people are kept safe at the care home.” Another yes, “Yes, absolutely. I think [family member] is safe here. The staff look after [them].”

Staff were aware of safeguarding procedures. Comments included, “I always tell my team to report any concerns to me or the other managers. We don’t allow or give space for abuse,” “Safeguarding is to promote the safety of the residents” and “I haven’t noticed any abuse, but if I did you have to be professional and would report it to the nurse or the team leader. We’ve had training on that.” Staff were also familiar with reporting procedures if they were to witness anything untoward taking place. One staff said “I can report to my line manager, the police or Merton council. I can also whistle-blow to headquarters anonymously.”

The provider's safeguarding policy and processes were in line with relevant legislation. Records showed safeguarding concerns reported to the registered manager were recorded in detail and reported promptly to the relevant external agencies. The registered manager worked well with these agencies and acted in a timely way to make sure people were safeguarded and protected from further risk. People and those important to them were involved in this process and informed about what action would be taken to keep people safe. Training records showed that staff had received training in safeguarding adults which was current. Feedback from partners was consistently and continually positive about the standard of care described in this quality statement. Partner agencies had no concerns about how the service worked with them when undertaking enquiries and investigations about safeguarding concerns.

Peoples relatives told us staff knew how to support them with known risks and that they were involved in planning the care they received.

Staff were aware of the risks to people and how they would keep them safe from unsafe practice. They were familiar with risk management techniques and how to reduce the potential risk to people. Comments included, “We get information about risk form pre-admission documents, we do checks on their safety when they come here,” “Residents that are bed bound will be at risk of pressure sores, they have pressure relieving mattresses, we make sure they are turned regularly. If people are at risk of falls, we do assessments to see if they need a crash mat, the bed is on the lower level or they may need a bed rail” and “We are given time to read through care plans and the more you work with them, you get to know them.” Staff told us they were confident using the equipment in the home, such as mobility aids. They said, “I’m a moving and handling trainer so I’m involved in training staff. We have 2 full body hoist on the unit, we also have a sara steady and a standing hoist. We also have an emergency riser chair, we use that to put people in a seating position if they have fallen,” “I’ve had training on all the hoists and there are always 2 of us when we use the equipment, so it’s a 2-way process. But I’m still confident.”

We observed staff supporting people in an appropriate manner, in line with their care plans. For example, 2 cares were allocated to support those people where this was recorded in their care plans. Staff were allocated into pairs to support people during the day.

Risks to people had been assessed and risk management plans had been put in place to help staff prevent or minimise these identified risks people might, so far as possible. These risks included area such as supporting people with mobility equipment or with personal care. This meant staff had up to date information about the action they should take to manage these risks and keep people safe. There were systems in place for staff to report concerns, incidents, and accidents. This promoted the provider having oversight and being able to manage risks. The management team completed regular audits and action plans were put in place if any risks were identified. Appropriate checks were completed on equipment such as hoists, mobility aids and mattresses to ensure the safety of people.

There are effective arrangements to monitor the safety and upkeep of the premises. Regular checks were completed to help ensure the safety of the home’s physical environment and their fire safety equipment. There was clear guidance available to staff to follow to help them deal with emergencies. For example, in relation to fire safety we saw personal emergency evacuation plans were in place to help staff evacuate people in an emergency. General risk assessments were regularly reviewed and updated including reference to equipment used to support people, such as mobile hoists. This equipment was regularly serviced and maintained. Maintenance records demonstrated that the environment was maintained to a good standard. These included fire alarm call point, emergency lighting, fire extinguisher checks. Current certificates for gas safety and electrical appliance were seen. Lifting and baths servicing took place regularly and visual check s were completed for bed rails, window restrictors and other equipment.

Managers and staff told us people lived in a suitably adapted, safe environment.

We saw the premises were kept free of obstacles and hazards which enabled people to move safely around the home. Cleaning staff were a visible presence in the home, maintaining the environment to a good standard.

Peoples relatives told us the care homes environment was safe and always kept clean. One relative remarked, “The care home is spotless and provides a caring, homely environment for my [family member]. Another relative added, “There are cleaners constantly cleaning the premises, and one thing we noticed was there isn’t a constant smell of urine that we noticed in other care homes.”

