Corrina Lodge

Corrina Lodge is a care home providing accommodation with nursing and personal care for up to 58 people. Peoples’ needs were varied and included people with nursing needs and people living with dementia. At the time of our inspection there were 53 people using the service.

Corrina Lodge is a purpose-built care home which has two floors. Each floor has its own dining and lounge areas.

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

People were happy living at Corrina Lodge. They told us staff were kind towards them and knew their needs well. People were encouraged to make their own choices and retain their independence and people’s care plans were individualised and person-centred.

People felt safe living at Corrina Lodge and where risks to people had been identified there was good guidance in place for staff. Staff were able to tell us how they kept people safe and had a good knowledge of how to identify and report a potential safeguarding concern.

People lived in an environment that was checked for its safety and suitable for their needs. The environment was spacious and well laid out and was kept clean and tidy by a team of housekeeping staff.

People were cared for by a sufficient number of staff who had been trained and demonstrated competence in their roles. Staff received the support they required through continual learning and development and regular supervision with their line manager.

The registered manager was involved in initiatives to help assist with the pre-assessment stage for people and also the ordering of people’s medicines. Medicines practices were good and people received the medicines their required in line with their prescription.

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.

People were provided with sufficient food and drink prepared in a way that met their needs. There was also a range of activities available and links had been made to the outside community to enable people to go out more.

People were shown respect and dignity by staff and where care did not go to plan, or people had concerns, these were taken seriously and apologies were given.

The registered manager had a clear drive to improve the service for the benefit of people. They had developed strong links with external providers and had plans in place for future further development. They kept themselves updated with news and guidance through the Surrey Care Association and also gave people and relatives the opportunity to provide their views and feedback on any improvements that could be made.

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 27 June 2019).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is the subject of a safeguarding investigation.

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

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.

Corrina Lodge is a care home providing personal and nursing care to up to 58 people in one adapted building. At the time of our inspection there were 57 people living at the service. People were living with a range of complex health care needs. This included people who have had a stroke, diabetes and Parkinson's disease.

People’s experience of using this service:

People told us they felt safe living at Corrina Lodge and that risks to their safety were managed well. Systems were in place to ensure staff were aware of their responsibilities to safeguard people and there was an open culture regarding reporting concerns. Staff deployment had improved and further changes were made following our inspection. People lived in a safe and clean environment. Accidents and incidents were monitored to reduce further risk to people.

Staff received training in their roles which was tailored to people’s needs. People told us they enjoyed the food provided and had access to support from health care professionals. People’s legal rights were protected as the principles of the MCA were followed.

People described staff as caring and kind. We observed many examples of people being treated with kindness, dignity and respect although on some occasions staff practice could have been improved. The registered manager provided assurances these concerns would be addressed. Staff respected people’s independence and aids and adaptations were available to support people in maintaining this. Visitors were welcomed to the service.

Staff knew people well and understood their preferences. However, records did not always contain the detail required. We have made a recommendation in relation to this. People had access to a range of activities in line with their preferences and interests. People told us they would feel comfortable in raising any concerns they had and felt prompt action would be taken.

The registered manager had joined the service since our last inspection. People, relatives and staff commented on the positive impact this had on the service. The registered manager was visible throughout the service and seen to be approachable. Changes in the culture and person-centred nature were noted in the way in which the service was led. There was a strong emphasis on people relatives and staff being involved in the running of the service which had brought many positive, changes.

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 (report published 6 June 2018). Following our last inspection, the provider completed an action plan to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and will next inspect it in line with our published inspection process and methodology.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective and Well-led to at least good. At this inspection, we found that despite some improvements having been made the provider had not met the legal requirements. We found further breaches of regulation in relation to risk management, medicines and consent.

Corrina Lodge 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. Corrina Lodge accommodates up to 58 people in one adapted building. At the time of our inspection there were 57 people living at the service. People were living with a range of complex health care needs. This

included people who have had a stroke, diabetes and Parkinson's disease. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required a variety of help and support from staff in relation to their health, mobility and personal care needs. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home.

There was a registered manager in post who was present during the inspection. 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 not always effectively deployed to ensure people’s needs were met in a timely manner. We observed people waiting for care and some people told us they felt isolated and lonely. There was a lack of leadership and direction on individual shifts and nurses and care staff worked in isolation.

