Archived: Cornish Close

At the time of this inspection there were three people accessing the respite unit, some on a longer-term basis until a more suitable placement could be sourced. Thirteen people were being supported in five bungalows. A bungalow empty at the last inspection was now refurbished. Two people previously living in the respite unit had moved into this bungalow as planned.

The service has been designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service did not always consistently apply these principles and values. Staffing levels meant people could not always participate in activities they enjoyed doing on occasions.

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

Premises checks were in place to ensure that all the accommodation was safely maintained, although not all aspects of electrical installation had been completed to ensure compliance. All necessary work was completed shortly after this inspection. There were sufficient numbers of staff providing support to people. In times of emergency staff from the respite unit had supported people living in the bungalows. This had impacted on people’s support. Recruitment processes helped ensure staff employed were suitable for their job role. People were offered and received their medicines as prescribed; staff had been trained and had their competency checked to administer medicines safely. The service had learned lessons following the outcome from a safeguarding investigation and delivered additional medicines training to night staff. Systems were in place to help ensure people were protected from the risks of abuse and avoidable harm.

Staff had received training in aspects of care relevant to people's needs and now received regular supervision. People received sufficient nutrition and fluids, including any modified or specific diets. People accessed appropriate healthcare services when required and were able to live healthier lives. 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. Where the provider deemed the service no longer best met people’s increased needs, referrals for reassessments were sent to the local authority.

Steps had been taken to ensure people's rights were understood and respected. People were assured they would receive care that was not discriminatory. Staff respected people's privacy and dignity and encouraged people to be as independent as possible. People’s views and preferences were reflected in their support plans. People were cared for by friendly staff.

People received personalised and responsive care. People were supported to achieve their goals and pursue activities that supported their independence. The registered manager was aiming to encourage people to try new things and use local public transport more. Communication needs were assessed, although specific communication needs were not always fully supported. We have made a recommendation about addressing this. Processes were in place and followed to ensure any complaints received were investigated and resolved.

The systems the provider had introduced since our last inspection had helped to shape and improve the service, but these were not fully effective and needed to be properly embedded by the registered manager. The registered manager was supported by a wider management team. Staff felt supported and considered the service had improved. The service worked in partnership with numerous external stakeholders, and shared information appropriately where required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The provider completed an action plan after the last inspection to show what they would do and by when to improve and we identified one breach in regulation. At this inspection we found the service had improved and the provider was no longer in breach of regulations.

The last rating for this service was requires improvement (published 20 February 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections whilst managed by this provider.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. 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.

At the time of this inspection there were four people accessing the respite unit, two of whom lived there on a long term basis. Eleven people were being supported in four bungalows. One bungalow was empty at the time of this inspection and was being refurbished. Two people were planning to move from the respite unit and into the vacant bungalow. They were being involved in the process of refurbishing the property so that the home met their needs and personal taste.

The respite unit at Cornish Close 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. People living in the bungalows received personal care and support from staff based on individual needs.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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. There was a registered manager in post at the time of this inspection who was present during the inspection .

This was our first inspection of Cornish Close since the change of provider in June 2017. We judged that the service required improvement. We identified one breach in regulation during this inspection.

Staff received the training and support to effectively meet people’s needs, although we identified that supervisions had not been undertaken with staff in line with company policy. Observations of staff competencies were completed although annual appraisals had not been undertaken. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as staff had not received adequate supervision or feedback about their performance.

People enjoyed living at Cornish Close and felt safe. There had been issues with the general public accessing the grounds of Cornish Close, especially late at night. The provider was working with the housing association to stop this from happening, whilst also making sure that people living at Cornish Close were kept safe and not restricted from leaving.

A safe system for recruiting new staff was in place. The number of staff on duty in the bungalows depended on people’s needs and the activities people planned to participate in during the week. Care and support in the respite unit was provided to people continuously over a 24 hour period.

Medicines were administered as prescribed. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. At this inspection we saw that equipment was maintained and serviced in line with national guidelines.

Person centred care plans and risk assessments were in place to guide staff on the support people needed and how to reduce any identified risks. Where applicable, care plans were in place to support specific health conditions, for example diabetes and dysphagia.

People’s health and nutritional needs were met by the service. People told us they were involved in helping to set weekly menus and sometimes shopped for food if this was their choice. The food was good and the menus showed that people were offered variety and choice in their meals.

Not all aspects of the premises were well maintained. The provider was working with the housing association to address the repairs needed. There was inappropriate storage of some cleaning equipment and materials in two of the bungalows bathrooms. We brought this to the registered manager's attention.

People's individual needs where considered when re-designing and re-decorating the premises. People were involved in choosing how they wanted to decorate their own bedrooms. Two people were waiting to move into the vacant bungalow and had been involved in the refurbishment of the property to make sure it met their needs.

Information about people’s preferences, culture, likes and dislikes was recorded. A description of people’s preferred daily routines was held on their support plans and replicated on an electronic care planning system. Staff had access to this and could see updates from the registered manager or team leaders and record daily progress notes on the system.

It was not always clear if people had been involved in reviewing their care plan, or if they wished to be involved. Whilst we were assured from speaking to people that they were happy with the support and able to discuss this with staff, this was not always documented.

The registered manager had auditing systems in place to monitor the quality of the service, although they had not identified the infrequency of supervisions undertaken with staff. Other quality checks and audits were carried out at the service by other managers in the group. The provider shared information about incidents that had occurred in other services so that lessons were learned and to minimise the risk of a reoccurrence in other services.

A recent incident had occurred at the respite unit where staff had needed to contact the police and the provider had not notified CQC of this event, as is the law. We reminded the registered manager of their statutory obligations and the occasions when a notification was required. We will continue to monitor this aspect.

People were given the opportunity to provide feedback about the service as the registered manager had newly recently introduced ‘service socials’ in September 2018. These were informal gatherings where people could tell managers what was working and what needed to be improved. A second ‘service social’ was planned for November 2018.