Cornerways

Cornerways is a care home providing accommodation for up to 50 older people, including people living with dementia. At the time of the inspection there were 33 people living at the home.

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

People and their relatives told us there were enough staff. Our observations confirmed the service had enough staff to meet people's needs. During the inspection, call bells were answered in a timely manner and staff did not look rushed. Staff told us there were enough staff to meet people's needs.

The registered manager had been in post since June 2021, during their time in post the registered manager had made changes to how the service was run and how people received their care. Staff told us the registered manager was supportive and included them in decisions about any changes.

The leadership team had quality assurance systems in place which were used to drive improvement. We found risks in relation to nutrition, dietary requirements, falls and pressure care had been identified, and there were management plans in place to reduce these risks.

We found people were protected from the risk of acquiring infections and the service was clean. Personal protective equipment was readily available, and all staff were following the latest infection prevention and control guidance.

We have made recommendations about the management of some medicines and one aspect of the quality assurance process for medicines.

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 5 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about leadership, person-centred care, scalding, medicines management and personal care. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm on this concern. Please see the Safe and Well-led sections of this full report.

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.

The inspection was prompted in part by notification of an incident following which a person died. The incident is subject to investigation by another agency. As a result this inspection did not examine the circumstances of the incident. However the information shared with CQC about the incident indicated potential concerns about the management of the risks of falls. This inspection examined those risks.

Cornerways is a ‘care home’, operated by Peninsula Care Homes Ltd, a small local care provider with 4 other services in the Devon area. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People living at Cornerways were older people, living with physical health conditions associated with older age and/or dementia. The service accommodates up to 50 people in one adapted building, with lifts to access the rooms on the first and second floor. 42 people were living at the service at the time of the inspection.

The home had a registered manager. 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.

At the last inspection on 11 July 2016, Cornerways was rated good in all areas. On this inspection we found this had been maintained.

The home continued to be well led. The management team promoted open communication with people, their relatives and healthcare professionals involved in their care. Healthcare professionals were involved at an early stage to monitor and support people’s health. Staff at the service were alert to changes in people’s behaviour which might indicate physical ill health. Staff understood their roles and had daily opportunities to contribute to care practice and developments at the service.

The management of the service carried our regular audits of practice. Incidents and accidents were analysed and lessons learned to improve practice and safety. People were protected from abuse and neglect. We found staff had access to information about risks to people and how to avoid foreseeable harm. Risks related to people's care were assessed, recorded and reviewed. Medicines were stored and administered safely.

People and relatives told us the home was safe and they felt well cared for and supported.

People's privacy and dignity were respected. Staff ensured people were encouraged to maintain their independence and had a say in the way their care was delivered. As many of the people at Cornerways were living with dementia, staff had a good understanding of the way people’s life and past history affected their behaviour at this stage of their life. Staff used this knowledge to help support people well.

We found enough staff were on duty to meet people's needs and staff had been subject to a thorough recruitment process to make sure they were suitable to work with people. People and relatives told us staff were kind and caring. Staff were attentive when people asked for assistance and had clear understanding of strategies to support people when they became distressed or anxious. The home had a busy but cheerful atmosphere. Although the building was not ideal to support people with dementia the service had made efforts in line with good practice guidance to make it more suitable. This included use of coloured doors, easy read directional signage, a themed dining room and a newly developed secure garden with sensory areas.

Staff had the training and support they needed to care for people and told us the provider was a good organisation to work for. The home was well resourced, and equipment was provided as needed to assist people to be cared for safely.

People received care and support based around their individual needs and requirements. Care plans were person-centred and reviewed regularly. People were able to make choices about their day to day lives. There was a variety of activities for people to do and take part in and people were supported to pursue their own hobbies and interests. Systems were in place to manage and investigate complaints and concerns.

This inspection took place on 11 July 2016 and was unannounced. At the time of our inspection there were 41 people living in the home.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous unannounced comprehensive inspection of this service on 27 May 2015. The service was rated as requires improvement overall. Breaches of legal requirements were found in relation to risks to people not being well managed, people being at risk of cross infection, and people’s food and fluids not being sufficiently well monitored.

The provider sent us an action plan which detailed how they were planning on meeting the regulations and told us these actions would be completed by the end of September 2015. At this inspection we found action had been taken to respond to our concerns and the service was no longer in breach of these regulations.

Cornerways is a care home which provides accommodation for up to 50 people. Nursing care for people was provided by local district nursing teams. People who lived in Cornerways were older people with a variety of needs including mobility needs, personal care needs and needs relating to dementia.

Following our previous inspection, action had been taken to review the infection control practices at the home. Work had gone into re-organising the laundry area and the storing of cleaning equipment. Audits had been carried out and new processes had been put in place in order to protect people from the risk of cross-infection.

