Cornford House

Cornford House is a residential care home providing accommodation and nursing and personal care for up to 70 people. The service is arranged across four floors with lift access to lower ground and upper floors. There were 20 people using the service at the time of our inspection. Cornford House also provides personal care for people living in their own homes, within the same accommodation. These people have a tenancy agreement and a separate agreement for their care provision. There were 46 people receiving personal care in their ‘own homes’. People receiving personal care can choose to have their care provided by another care provider. However, everyone living in Cornford House had their care provided by staff employed by Cornford House.

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

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

People were not always offered choice in the care and support process. Some people had tenancy agreements in place, separate to their care agreement, and were not always aware of their rights to choose between a tenancy agreement or an agreement for accommodation with care. Tenancy agreements placed restrictions on people, for example, they were not able to have cooking facilities in their home.

People had comprehensive risk assessments in place that contained enough information for staff to support people safely. Staff had received training and people were supported by staff who knew them well. Staff had been recruited safely. The provider had systems in place to manage environmental risks, such as fire.

People and their relatives told us they felt safe and happy living in Cornford House and that it was a nice place to live. One person said, “I feel very safe, one hundred and ten percent. Everyone is so lovely.” Another person said, “I like it very much. People are very nice. You’ve only got to ask, and they’ll get it for you.” A relative said, “Yes, it is safe. [Relative] is well cared for; there is a resident nurse on duty; and doors are secured.”

Medicines were managed safely, and people received them as prescribed. People were protected from the risk of infection. People were supported to eat and drink enough and told us the food was good in Cornford House.

People, relatives and staff told us the management team were supportive and approachable and they were confident to raise concerns. Checks and audits had been completed on the service and actions had been taken to address any shortfalls.

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 23 October 2018). At this inspection the service has been rated requires improvement and there were breaches of regulations in relation to person centred care and consent.

Why we inspected

The inspection was prompted in part by notification of an incident, following which a person using the service died. This incident is subject to further investigation by the Care Quality Commission (CQC) as to whether any regulatory action should be taken. 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 health and safety in the service. This inspection examined those risks. We found people were no longer at risk from these concerns. We had also received some concerns about the service in respect of physical abuse and poor care practices. We found no evidence during this inspection that people remained at risk of harm from these concerns.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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

Enforcement and Recommendations

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 person centred care and need for consent 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.

Cornford House is a purpose-built modern building that provides accommodation and nursing and personal care for up to 70 people, in a range of studio or one bedroom suites, with en-suite shower rooms. People living in Cornford House are either owner occupiers or tenants. Nursing and personal care is provided by staff on site although people are able to choose another care provider if they wish; no one received care from another provider at the time of our inspection. If people choose to have their care provided by Cornford House Limited, they will have two agreements with the provider, one for their tenancy and a separate one for their care. At the time of our inspection, there were 53 tenants living in the service. The service provides nursing care across all floors. The second floor supports people living with dementia or mental health needs, some of whom also require nursing care. People had varying care and support needs. Some people were living with dementia, whilst others had diabetes, Parkinson's disease and physical disabilities.

There was a registered manager employed at the service. 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 on 13 and 14 July 2017, we found that the registered provider had made improvements to the culture of the service and the care people received. A new management team had been introduced to implement and monitor improvements in the service. However, new monitoring systems needed to be embedded and improvements needed to be sustained over time. At this inspection we found that new systems were embedded and sustained and the service that people received had improved.

People were kept safe and staff were knowledgeable about reporting any incidents of harm. Staff received training in safeguarding people from abuse. Staff demonstrated that they understood the signs of abuse and how to report any concerns in line with the registered provider's procedures. People's needs were met by sufficient number of staff who had undergone safe recruitment checks.

Risk assessments were in place and reviewed regularly to minimise the potential risk of harm to people during the delivery of their care. People's care records were held securely and these records were reviewed and any changes to people's care and support needs had been recorded.

Medicines were administered to people in a safe way. Records for the administration of medicines were maintained and medicines were stored safely.

Before people moved into the service they had their needs assessed to ensure the service could meet them. Once people moved into the service, detailed person centred care plans were prepared, with important information recorded to assist and guide staff to meet people’s needs.

People had access to nutritious food and refreshments. Support was offered to maintain dignity and respect to those who could not fully manage themselves. This included, for example, help with meals, personal care and mobility.

People had access to healthcare professionals and their healthcare needs had been met. Care records seen confirmed visits from healthcare professionals had been recorded.

Systems involving digital technology were used and these enabled the service to provide care and support tailored to people’s requirements and preferences. It also helped the service move forward. People participated in activities they enjoyed and were encouraged and supported to socialise. People were supported to maintain relationships which mattered to them.

Staff understood people's needs and treated them with respect, kindness and dignity. Staff communicated with people in the manner they understood. Staff supported people to express their views. People and their relatives were involved in their care planning and their views respected.

Staff had the necessary guidance when they required it and were appropriately trained for their role. Staff supported people to make decisions for themselves as legally required by the Mental Capacity Act 2005 (MCA).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Mental capacity assessments had been conducted and Deprivation of Liberty Safeguards had been submitted to the local authority.