Feedback we received from staff about staffing levels in the care home were also mixed. While most staff told us the care home was adequately staffed, several said this was not always the case. Typical comments included, “We don’t always get 5 (staff on the unit), sometimes we have 4 and those days can be difficult. For example, during mealtimes we have 3 people on the unit that are on puree diet and need a lot of encouragement to eat, they need 1 staff each. That leaves us with 1 staff to support the other people”, “5 staff is better due to people’s needs. We are able to manage with 4 but 5 is better. The nurses help too.” We discussed this staffing issue with the managers at the time of our inspection and they agreed to review current staffing levels in the home and increase them if it was deemed necessary. Progress made by the provider to achieve this stated aim will be closely monitored by the CQC.

We observed staff were visibly present throughout our inspection. Staffing levels matched the rota and enabled people’s needs to be met safely. For example, we observed staff were always quick to respond to people’s requests for assistance or to answer their queries.

Training records showed staff attended relevant courses to support them to meet a range of people’s needs. This training was refreshed at regular intervals so that staff stayed up to date with current practice. However, most staff had not received any positive behavioural support (PBS) training, which meant they might not know how to prevent or safely manage incidents of behaviours that were an expression of peoples’ distress. We discussed this training shortfall with the managers at the time of our inspection and they responded immediately. After our inspection, the registered manager confirmed a time specific action plan had been agreed for all staff to receive PBS training by the 1/04/2024. This would ensure all staff would knew how to prevent or safely deescalate incidents of behaviours that were an expression of peoples’ distress. Staffing levels in the care home matched that days staff duty rota and were suitably deployed and sufficient to meet people's needs. Managers used a staffing dependency tool to make sure there were always enough staff to meet people’s needs safely. Supervision and appraisal records showed staff had regular supervision meetings and an annual appraisal of their overall work performance with their line managers to support them in their role and to identify any further training or learning they might need. Managers carried out checks on staff that applied to work at the service to make sure they were suitable to support people. This included checks with the Disclosure and Barring Service (DBS) who provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Feedback we received from people relatives about staffing levels in the care home were mixed. Most people told us the care home was adequately staffed however, a few relatives said there were not always enough staff on duty to keep people safe. Typical comments included, “I often visit and see there’s plenty of staff about,” “There isn't enough staff to spend quality time with people. They could do with extra staff sometimes.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us staff supported them to take their prescribed medicines as and when they should. One person who lived at the care home told us, “I am satisfied that staff ensure I receive my medicines without delays.” A relative added, “Staff are very good at ensuring my [family member] is always given their medicines when they’re due.”

Staff authorised to manage medicines in the home were clear about their responsibilities in relation to the safe management of medicines. For example, staff said they received safe management of medicines training and their competency to continue managing medicines safely was routinely assessed by the managers and nursing staff. The staff are aware of medicines with additional risks and have appropriate information in the MAR chart regarding potential risks and side effects.

The providers medicines systems were well-organised, and people received their medicines safely as they were prescribed. People received medicines safely and as intended by the prescriber. Electronic Medicines Administration Records (MARs) were in place which provided staff with accurate information about the medicines. Each MAR profile included a personalised landing page which explained how the person prefers to take their medicines, enabling staff to provide person-centred care. We found no recording errors or omissions on any electronic medicines records we looked at. People’s care plans included detailed guidance for staff about their prescribed medicines and how they needed and preferred them to be administered. ‘When required medicines’ (PRN) protocols were in place for prescribed medicines. These explained what a medicine was to be used for and what the outcome should be. Medicines used to manage agitation and anxiety prescribed on a PRN basis were not excessively used to control behaviour. However, as discussed with the managers at the time of our inspection we found some omissions on clinical room and medicines fridge daily temperature checks where staff had failed to always maintain these records accurately. Furthermore, for people prescribed patches, the provider was not using body charts to indicate the site of application to ensure site rotation as per manufacturer’s advice. We recommend the provider consider current guidance on recognised best medicines recording practices and take action to update them accordingly.