People were supported to have enough to eat and drink. People were supported to make choices about what they wanted to eat. Each meal consisted of a number of alternative dishes to meet people’s preferences. Where people required changes to their diets, the consistency of their food, or required support from staff this was provided. Where people required closer monitoring of their food and fluid intake because of identified risks, this was being completed and people were referred to specialist healthcare professionals where required.

Improvements were needed in relation to making the environment and the activities more appropriate for people living with dementia. The registered manager had identified these areas as needing improving and was working towards implemented some changes, however, at the time of the inspection significant improvements were needed. Cornerways is a large three story building with many staircases and narrow hallways. Adequate steps had not been taken to assist people with finding their way around the home with the use of distinguishing colours and signage. What signage was available was unclear and often written in small print people would not be able to see. There were few activities which did not involve memory testing and these can have a negative impact on some people living with dementia.

We have made recommendations for the provider to seek further guidance in relation to providing an environment which promotes independence for people living with dementia and into an activities programme which caters for people’s individual needs.

All the people who lived in Cornerways required support with taking their medicines and staff had been trained to administer medicines safely. People, relatives and staff confirmed medicines were safely managed and people received their medicines as prescribed by their doctor. We found some issues with the recording of medicines and have made a recommendation for the registered manager to review the systems in place to monitor and audit medicine records.

People’s individual health and care needs were assessed prior to them moving into the home. Specific management plans had been put in place to assist staff to respond to people’s needs. Specialist external professionals had been consulted in order to ensure people received the best possible care.

Where people were at risks relating to their mobility, their nutrition or their behaviours, specialist input had been sought and plans had been put in place to ensure these risks were minimised for people. Where accidents and incidents had taken place, the registered manager had reviewed these, had learned from them and had taken action to reduce the risk of reoccurrence. There were arrangements in place to deal with foreseeable emergencies.

People were protected by staff who knew how to recognise possible signs of abuse. Staff told us what signs they would look for and the procedures they would follow to report these. Safeguarding contact numbers were accessible to staff who told us they felt confident and comfortable reporting concerns.

Recruitment procedures were in place to ensure only people of good character were employed by the home. Potential staff underwent Disclosure and Barring Service (police record) checks to ensure they were suitable to work with vulnerable adults.

Staff treated people with kindness and respect. People enjoyed pleasant and affectionate interactions with staff who spent time individually chatting with people throughout the day. Staff knew people’s preferences and worked hard to ensure they met people’s personal likes and dislikes. Staff supported people in a calm, unrushed and caring manner.

Staff had the competencies and the information required to meet people’s needs. Staff received regular training, supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. People were involved in every aspect of their care and were encouraged to make choices where they were able. Where best interest decisions had been made, these had not always be recorded. The registered manager told us they would address this immediately.

Some people were being deprived of their liberty as they were under constant supervision and were not able to leave the home on their own for their own safety. The registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority where required.

There were sufficient numbers of staff to ensure people received the care they needed at the time they needed it. Staff were able to spend time with people individually and complete tasks in an unhurried fashion. Where people rang their call bells for staff assistance, these were answered without delay.

There was a clear management structure at Cornerways with staff having a good understanding of their roles and responsibilities. People, relatives, staff and healthcare professionals spoke highly of the registered manager and told us they were approachable and open. There were systems in place to assess, monitor and improve the quality and safety of the care being delivered. Staff performance was regularly checked by team leaders and the registered manager to ensure the care being delivered was of a high standard.

There was an open culture at the home with people, relatives and staff being encouraged to share their views and ideas.

People who lived at the home told us they were well looked after and were happy. One person said "I really like living here".

People told us they were happy with their care. People were supported to access different areas in the home.

We saw that staff respected people's wishes and people told us they felt respected. People's privacy was protected by staff.

People told us that they felt safe and knew what to do if they had concerns. Staff knew what to do if they suspected abuse or poor practice.

People told us that they would not hesitate to report any issues to any member of staff. We saw people being encouraged and supported to take part in activities; on the day of the inspection some people took part in a quiz and bingo.

The home was clean and staff had a good understanding of infection control procedures.

The home had a robust recruitment policy and procedure which meant that people were protected from the risk of harm.

People who lived at the home told us they were happy. One person said "I'm very happy. I like it here." People told us they were happy with their care. We found that staff administered and recorded medicines safely.

People were supported to access different areas in the home. One person said "They (the staff) help me walk." We found staff had an understanding of the Mental Capacity Act (2005) and obtained consent from people when providing day to day care.

We saw that staff respected people's wishes and people told us they felt respected. People's privacy was protected. We saw staff knock or doors before entering rooms.

People told us that they felt safe and knew what to do if they had concerns. One person said "Oh yes, I feel safe." Staff knew what to do if they suspected abuse or poor practice.

We found that the home had an activities co-ordinator and activities programme in place. We saw that people were enjoying activities.

We saw that the home had a system in place for checking on and monitoring the quality of the service. We found that care plans were not individualised or person centred.