Cornerleigh

Cornerleigh is a residential care home providing personal care for up to 11 people. The service provides support to people with mental health needs, physical disabilities, learning disabilities and/or Autism. At the time of our inspection there were 11 people using the service.

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

People and their relatives gave us positive feedback about their safety and told us staff treated them well. One person said, “I feel safe, the staff keep me safe.”

Risks to people's individual health and wellbeing were identified and care was planned to minimise the risks. However, we found some risks had not been recognised and further guidance was needed, so staff could support people safely. There were enough staff to support people and staff had received appropriate training to enable them to carry out their role safely.

Staff had received training in safeguarding and understood their responsibilities. People were protected from abuse and staff supported people to have regular conversations where they could express any concerns. However, one incident had not been recognised as a safeguarding concern, so action could be taken to prevent a reoccurrence.

People received support with their medicines from staff that had been trained to do so safely. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines. However, we identified some areas for improvement, relating to repeat prescriptions and risk assessments for some medicines.

The provider had systems and processes to monitor quality within the home. However, these had not identified all the areas we found that needed improvement. The registered manager understood their regulatory responsibilities and shared information with stakeholders in a timely way.

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.

Based on our review of Safe and Well Led the service was able to demonstrate how they were meeting underpinning principles of “Right Support, Right Care, Right Culture.

Right support:

Staff used person-centred approaches to support people to reach their goals and aspirations.

Staff discussed ways of ensuring people’s goals were meaningful and spent time with people understanding their wishes and listening to what they wanted.

Right care:

People received kind and compassionate care from staff who used positive, respectful language which people understood and responded well to.

Staff were patient and used appropriate styles of interaction with people.

Staff were calm, focused and attentive to people’s emotions and support needs such as mental health needs and sensory sensitivities.

Right culture:

Management were visible in the service, approachable and took a genuine interest in what people, staff, family, advocates and other professionals had to say.

The provider and registered manager were alert to the culture within the service and spent time with staff and people discussing behaviours and values.

The registered manager worked directly with people and led by example.

There was a complaints procedure which provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. The provider and registered manager welcomed suggestions on how they could develop the service and make improvements. They were responsive to areas we identified that needed improvement, so that action was taken promptly.

People, their families, staff and external professionals all told us that the registered manager was supportive, and they felt the service was well led.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 16 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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.

At the time of the inspection relatives were not permitted to visit due to a COVID-19 outbreak. People had been supported to maintain contact with their relatives through regular phone calls and video calls.

Prior to the outbreak, people had been able to see their relatives through pre-arranged garden visits and some ‘window’ visits. The provider’s visitor’s policy was available and shared with relatives prior to their visit. All visits were booked in advance, so the staff could support them to take place safely and thorough cleaning could take place before and after the visit. The provider was in the process of developing a visiting plan for the winter months, in line with government guidance. The manager told us they hoped to facilitate visits in a safe space within the home, once they were able to receive visitors again.

On arrival to the home, visitors such as external health professionals, had their temperatures taken and were asked to sign a health declaration to confirm they have no symptoms of COVID -19. All visitors were asked to wear face masks and any other PPE as required.

Admissions to the home were carefully considered and planned to ensure people were admitted safely. The manager told us people had tested negative for COVID-19 before they were admitted to the home and were supported to isolate in their room for 14 days, in line with guidance.

Staff were using (PPE) in line with guidance, implementing training provided by the clinical commissioning group (CCG), to safeguard people using the service and staff. Arrangements were in place for the manager to complete spot checks to ensure infection control and PPE use, was consistent and safe.

Staff supported people to understand the reason for masks being worn and several people living at the home, had chosen to wear masks themselves in communal areas.

There were detailed risk assessments to manage and minimise the risks COVID-19 presented to people who used the service, staff and visitors.

The manager and provider had systems to ensure there was clear oversight in relation to infection prevention and control. There were robust infection control audits and cleaning schedules in place.

Following the last inspection in July 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key question safe to at least good. We found that risks were not always effectively assessed and managed. At this inspection we found improvements had been made and the provider was meeting the regulations. Risks were assessed and there were management plans in place to ensure risks were managed.

Cornerleigh is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cornerleigh accommodates up to 11 people with learning disabilities and autism. At the time of our inspection there were 10 people using the service. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was 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 was a relaxed and cheerful atmosphere throughout the inspection. People had developed positive relationships with staff and we saw many kind and caring interactions.

People were supported to maintain and improve their independence by staff who understood the importance of people living full and meaningful lives. Staff supported people to access arrange of activities that met their individual needs and involved people in the planning of activities.

The service responded promptly to people’s changing needs to ensure they had access to appropriate health care support. This promoted people’s health and well-being.

Staff understood their responsibilities to identify and report concerns where they felt a person was at risk of or had suffered harm or abuse. There were systems in place to ensure medicines were managed safely and that people received their medicines as prescribed.

The provider had systems in place to support safe recruitment decisions. People were supported by sufficient staff who had the skills and knowledge to meet their needs.

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.

There was a complaints policy and procedure in place and people were confident to raise concerns about the service. There were systems in place that enabled people and staff to be actively involved in the development and running of the service.

There was a range of systems in place that monitored the quality of the service and enabled areas of improvement to be identified and action taken.

