Corton House

Corton House is a not for profit residential care home with charitable status and a Christian ethos providing personal care to 40 people aged 65 and over at the time of the inspection. The service can support up to 44 people. Accommodation is provided over two floors. Bedrooms have en-suite facilities and there are several communal spaces, including a communal lounge, garden room, activities room and dining room.

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

People were not always supported to stay safe because individual risks to them had not always been identified or assessed. Medicines were not always managed safely. Some people had not received their medicines because the service had not obtained them in time. People were not fully protected from infection control risks as we identified some staff were not wearing masks properly and consistently. Governance systems were not effective as they had failed to identify the concerns and improvements required.

The physical environment was well maintained, clean and hygienic. The registered manager had taken action to review staffing arrangements, so people were supported by enough staff. Staff had been recruited safely. Staff were supported to discuss incidents that had occurred and learning from these was encouraged. The provider maintained oversight of any safeguarding concerns and these were reported to the appropriate authorities as required.

Staff worked with other professionals to ensure people’s needs were met. There was a strong inclusive culture in the service. People, relatives, and staff were listened to and involved in the running of the service.

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 19 May 2021)

Why we inspected

We received concerns in relation to the management of medicines and how staff supported people with their mobility. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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.

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

You can see what action we have asked the provider to take at the end of this full report.

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 safe care and governance 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.

Corton House is a not for profit residential care home with charitable status and a Christian ethos providing personal care to 26 people aged 65 and over at the time of the inspection. The service can support up to 44 people. Accommodation is provided over two floors. Bedrooms have en-suite facilities and there are several communal spaces, including a communal lounge, garden room, activities room and dining room.

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

People were supported to stay safe. Risks to people, including environmental risks, were assessed and actions taken to mitigate them. Systems and processes were in place to safeguard people. There was enough staff to meet people’s needs and staff were recruited safely. Medicines were managed and administered safely. Incidents, such as falls, were monitored and actions taken to help prevent reoccurrence. The environment was clean, hygienic, and well maintained. Measures to help prevent the spread of infection were taken.

People were supported to eat and drink enough. People’s dietary preferences and needs were known and catered to. People’s needs were supported in line with best practice guidance and legislation, this included in relation to people’s individual health needs. The service worked alongside health and social care professionals to ensure people’s needs were met. People were supported by trained and competent staff. Training had been delivered that was specific to people’s needs in the service. 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.

A person-centred culture had been created through a range of systems which sought to involve people, capture and use their feedback. There was a clear governance structure in place, which included quality monitoring systems. The provider and registered manager were keen to provide the best service they could. A service development plan was in place to help continue to develop and strengthen the service. The service had long standing community links which they had retained. The service had also developed new community links for the benefit of people using the service.

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 requires improvement (published 30 April 2020).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 March 2020. The service was rated requires improvement. This was the second time the service had been rated requires improvement.

We undertook this focused inspection to check the service had made improvements. This report only covers our findings in relation to the Key Questions, safe, effective, and well-led as these areas were rated requires improvement at the last inspection.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Corton House on our website at www.cqc.org.uk.

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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ People who used the service were supported to maintain regular contact with friends and family.

¿ People’s well being was supported. Staff supported people to engage in activities and interests whilst isolating.

¿ Regular infection control audits took place and staff competency in respect to infection control measures had been assessed.

Corton House is a not for profit residential care home with charitable status and a Christian ethos providing personal care to 41 people aged 65 and over at the time of the inspection. The service can support up to 44 people. Accommodation is provided over two floors. Bedrooms have en-suite facilities and there were several communal spaces, including a communal lounge, garden room, activities room and dining room.

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

We have made a recommendation regarding the deployment of staff and consistent staffing levels. Whilst staffing levels did not significantly impact on people’s experience of their care, we were concerned about the ability to provide consistent staffing and ensure the adequate deployment of staff. We have also made a recommendation the provider reviews their recruitment systems and checks. People were not fully involved in the design of menu choices. Systems to support people who had memory difficulties to make meal choices, needed improving to ensure they had a good meal time experience. We have made a recommendation regarding this.

People received their medicines as prescribed. Overall improvements in the management of medicines had been made although we noted some further work was still required in some aspects of medicine management. 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 did not support this practice.

Governance systems had been reviewed and strengthened. We noted continued improvements were needed to ensure the service continued to improve and develop. Some systems in the service could be strengthened to better support engagement with people living with dementia. Further work also needed to continue to develop a fully person-centred culture. The provider and the service’s management team were committed to driving improvements. Whilst some improvements in some areas of the service were required, we recognised that the provider had made significant progress and improvements to the quality of the service since its last inspection.

People were supported to stay safe. Risks to themselves and environmental risks had been assessed and actions were taken to manage identified risks. Systems and processes were in place to safeguard people from the risk of abuse. The environment was clean and infection control measures were in place.

People were supported to eat and drink enough, systems were in place to monitor people’s intake where they had been assessed as at risk. People’s needs had been assessed holistically and best practice guidance had been utilised and followed. People were supported by trained staff who understood their needs. People were supported to maintain their health needs, staff liaised with health care professionals where necessary and implemented their advice.

People were supported by kind and caring staff who knew them well. This helped them to deliver in line with people's wishes and preferences. The service had a strong Christian ethos and there was a strong emphasis on meeting people’s religious and spiritual needs. People and relatives were provided with opportunities to discuss the support provided to them. The independence and dignity of people living in the service was promoted.

