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Inspection carried out on 5 April 2017

During a routine inspection

Cornelia Manor RCH is a care home registered to provide accommodation for up to 34 people, including people living with a cognitive impairment. At the time of our inspection there were 32 people living in the home. The home is set out over three floors, connected by two passenger lifts. There was a choice of communal rooms where people were able to socialise and some bedrooms had en-suite facilities.

The inspection was unannounced and was carried out on 5 and 7 April 2017. The inspection was undertaken by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

At our last inspection, in May 2016, we identified that risks to people were usually managed safely although special mattresses used to help manage the risk of pressure injuries were not always being used correctly. At this inspection we found a system was now in place for the pressure mattresses to be checked weekly by a senior staff member to ensure they were being used appropriately. However, new issues had been identified and not all risks to people and the environment were minimised meaning people were not always safe. By the second day of the inspection all new issues we identified had been addressed and appropriate action had been taken. We have made a recommendation about this.

At the previous inspection in May 2016 we found that care staff morale was low and that they felt there was a lack of consistency in management decisions. At this inspection we found there had been an improvement in staff morale and staff had increased confidence in the management decisions. There was a clear management structure in place and staff and people were encouraged to raise issues of concern with the registered manager, which they acted upon.

People, their families, staff and health professionals felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values and how they related to their work.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

People were supported to receive their medicines safely. However, the medicine fridge temperature was regularly recording as being outside the safe range which meant the medicine may not always be stored at the correct temperature. In addition, there was no individual guidance specific to a person as to when their ‘as required’ medicine should be administered.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests. People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire. They were also supported to raise complaints should they wish to.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

Inspection carried out on 30 March 2016

During a routine inspection

This inspection took place on 30 March and 1 April 2016 and was unannounced. The home provides accommodation for up to 34 people including people with dementia care needs. There were 30 people living at the home when we visited. The home comprised an older part that is based on two floors, connected by a passenger lift, and a newer single storey extension. There was a choice of communal rooms where people were able to socialise and some bedrooms had en-suite facilities.

A registered manager was 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.

At our last inspection, in February 2015, we identified the provider was not meeting the fundamental standards of quality and safety relating to consent. We issued a requirement notice and the provider sent us an action plan detailing improvements they would make.

At this inspection we found action had been taken. Staff followed the principles of legislation designed to protect people’s rights and liberties. They sought verbal consent from people before providing care and support.

Most risks to people were managed effectively, although special mattresses to prevent people from developing pressure injuries were not adjusted correctly. People were supported to take risks that helped them retain their independence and avoid unnecessary restrictions.

Staffing levels on two nights each week were not sufficient to meet people’s needs, but the registered manager told us of plans to address this. There were enough staff to meet people’s needs at other times and recruitment procedures were effective.

Medicines were managed safely and administered by staff who were suitably trained. Most people received their medicines when needed, apart from one person who was not always able to access their medicines when they went out for the day.

Staff understood their roles and worked well as a team. However, staff morale had been affected by changes to the duty rota and the management team was not always consistent in its approach to staff.

People felt safe at Cornelia Manor and staff knew how to protect people from the risk of abuse. Enhancements had been made to the environment which supported people living with dementia and helped them navigate their way around the home and be aware of the time.

People praised the quality of the food and were supported to make choices through the use of visual prompts. They enjoyed meal times and were encouraged to eat and drink enough.

Staff were suitably trained and had a good understanding of people’s individual needs. People had access to healthcare services when needed. Care plans provided comprehensive information about the way in which people wished to receive care and support. Staff recognised when people’s needs changed and responded promptly.

People were cared for with kindness and compassion. Their privacy was protected and they could choose whether they received personal care from a male or a female care worker.

People were involved in planning their care and relatives were kept up to date with any changes in people’s health. The provider sought and acted on feedback from people and there was an appropriate complaints procedure in place.

Most people were satisfied with the provision of activities, although some people in one part of the home expressed feelings of isolation.

People felt the home was run well. There was a clear management structure in place. Staff were organised and were encouraged to make suggestions about how the service could be improved. Audits of key aspects of the service were conducted and the provider had a plan in place to develop and improve the service further.

The service was open and transparent. The previous inspection report was available in the entrance hall, there was a duty of candour policy in place and the provider notified CQC of significant events.

Inspection carried out on 17 and 19 February 2015

During a routine inspection

This inspection took place on 17 and 19 February 2015 and was unannounced. The home provides accommodation and personal care for up to 34 people, including people who were living with dementia. There were 29 people living at the home when we visited.