People knew how to raise a concern or make a complaint and were confident that if they did, the management would respond to them appropriately. Effective systems were implemented to manage any complaints that the service received.

The environment was safe, clean and hygienic. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. Suitable checks were made on the premises and equipment to ensure they were safe. Emergency contingency plans were in place in case of emergencies.

Systems were in place for monitoring the quality of service provided and the management team was open, transparent and visible during the inspection process. Action plans had been developed, lessons were learned when things went wrong and when improvements needed to be made. This helped to ensure the people that lived at Cornford House received a good quality service.

The provider had submitted statutory notifications and had displayed its inspection rating in the service and on its website as legally required.

Cornford House is a purpose-built modern building that provides accommodation and nursing and personal care for up to 70 people, in a range of studio or one bedroom suites, all with en-suite shower rooms. People living in Cornford House are either owner occupiers or tenants. Nursing and personal care is provided by staff on site although people are able to choose another care provider if they wish, although no one received care from another provider at the time of our inspection. If people choose to have their care provided by Cornford House Limited, they will have two agreements with the provider, one for their tenancy and a separate one for their care. At the time of our inspection, there were 70 tenants living in the service. The service provides nursing care on the lower ground floor, ground floor, first floor and the second floor. The second floor supports people living with dementia or mental health needs, some of whom also require nursing care.

At our last inspection on 12 December 2016 we found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in regard to staffing levels, individual risk and mental capacity assessments, protocols relating to some medicines administration, internal systems to prevent harm or abuse, people’s dining experience, social isolation, continence needs and effectiveness of the monitoring systems.

The registered provider sent us an action plan detailing the improvements they would make and confirmed they would be meeting the requirements of the regulations by June 2017. They kept us informed of their progress.

This inspection was carried out to follow up on compliance with these notices. At this inspection we found that the registered provider had met the requirements detailed in the warning and requirement notices and had made improvements to the culture of the service and the care people received. A new management team had been introduced to implement and monitor improvements in the service. However, new monitoring systems that had been introduced need to be embedded and improvements need to be sustained over time.

There was a new general manager in post since 27 March 2017, whose application to the Care Quality Commission for registration was in progress at the time of our inspection. Their registration was confirmed shortly after our visit. A registered manager is a person who has registered with the CQC 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 knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were appropriately recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to consistently meet people’s needs and respond to call bells in a timely manner. Staffing levels had been increased and calculated taking into account people’s specific needs and dependency levels. These improvements needed to be sustained over time to ensure people remained safe in the service. Thorough recruitment procedures were in place which ensured staff were suitable to work in the service.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. A new system of medicines management had been introduced that was effective and that minimised risks of errors.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Staff had received essential training to enable them to meet people's needs, and were scheduled for refresher courses. All members of staff received regular one to one supervision sessions. Staff reported feeling well supported in their roles by the new management team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions; meetings with appropriate parties were held and recorded to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us the quality of meals had improved and that they enjoyed the food provided. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors. Complaints were appropriately addressed.

People were promptly referred to health care professionals when needed. Their recommendations were acted on. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities.

People were involved in the planning of activities that responded to their individual needs. People and their relatives’ feedback was sought at dedicated meetings, and through satisfaction surveys.

Staff told us they felt valued by the new registered manager; that they had confidence in their leadership and in the new management team. The registered manager was open and transparent in their approach and led by example. They had driven a significant amount of improvements in the service and placed emphasis on continuous enhancement of people’s experience in the service.

There was a system of monitoring checks and audits to identify the improvements that needed to be made. The registered manager, the assistant manager, and the lead registered nurse acted on the results of these checks to improve the quality of the service and care. Although many improvements had been implemented, the new management team had only been a place since March 2017. Improvements need to be firmly embedded in the service and sustained to ensure standards of quality and safety are maintained. We have recommended that the registered provider and registered manager continue to closely monitor the service to ensure the improved standards of governance are sustained.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service has a registered manager, who was present throughout 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.

Cornford House was last inspected in January 2016 where a number of breaches of the regulations were identified in staffing, nutrition, person-centred care, and governance and it was rated Requires Improvement. The provider sent us an action plan to tell us what actions they were taking to implement those improvements. At this inspection, we found the provider had made improvements to person-centred care and meeting people’s nutritional needs but the provider continued to breach the regulations relating to the other areas. Further areas of concern were also identified at this inspection. We also found a new breach of person-centred care.

Staffing levels had been increased since the last inspection. However, people continued to have concerns over response times to call bells. The deployment of staff and visibility of staff on certain floors was not sufficient. This added to people’s risk of social isolation.

The management of medicines was not consistently robust. Risk assessments for self-administration of medicines were not in place. Pain assessments had not been completed and protocols for the use of ‘as required’ medicines were not consistently in place. Checks were not in place for the use of emergency equipment.

The principles of the Mental Capacity Act (MCA 2005) were not embedded into practice. Assessments of capacity had not been considered for decisions such as the use of bed rails, inability to use call bells and consent to care plans. Where people had lap belts done up whilst using wheelchairs, the rationale for this restriction was not consistently recorded.