Cornerleigh is a care home without nursing that provides support and accommodation for up to 11 adults who live with a learning disability or acquired brain injury. At the time of our inspection there were 11 people living in the home. Support is provided in a large home that is across three floors, with the top floor being an individual flat-let. Communal areas include a lounge, dining room and kitchen that people freely accessed.

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. Although our register showed a registered manager was in place, this person had received an internal promotion so was not working in the home. A new manager had been appointed however at the time of our inspection visit this was only their second day in the role. They told us they had begun the process of applying to become the registered manager. Throughout the report we refer to this person as the manager.

At our inspection in April 2016 we identified breaches in the regulations relating to the assessment and management of risk, staffing levels, supervision and training, person centred care and governance systems. At this inspection improvements were seen.

Risk assessments and guidance for staff had improved. Staff were aware of risks for people when this was related to a health condition or their behaviours and knew the support they needed to provide. However their knowledge regarding the risks and use of some equipment and a medicine needed to improve and guidance developed to aid this. Improvements were found in relation to the staffing levels and there were sufficient staff to keep people safe. Staff were receiving regular support through supervisions, appraisals and development plans. They had completed a variety of training to help them in their roles.

Staff understood the importance of gaining consent and assuming people could make their own decisions and described the best interests decision making process, although there was a lack of documented capacity assessments when DoLS were applied for and staff’s understanding of DoLS required some improvement.

People received personalised care and support, which was responsive to their current and changing needs. Care plans were developed with the input of people who were involved in decisions about their care and support.

Systems and processes to monitor and assess the service had improved although some areas that required improvement had not been identified through these processes. Records for people had improved.

People told us they felt safe at the home and staff had a good understanding of their roles and responsibilities in protecting people from abuse. They knew what to look for and the action to take if they were concerned. Staff and the management team understood their responsibilities in safeguarding people from harm. Medicines were managed safely and staff were recruited safely. People were supported by staff who were kind and caring, although the communication by some staff could improve.

People were supported to eat adequate diets and where they needed support with specialist diets this was provided. Staff accessed other professionals to ensure support provided was appropriate for people’s needs

Concerns were listened to and dealt with promptly. A system was in place ensuring any complaints were dealt with.

A new manager was in post and had begun the processes of applying to become the registered manager. They were described as person centred, approachable, supportive and willing to listen.

We found a breach 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 end of the report.

Cornerleigh is a care home without nursing that provides support and accommodation for up to 14 adults who live with a learning disability. At the time of our inspection there were 10 people living in the home.

Although our register showed a registered manager was in place, this person had resigned and was no longer working in the home. 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. A temporary manager was working in the home, five days a week to provide management and support while the provider recruited to this position.

People who lived in the home told us they liked living at Cornerleigh. They said they felt safe, could make their own decisions and that staff supported them well.

The provider was using agency staff while they recruited new staff. At times the staffing levels did not support people’s needs or keep them safe. Not all risks associated with peoples care had been assessed and plans to reduce the risks developed. Whilst permanent staff’s knowledge of people was good, a lack of clear assessment and guidance available meant risks associated with people’s care and support may not always be identified and appropriate action taken. Not all plans of care were personalised or followed by staff. A lack of accurate, clear, person centred and individualised plans meant people may not receive care and support in a way they require. The provider was unable to demonstrate that medicines were stored at safe temperatures and we have made a recommendation about this.

The provider was unable to demonstrate that appropriate supervision and training had supported staff to be effective in their roles. Records associated with peoples care were at times inconsistent or could not be found. The systems used by the provider to monitor and assess quality had been ineffective and concerns had not been identified until these were raised to them, externally. A lack of clear, accurate and contemporaneous records and ineffective quality systems placed people at risk of receiving a service that was ineffective.

Staff described a low morale and a feeling of being unsupported by the provider. However, despite this they demonstrated a kind, caring and compassionate approach to people who they knew well. They interacted positively and were motivated. They demonstrated an understanding of the need for respect and consent. Where required the Mental Capacity Act 2005 had been applied. The locality manager was open and honest about the failings in the service and demonstrated a commitment to making positive changes for staff and people.

We found a number of 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.

At the time of our visit there were 11 people living at the service. The home did not have a registered manager at the time of our visit and so we spoke with the acting manager of the home.

At our previous inspection in October 2013 we found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained and records were not always secure. We judged this as non-compliance with moderate impact and asked the provider to send us an action plan. The provider sent us an action plan in November 2013 detailing what they would do to improve this. They told us they would achieve compliance by December 2013.

At this inspection we found that the home had taken appropriate action and were now achieving compliance. Records we reviewed were stored securely and were accurate.

We spoke to three people during our time there. All said that they were happy with the home and the staff helped them to do things they enjoyed.

We found that the provider had effective systems in place to ensure that medicines were managed effectively.

The home had enough skilled, qualified and experienced staff to meet people's needs. We spoke with four staff and they told us that they were supported and trained to carry out their roles.

The provider had effective systems in place to monitor and assess the quality of the service they provide. People were asked for their views and these were acted upon.

We reviewed care records of four people using the service and found that these were not always accurate and up to date. We found that care records were not secure and could not be located promptly when needed.

We looked at the home's arrangements for the handling, management and safekeeping of people's money. We found that where the home supported people with their finances there was a clear system of recording any assistance people were given. This included records of any amounts of money being held on their behalf. We saw that money was securely stored.

We spoke to two people who use the service. One person said they were given help with their finances. Another person said they were satisfied with the arrangements where the home looked after their money and that they could access this at any time by asking staff.