At our last inspection, on 23 and 24 July 2014, we found people were not always protected from abuse and the provider had not reported instances of abuse to the Local Authority or to us. There were not enough staff to keep people safe at all times and staff did not always comply with legislation designed to protect people’s rights. We issued a warning notice and set compliance actions. The provider wrote to us telling us how they would become compliant with the regulations by 31 December 2014.

At this inspection, on 17 and 19 February 2015, we found improvements had been made, and the provider was meeting the requirements of all but one of the regulations.

Staff did not understand and or follow the requirements of the Mental Capacity Act, 2005 (MCA). MCA assessments were not always conducted before decisions were made on behalf of people. Relatives had been asked to make decisions for people when they had no power in law to make such decisions.

People felt safe at the home. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. Effective measures were in place to protect most people from the risk of abuse. However, the risks posed by one person, who had a history of becoming involved in minor altercations with other people, were not managed consistently.

The process used to recruit staff was safe and ensured staff were suitable for their role. There were sufficient staff to meet people’s needs and people were attended to promptly. Risks of people falling or developing pressure injuries were managed safely. Equipment, such as hoists and pressure relieving devices were used safely and in accordance with people’s risk assessments.

People were supported to receive their medicines safely, although one medicine was not always given as prescribed. Emergency procedures in the event of a fire were in place and understood by staff.

People and their relatives spoke positively about the care they received and praised the quality of the food. People were offered a choice of suitably nutritious food and drinks and were given appropriate support when needed. This encouraged them to eat well.

Staff were skilled and knowledgeable about the needs of people living with dementia and knew how to care for them effectively. They received appropriate training and supervision to support them in their role. Where necessary, people were referred to doctors and health care specialists and staff followed their advice.

People were cared for with kindness and compassion and could make choices about how and where they spent their time. We observed positive interactions between people and staff. However, on one occasion a lack of communication led to a person being startled when they were supported to move. People’s privacy was protected and confidential information was kept secure.

People were involved in planning their care and treatment and told us their needs were met. Care plans were comprehensive and personalised. However, the care plan for one person lacked information about how they should be supported when they displayed behaviours that upset other people.

A range of activities was provided and tailored to meet people’s individual needs. These included staff spending time with people on a one to one basis using a hand held computer to research topics of interest to people.

The provider sought feedback from people and acted on comments made. People knew how to make a complaint and these were dealt with appropriately. The service was well-led and there was an open and transparent culture within the home. Family members praised communication with staff and visitors were welcomed.

The registered manager had left the service shortly before our inspection. The provider had made suitable arrangements for the management of the home in their absence and had advertised for a new manager. Staff were organised, understood what was required of them and went about their work in a quiet but efficient way. This created a relaxed and happy atmosphere and was reflected in people’s care.

Staff were happy in their work and described the management team as “supportive” and “approachable”. A system was in place to regularly assess and monitor the quality of service people received, through a series of audits. Action was being taken following the findings of a recent additional audit conducted by the provider.

Incidents and accidents were responded to appropriately and investigated effectively. Lessons were learned and action taken where required. The provider had a development plan in place, which people and staff had contributed to.

We have made recommendations about creating suitable environments that support people living with dementia and the introduction of a pain assessment tool for people who were unable to verbalise their pain.

We identified a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 11 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 this report.

Inspection carried out on 23 & 24 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. Cornelia Manor provides accommodation and personal care for up to 34 people, including people living with dementia. At the time of our inspection 29 people were living at the service. 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found people’s safety was being compromised in some areas. This included the way incidents of abuse were responded to by staff which meant people were not always protected from abuse. We also found there were not enough staff to keep people safe at all times. The provider had not made an application under the Deprivation of Liberty Safeguards for a person who was subjected to restrictions that could have amounted to a deprivation of their liberty.

Staff were not always following the requirements of the Mental Capacity Act, 2005 (MCA). The recording of decisions following MCA assessments was not consistent. Meetings had not been held to make sure the best interests of people who lacked capacity to make decisions were considered, for example in relation to the use of medicines being given in a covert way.

Providers are required to notify CQC of certain incidents which occur, so we can monitor the safety of people using services and take regulatory action where required. We identified six incidents of abuse, or allegations of abuse, of and by people living at the service which had not been reported to CQC.

