Archived: Cornwallis Court

There were 70 people living in the service when we inspected on 10 and 11 January 2017. This was an unannounced inspection.

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.

We are currently investigating an incident where a person fell on an exposed pipe and sustained burns and will report on this once the investigation is complete.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

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

Not all risks to people living in the service were being identified. Improvements were needed to ensure that all risks in people’s daily living were assessed and these assessments provided staff with information about how to effectively manage and minimise these risks. This included environmental risks and those linked to health conditions. Where risk assessments had been carried out they were not always completed fully to include relevant and detailed guidance for staff.

Incidents such as falls had not been consistently reviewed by the provider so that preventative actions could be considered and put into place where needed.

People generally received their medicines safely and had access to healthcare professionals such as GP’s, dentists and chiropodists when required. However, improvements were required to provide guidance to staff regarding as and when required medicines.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice. There was not always reference to the Mental Capacity Act 2005 (MCA) to promote people's rights and where people were unable to give their consent, best interest decisions were not always recorded as having taken place.

Care plans, as identified by provider's own audits, were contradictory and had not always been updated as people’s needs changed.

A complaints procedure was in place, however not all complaints had been recorded.

There was a lack of oversight of the service by the provider to ensure the service delivered was safe. Although the provider had some quality assurance systems in place, these had not been effective in allowing the management team to identify concerns and take the required action. Improvements were required around the effective auditing of health and safety.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs.

People were safeguarded against the risk of abuse as the staff were trained to recognise abuse. This was supported by appropriate safeguarding and whistleblowing policies.

Is the service safe?

When we arrived at the service staff greeted us and noted our identification and we signed in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We found that risk assessments to keep people safe when moving and handling people were detailed and contained all the information needed for staff to follow, detailing equipment to use and therefore keeping all concerned safe. We brought to the attention of the manager the weak risk assessments in place relating to the use of bed rails.

We found that windows had been restricted to prevent people falling from heights but we were able to freely access the veranda in St Winnolds on the first floor. The temporary measure of locking the sliding door in this dementia care unit had been overridden. This meant people were not as safe as they should have been.

We examined the medication systems in use and found that these protected people as they were being followed by staff who were trained to administer medication safely.

There have been no applications made under the Mental Capacity Act (MCA) 2005 in relation to a Deprivation of Liberty Safeguards (DoLS).We saw that there was a policy and procedure in place and that staff had received training. This demonstrated that staff at the service were aware of the legislation and should have known how to protect people and uphold their rights by appropriately using this legislation. However we brought to the attention of the manager the need for a 'best interest decision' where a person was potentially being restricted of their liberty. We could not see documentation that showed the least restrictive option was in place with consultation with family and professionals.

Is the service effective?

Care at Cornwallis Court was effective because we saw an independent survey that showed good results with 100% of people strongly agreeing to being treated with kindness, dignity and respect. Systems were in place to audit medication, care plans, health and safety matters and infections control, this made for effective organisation in the delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People using the service told us staff were caring and met their needs. One person told us, 'All the staff are lovely to me'.

People using the service were able to spend their day as they chose. Activities and entertainment were facilitated well with the service employing two activities persons. We saw a high attendance at a good quality singing performance.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to. This included regular trips out to the local town in transport provided. People told us that they had access when needed to medical professionals.

There had been no changes of note to the newly developed dementia care facility on the first floor therefore, our concerns as reported in our last report still stand in that St Winnolds is not a suitably designed environment responsive to people living with dementia.

The service had a complaints procedure and whistle blowing procedure in place. No complaints had been raised, but we saw evidence that the whistle blowing procedure was working. People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to regularly review care plans. This included seeking support and guidance from health care professionals, including falls prevention specialists.

Is the service well-led?

The service worked well with other agencies such as health and social care professionals to make sure people's care needs were met comprehensively.

The service had quality assurance systems, audits and records seen by us that showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

We examined five care plans and spoke with six staff. Overall we found that care plans were acceptable, but that they could be improved to ensure the safety of people. Moving and handling risk assessments were not as detailed as needed to ensure that potential risks were minimised. We found that not all plans were regularly reviewed to keep all risk assessments up to date.

Environmentally we found that the service could improve people's safety and was not responsive to peoples changing needs. The first floor now accommodated people living with dementia. Access to balconies, stair cases and unrestricted windows placed them at potential risk. The design and layout of the area did not lend itself to those people who needed to walk as part of their dementia as there was no immediate access to outside space and dead ends to corridors.

When we inspected the service in July 2012 we found issues around the safety of care, environment, staffing and quality assurance. We have re-inspected the service in both October 2012 and January 2013 and have found improvements across all areas. Care plans have been improved and now provide improved support to staff in providing person-centred care. People's preferences and life histories are now better known to staff so that they can support people to make independent choices. A rolling training programme is in place and includes topics that are specific to individual's needs.

We spoke with five people using the service during our inspection. Three people told us that they were pleased that staff were now attending much more swiftly to call bells. One person told us that the new manager had made improvements since being at the service, 'Because call bells are answered much quicker than they have ever been. Last night I needed a matter sorting out about my supper choice and the manager sorted it out straight away'. One person informed us that the personal care they received from staff was 'top notch' and another person said, "I cannot fault the staff in any way. They are warm and helpful and they even make my coffee extra strong, just the way I like it." One person told us that 'They have been doing new care plans. They have put that box on the wall to keep it in, but it's not there yet'. The same person was able to tell us about their advanced care plan and their wishes and preferences and confirmed that the staff at the service were aware. We were able to substantiate this was the case as up to date documentation was in place. One person told us that they did not know where her care plan was kept and they requested that the manager talk them through it.