People’s communication needs had been assessed and met. Important relationships were supported. People living in the service were involved in planning the activities that took place, this meant the activities organised were informed by people’s interests and hobbies. A complaints system was in place, complaints were investigated and responded to. People’s end of life care needs were assessed and met.

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 08 October 2019) where we found multiple breaches of regulation. Following the last inspection of the service, conditions were imposed on the provider’s registration telling them they had to send us a monthly report of audits carried out in the service and actions taken to make improvements.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Corton House is a not for profit residential care home with charitable status and a Christian ethos providing personal care to 42 people aged 65 and over at the time of the inspection. The service can support up to 44 people. Accommodation is provided over two floors. Bedrooms have en-suite facilities and there were a number of communal spaces, including a communal lounge, garden room, activities room and dining room.

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

People had been placed at risk of harm. We found actions to assess and mitigate risks to people had not always been taken, this included risks regarding people’s care needs, the environment, and the management of medicines. People were not sufficiently safeguarded from the risk of abuse. This was because staff had failed to identify safeguarding incidents and report these to the relevant authorities.

There was a lack of effective and clear quality assurance processes and systems. Those that were in place had failed to fully identify areas in the service that required improvement. There was no clear and effective system or plan of action to monitor and drive forward the improvements needed. Staff had failed to notify CQC of notifiable incidents that occurred in the service. This, and other failures, resulted in the service not meeting the regulatory requirements. People did not receive a service that was based on current and best practice guidance. Some people were living with dementia, the service had failed to sufficiently take this in to account and ensure that the service it provided was inclusive of this and met associated needs.

People were not supported to have maximum choice and control of their lives because the policies and systems in the service did not support this practice. The service had not fully considered if they were providing care in the least restrictive manner and if applications to deprive people of their liberty were required. The service had failed to properly assess people’s ability to make decisions and had not considered who had formal legal authority to do so on a person’s behalf, where people could not do so independently.

People did not receive care in a way that met best practice guidelines. Staff had not always followed recommendations from health professionals and did not have sufficient training to meet people’s needs in some areas. The environment did not fully meet the needs of people living with dementia,

People received support from kind and well-intentioned staff, however we found on some occasions they had failed to attentively investigate and respond to people which had compromised their dignity. People had the opportunity to contribute and formally discuss some elements of their care, but there was a lack of consideration around how people, particularly those living with dementia, could be better supported to engage in decision making.

People did not always have their care delivered in a way that met their individual needs. Care plans did not provide enough guidance for staff on how to meet people’s needs, including end of life care. There were no formal systems in place to enable people to review and discuss the care provided. People were provided with written information regarding the service but there was a lack of information in other formats which took in to account some of the needs of the people living in the service.

People were receiving a service which required improvement. The provider had started to take some positive actions to make improvements to the quality of the service, although it was too early to assess how effective these would be. Following our inspection, they also took action to respond to the immediate risks identified. There was a pleasant, friendly and sociable environment. People benefited from effective networks the service had built with other resources in the community. People were supported by enough staff, who worked well together, and felt supported by the management team. The general environment was pleasant, and people spoke positively of it. People told us the food was of good quality and they received the support required to meet their nutritional needs. There was a wide range of activities on offer and these were informed and tailored to people’s interests. If people raised concerns about the service, these were robustly documented, investigated, and responded to.

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. (Report published 15 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, good governance, safeguarding people from abuse and improper treatment, the need for consent, and failure to notify CQC of notifiable events.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This unannounced inspection took place on 22 December 2016. There were 39 people receiving care at that time.

The service had a registered manager in place. 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.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well trained, and well supported, by their managers. Staff were also sufficient staff to meet people’s assessed needs. These were supported by a team of volunteers.

Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm. People received their prescribed medicines appropriately and medicines were stored safely. People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet. and staff were aware of people’s dietary needs and preferences. People praised the quality of food served to them.

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. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. People’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process.

People received care and support from staff who were kind, caring and respectful to the people they were caring for. Staff encourage people to be independent, and make as many decisions for themselves, as possible. Staff treated people with dignity, respect and compassion.

Staff received sufficient guidance to ensure they provided consistent care to each person. Changes to people’s care was kept under review to ensure the change was effective.

The was a varied programme of events for people to join in with and ample opportunities for people to develop and maintain hobbies and interests. Staff took steps to reduce the risk of social isolation and there were opportunities for people to access the local community. There were good links with the local community.

The service was well run. The registered manager and staff were approachable. People, relatives and staff were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. Concerns and complaints were thoroughly investigated.

Quality monitoring procedures were in place and action was taken, or planned, where the need for improvements were identified. We saw the registered manager strove to continually improve the service.

We found that the provider had in place suitable systems to ensure the safety and suitability of the premises and to protect people from harm.

We looked at the records for four members of care staff and found that training in manual handling and fire safety was up to date for these individuals. However, the provider may find it useful to note that at the time of visit, some staff members were overdue for medications and safeguarding training. We found that staff received adequate supervision and appraisal. One person we spoke with told us, "Staff are bright, cheerful and very willing."

We found that the provider had in place systems to monitor and assess the quality of the service, and identify any issues. People were asked for their views and these were acted on.

We found that there was an appropriate complaints system available.