Most people spoke highly of the staff and told us they were treated with compassion. One person told us of two staff members had “wonderful laughs” and “make the place feel very happy”. A visiting healthcare professional said “people are treated well”. However, two people told us they did not always feel respected and one person’s dignity was compromised by their bedroom door having to be kept open to keep the room cool.

Staff maintained records to monitor whether people’s nutritional needs were being met. However, although staff told us people could ask for alternative meals, two people who asked for a cold lunch were told they were not available. People had access to a range of group activities, but no provision was made for people who chose not to join in with such activities. This put some people at risk of social isolation.

There was a comprehensive system in place to regularly assess and monitor the quality of service people received. However, it had not identified the concerns we found during this inspection as it focussed on processes rather than outcomes for people.

Risks of people falling were managed effectively and equipment was being used safely.  Records were maintained to show people at risk of developing injuries due to sitting or lying in the same position were turned regularly and pressure relieving cushions and mattresses were being used.

Care plans were personalised and staff knew how to support people according to their individual needs.  People were supported to have access to healthcare services and healthcare professionals praised the quality of care provided. People told us their needs were fully met and they were looked after well.

Necessary checks were undertaken to ensure staff were suitable to work with people. Emergency procedures for fire evacuation were in place and understood by staff.

The provider conducted yearly surveys of people, their families and professionals to ascertain their views. People knew how to make complaints and these were dealt with promptly. Feedback provided from surveys, comments and complaints was used to improve the service.

With the exception of incidents of abuse, investigations of other incidents and accidents were prompt and thorough. Learning was identified and passed on to staff to reduce the likelihood of similar incidents occurring again.

Feedback from people, relatives and staff showed the service had a positive, open culture. People were asked for their views and these were used to improve the way the service was run. Visiting relatives and friends were made welcome and staff engaged well with external professionals. Staff told us they enjoyed working at the service, felt it was well-led and spoke positively of senior management.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Following the inspection we spoke with staff from the local safeguarding authority to discuss some of the concerns we had identified.

Inspection carried out on 18 April 2013

During a routine inspection

We looked at three care plans and related records of care. We saw these contained records showing care and treatment had been discussed with people and that they had agreed to receive the care.

We spoke with the manager and three members of staff. Each demonstrated a good understanding of people’s needs and how those needs should be met. We spoke with six people who told us their needs were met. One said, “The care is very good”.

We also spoke with two external health care providers. One told us, “We have no problems with Cornelia”. The other said, “The care is fantastic”.

We looked at records which showed all staff had received training in safeguarding. Staff knew how to identify and prevent abuse.

During our previous visit we found an infection control issue relating to the use of slings. On this occasion we found there were effective systems in place to manage and monitor the prevention and control of infection, and slings were individually issued.

There were enough qualified, skilled and experienced staff to meet people’s needs. Staff received appropriate professional development.

Medical records and other records relating to the management of the service were accurate and fit for purpose. They were kept securely and could be located promptly when needed.

Inspection carried out on 16 January 2013

During a routine inspection

We visited the home in July 2011 and judged that it was non compliant with two regulations. Infection control procedures were not followed appropriately and medicines were not being managed safely. We told the provider to take action to improve these areas.

We visited the home again on the 16 January 2013. On this occasion we found that effective infection control procedures were mostly in place and medicines were being managed safely.

We spoke with five people and one family member who was visiting. We saw that care plans were signed by people or their relatives. People’s needs were assessed and delivered in line with their care plans. One person told us, “Everyone is treated well here”. Another person said, “I’m quite happy here, the service is very good”.

The home was clean and hygienic and there were some effective systems in place to reduce the risk and spread of infection. We saw detailed cleaning schedules and check sheets which showed when cleaning had been completed. However, the system used to allocate slings was not robust and could have put people at risk of infection.

Medicines were managed safely, and medication administration records were fully completed. We saw that arrangements were in place to administer 'as required’ medicines in a timely manner.

We looked at four staff files, and saw that there was an appropriate recruiting process in place, and there was an effective system in place to monitor the quality of service provided.

Inspection carried out on 15 July 2011

During an inspection in response to concerns

People told us that they were happy with the care at the home. They told us they were well cared for and they are supported, respected and valued.

People we spoke to were encouraged to make choices including what to eat and what activities they would like to participate in. We spoke to six people and they told us that they had plenty to eat and drink. People told us that staff gave them the support that they need to manage their medicines.

People told us the home was well maintained. However, on our visit we found a number of concerns with the cleanliness and infection control. For this area we have asked for immediate improvement.

Reports under our old system of regulation (including those from before CQC was created)