Risks to people’s health and well-being were not always effectively monitored. Records did not always contain clear and consistent information to evidence the action taken to keep people safe. Where accidents and incidents occurred, robust action was not always taken to ensure that lessons had been learned and reduce the risk of them happening again. Some areas of medicines management were not safe. Protocols for PRN (as and when required) medicines lacked detail and topical creams were not labelled when opened and were not appropriately stored. Other areas of medicines storage and administration were managed well.

The principles of the Mental Capacity Act 2005 were not always followed which meant there was a risk that people’s legal rights were not being upheld. There was a lack of management oversight of the service. The registered manager was unable to provide information in a timely way and did not demonstrate a clear understanding of the provider’s systems. Quality assurance process were not always effective in identifying and addressing areas of the service which required improvement. There was a lack of guidance for staff which had led to the service not moving forward in their development.

Although improvements had been noted to the training and supervision of staff, this was not always appropriately monitored. The registered manager was not able to demonstrate how clinical staff developed their professional skills. We have made a recommendation regarding this. Safe recruitment processes were in place to ensure staff safe to work at the service were employed. Staff told us they felt supported by the management team and regular staff meetings took place.

Staff were aware of their responsibilities to safeguard people from the risk of abuse. Systems were in place to ensure the local authority safeguarding team were made aware of any potential risks. People had access to healthcare professionals and were supported to attend medical appointments.

Staff interactions with people were positive and people were treated with kindness. People’s dignity and privacy was respected and staff were aware of people’s individual needs and interests. Staff supported people to maintain their independence and people’s religious and cultural needs were respected. Visitors told us they felt welcome and that there were no restrictions on the times they could visit. People’s nutritional needs were met and people told us they enjoyed the choice of foods provided.

People’s needs were assessed prior to them moving into the service to ensure they could be met. Care plans were detailed and contained information about the person’s life history and interests for staff to follow. There was a dedicated activities team in place who provided a varied activities programme. A group of volunteers also visited the service on a regular basis to provide support to the team and to spend time with people in their rooms.

People and their relatives were provided with the opportunity to give feedback regarding the quality of the service provided. Regular residents meetings were held and an annual survey was sent. The provider had a complaints policy in place which was made readily available.

Corrina Lodge provides nursing and personal care for up to 58 people. There were 57 people living at the service at the time of the inspection. People were living with a range of complex health care needs. This included people who have had a stroke, diabetes and Parkinson’s disease. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required a variety of help and support from staff in relation to their health, mobility and personal care needs. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home.

There was a registered manager in post who was present during the inspection. 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 and associated Regulations about how the service is run.

During the inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Sufficient staff were not deployed to meet people’s needs in a timely manner. People routinely needed to wait for their personal care needs to be met in the morning and we observed people spent considerable time without staff interaction. Staff did not consistently receive training updates and supervision records did not reflect that concerns regarding staff performance were followed up on.

Quality assurance processes were not always effective in ensuring continuous improvements. Where auditing processes identified shortfalls in the service, these were not always addressed in a timely manner. Records regarding the care people received were repetitive and task focussed. Although staff knew people’s needs well, care plans did not always reflect people’s current needs and preferences.

Care records contained up to date risk management plans which contained guidance for staff regarding how to support people in managing risks to their safety. Accidents and incidents were reported and action taken to update risk management strategies where required. Staff were aware of their responsibilities in safeguarding people from abuse and concerns were appropriately reported. Robust recruitment processes were in place to ensure staff employed were suitable to work at the service. The provider had developed a contingency plan which detailed the arrangements in place should an emergency occur.

People received their medicines in line with their prescriptions. Medicine administration records were accurate and consistently completed. People received support to access healthcare professionals and where advice was provided this was followed. People had a choice of foods and their nutritional and hydration needs were monitored. People told us they enjoyed the food provided and were able to request alternatives.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People were provided with choices and their wishes were respected. People were supported by staff who knew them well and understood their needs and preferences. Staff encouraged people to develop and maintain their independence. People told us that staff treated them with kindness and people’s dignity and privacy were respected.

People received support in line with their needs and staff responded to people’s changing in needs in a timely manner. People had access to a range of activities both within the service and in the community.

People, relatives and staff told us that the registered manager was approachable and responded well to suggestions and any concerns raised. There was a complaints policy in place and any concerns raised were responded to and monitored. The registered manager was committed to creating an open culture with the service and staff told us they were encouraged to work as a team. People had the opportunity to contribute to the running of the service and felt their views were listened to.

We last inspected Corrina Lodge on the 22 and 23 June 2015 were no concerns were identified.