Where people could not safely use their call bells, robust risk assessments were not in place. The management of continence required improvement. Person centred care plans and risk assessments were not in place to manage people’s continence needs.

The risk of social isolation had not adequately been addressed across all floors. Some people commented they felt lonely. One person told us, “Yes, I am lonely.” Improvements were required to make care plans person centred.

End of life care plans were in place. However, these were not consistently personalised. We have identified this as an area of practice that needs improvement and have made a recommendation about the review of end of life care plans.

Fire evacuation procedures were in place. However, people’s individual ability to evacuate the building had not been assessed and consideration had not been given to the factors which may prevent a safe evacuation. The provider had identified this as a concern and was in the process of implementing new fire evacuation plans for people.

People’s dining experience varied. People had mixed opinions over the quality of the food provided. One person told us, “Food is terrible, I don’t like it much.” The presentation of pureed food required improvement.

The risk of people experiencing harm and or abuse was increased because staff’s knowledge of adult safeguarding varied. During the inspection, a safeguarding concern was raised which was still being investigated at the time of writing this report.

Quality assurance systems failed to consistently drive improvement and identify shortfalls.

People spoke highly of the group activities provided. The provider and staff worked in partnership with the project ‘Ladder to the Moon.’ People spoke highly of the social coordinators and consideration had been given to making activities meaningful for people living with dementia.

People were protected, as far as possible, by a safe recruitment system. Nurses employed by the provider of Cornford House and bank nurses all had registration with the Nursing Midwifery Council (NMC) which were up to date.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. We saw many positive interactions and people enjoyed talking to the staff. The importance of promoting independence was understood by staff and staff told us how they protected people’s privacy and dignity. Staff said the management was fair and approachable, handover meetings were held every morning to discuss people's current needs and to direct staff in meeting these.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate enforcement action, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures.

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.

Cornford House is registered to provide both personal and nursing care to the people of the suites. The in-house team of registered nurses and carers is available 24 hours a day to respond to the persons’ care needs when required. With registered nurses available on-site, the suites offer a permanent home where people do not need to worry about moving when their care needs increase.

At present there are 42 people who have a tenancy care agreement and 33 people with a nursing care agreement living at Cornford House. There is no difference in the care provided and the care is delivered by the staff of Cornford House.

The accommodation provides nursing care and support for physically frail older people who live with health problems such as diabetes, strokes, Parkinson’s disease and end of life care. There is also a specialist unit for up to 18 older people whom live with a dementia type illness. Peoples’ spouses can also be accommodated, so that couples can stay together even when one develops the need for on-going care.

This inspection took place on the 28 January and 01 February 2016 and was unannounced. There were 75 people living in Cornford House.

People commented positively about the care and support received and their experience at Cornford House. However, the inspection highlighted shortfalls that had the potential to compromise the safety of people in the service.

Care plans did not all reflect people’s assessed level of care needs and care delivery was not always person specific or holistic. We found that people with specific health problems such as end of life care and diabetes did not have sufficient guidance in place for staff to deliver safe care. This had resulted in potential risks to their safety and well-being. Staffing deployment and levels had impacted on people receiving the support required to keep people safe. Whilst accidents and incidents had been recorded, strategies to eliminate risk and manage risk such as recurrent falls in the evening and at night were not in place.

Auditing had not been totally effective in highlighting shortfalls in the quality and safety of the service. Feedback had been sought about the quality of the service, but had not been acted upon.

Staff meetings were not as regular as staff wanted. They felt that meetings should be held so that they the staff could contribute to the running of the home.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.’

The home had an activity programme and staff who were part of an activity team. We observed that the activities were specific to each unit for small groups, guided by their specific social needs. There were also larger group activities for all units to join if they should choose to.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed in regard to enabling people to choose to walk independently and therefore promoting people’s independence. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and applications were in progress.

Essential training and updates were provided for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people’s needs. However specific training for people’s health needs such as diabetes, strokes and Parkinson’s disease had yet to be progressed for all staff delivering care.

People were protected, as far as possible, by a safe recruitment system. Nurses employed by the provider of Cornford House and bank nurses all had registration with the Nursing Midwifery Council (NMC) which were up to date.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. People said they were comfortable and relatives felt people were safe.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people’s needs were met. There were systems in place for the management of medicines and we observed staff completing records as they administered medicines.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them.

Staff said the management was fair and approachable, handover meetings were held every morning to discuss people’s current needs and to direct staff in meeting these.

Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

We found a number of breaches 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.

People told us they were treated with respect and dignity. People and relatives told us that people received the care and support they needed and that people were able to make choices about their lives. A relative told us 'privacy and dignity, you can't fault it'.

Another relative told us that the service 'caters for Mum's every need. '

People told us that they felt safe living at the service. Staff demonstrated that they understood what action to take if they suspected that a person may have been subject to abuse.

There were enough staff on duty to give people the support that they needed. We saw that people were comfortable with staff. The interactions between staff and people were positive and respectful. Staff did not rush people when supporting or speaking with them and respected when people wished to exercise their independence.

The provider had systems in place to monitor the quality of the service provided. These included internal audits and systems for consulting people who used the service and their relatives.