Below is a summary of what we found. The summary is based on our review of records, speaking with people who used the service, their relatives and staff who supported them.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People who used the service told us they were treated with respect and dignity. For example, one person said, 'The carers informed me of what they were going to do before undertaking the task'.

We observed the service had a system in place to ensure that people's risk assessments were kept under regular review. Any trends identified were dealt with to minimise the risks relating to people's health, welfare and safety.

We found that the service had systems in place to ensure that the staff they employed to support people had the required knowledge and skills. The service had processes in place to ensure that there were enough staff employed to keep the service clean and hygienic.

We saw documented evidence that the service used a range of quality monitoring tools such as yearly clients, relatives and staff satisfaction surveys to measure the quality of care and support people received from the service. People told us they felt safe with the staff.

Is the service effective?

We found that people's care plans provided detailed information on how they wished to be supported with their care needs. For example,individual care needs had been clearly stated. We observed that records of people's daily care were documented. Care staff spoken with told us they used the communication sheet to highlight any changes to the person's care to ensure continuity of care. These were appropriately maintained to ensure if necessary a new member of staff would be able to deliver care safely and effectively.

We found that people's health care needs were kept under regular review and they had been involved in the reviews. People had access to health care professionals such as the GP, dentist, optician and district nurse. This meant that people were supported to keep healthy and well.

Is the service caring?

People told us that care staff spoke to them in a kind and respectful manner. One person said, 'The staff all of them demonstrate a genuine affection, care and concern to me'. All members of staff spoken with were knowledgeable about people's care needs including their preferences and personal histories. It was evident that people were listened to and care staff responded to them in a positive and caring way. One person said, 'I feel I receive excellent care'.

Is the service responsive?

People told us they were supported to express their views and be actively involved in making decisions about their care, treatment and support. In the care plans we looked at, we saw evidence which reflected that people and their relatives were involved in making their views known about how they wished to be cared for and supported. If people were not able to sign their care plans these were signed by family members. We saw evidence that regular care plan reviews took place. This meant that people's care needs were regularly reviewed.

We found the service had received two complaints which had been dealt with to the satisfaction of the complainants. People we spoke with said they knew how to make a complaint, but had never done so. Relatives of people who used the service told us they discussed their relative's care needs with the manager or deputy manager and they worked well together so there was never any need to complain.

Is the service well led?

Staff told us they felt supported by the new manager and that since their arrival staff meetings had been re-instated. At these meetings they were able to raise questions relating to the delivery and implementation of best practice. This meant that staff felt supported and well-led.

Staff spoken with said that they were provided with adequate training. This enabled them to perform their roles and to be accountable for their actions.

People told us the manager or the deputy manager was always available in the home. They said, 'Either the manager or the deputy spoke daily with the residents to check if they were happy with the care and if the care workers were performing satisfactorily'. This ensured people received agreed and effective care as documented on their care plans.

The service had arrangements in place to monitor complaints, accidents and incidents. This meant that lessons were learnt from incidents and complaints investigations to ensure improvements to the service delivery.

People that we spoke with were very positive about the activities that had been organised. One told us 'The activities are good fun and I always enjoy them'. Others told us that they enjoyed the opportunity to be taken shopping locally in the service mini bus.

People that we spoke with confirmed that the food in the service was good and that there was always plenty for them to drink. One person said 'It is much better now'. Another person told us, 'I have not been here long but the chef took the time to come and sit with me and plan what I could eat and discuss what meals he could make for me. It has made me feel so welcome and has helped me settle in'.

Care staffing levels had been increased resulting in one additional nurse and two additional care assistants being scheduled to work during each day shift. A care assistant told us, 'I have learnt a massive amount from matron. There are enough of us now and we know what we're doing'.

We found that an effective complaints procedure was in place. Every person we spoke with confirmed that they would be confident to make a complaint about the service. One person said 'I am able to complain if I need to'.

The service was run by a manager who is registered with the Care Quality Commission. (CQC)

The views of people using the service were varied. Some told us that they felt safe and happy in the service. Others told us that the delays in receiving meals and care was a source of frustration.

The general manager told us that she had been reminded by the service provider of the requirement to register with the CQC as the registered manager following her appointment before our inspection in November 2011. They had not applied as this had not been viewed as a priority.

People told us that they had not been involved in developing their care plans and we saw that this was the case.

We found that, the provision of care and welfare was not person centred. Where preferences had been expressed by people, they were not always acted upon. Particular examples were meal choices and personal care preferences.

This service has a large number of high dependency residents which we considered was not reflected in the numbers of staff available to provide care. We found the staff to be enthusiastic and caring.