Cornmill Nursing and Residential Care Home

We found the following examples of good practice:

The provider and registered manager had established robust infection prevention and control procedures which were understood and adhered to by the staff. All staff had completed training on the use of personal protective equipment (PPE) and participated in the weekly testing programme. On the day of our visit, the staff were well organised and were wearing appropriate PPE. The home had plentiful supplies of the items required.

The home was hygienic and had a good standard of cleanliness in all areas seen. Additional housekeeping staff had been employed and the frequency of cleaning had been increased. Specialist cleaning equipment had been purchased to sanitise surfaces and rooms.

Although visiting was subject to government restrictions, the provider had found creative ways to enable people to maintain contact with their relatives. This included the employment of additional staff to help people make telephone calls and to see their relatives through the window. A warm and safe area was being developed to allow for visiting undercover. There were strict procedures in place for essential visitors, which included a temperature check.

The atmosphere in the home was warm, comfortable and calm. People were occupied with craft activities, spending time talking to others or watching television in their room. One person told us they were happy living in the home and the staff were kind and caring.

The provider’s infection prevention and control policies and procedures were up to date and an annual audit had been carried out. The provider had also developed a Covid-19 Response Plan and business contingency plan.

Further information is in the detailed findings below.

Cornmill Nursing and Residential Home is a family run care home, near the centre of Garstang, where all amenities are available. The home is registered for 52 adults, who require support with nursing and personal care needs. At the time of the inspection visit 47 people lived at the home.

People’s experience of using this service:

The service was praised by people they supported and by visiting professionals. People spoke extremely positively about the ways in which the quality of their life had improved and how well they were supported. We were repeatedly told staff made a ‘fantastic’ difference and promoted an exceptional quality of life for people with their outstanding caring attitude.

People’s care and support had been very well planned proactively and in partnership with them. People felt consulted and listened to about how their care would be delivered.

People consistently told us staff continued to be extremely polite, reliable, caring and professional in their approach to their work.

The service continued aim centred on promoting people’s individual and cultural needs. This included outstanding training to support staff in person-centred care and diversity and understanding so staff were aware of what high standards looked like.

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.

The service worked extremely well in partnership with other organisations to ensure they followed the best practice. The registered manager took a person-centred and holistic approach to meet the health and nursing needs of people who they cared for. This had resulted in exceptionally positive outcomes for people. Risk was managed well to keep people safe from harm.

Meal times were relaxed and organised around people’s individual daily routines. People who required help to eat their meals were supported by caring, attentive and patient staff.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek people’s views about the service provided. The service continued to seek the views of people and family members through satisfaction surveys, care plan reviews and meetings. Surveys had been returned with 100% extremely positive comments from people.

The service continued to be accredited through the ‘Gold Standards Framework.’ The GSF had annual appraisals to ensure the ‘Platinum’ standard was maintained. They had maintained this achievement for nine years and continued to involve people for their opinions to maintain the award.

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

Rating at last inspection:

At the last inspection the service was rated outstanding (published 30th November 2016).

Why we inspected:

This was a planned inspection of the service.

Follow up:

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

Cornmill Nursing and Residential Care Home is a family run business which is located in the centre of Garstang, near to all community amenities. The home has been built within an adapted corn mill and is situated on the bank of the river Wyre. The home is registered for 52 adults, who require support with nursing and personal care needs. At the time of the inspection visit 51 people were residing at the home.

There was a registered manager 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.

The service was last inspected in June 2013. We identified no concerns and found the service was meeting all standards we assessed.

At this inspection visit carried out in October 2016 people spoke extremely positively about the quality of service provided. People repeatedly told us staffing levels met their needs and staff went the extra mile to help people. Staff were constantly referred to as ‘kind’ and ‘caring.’

People who used the service, relatives and health professionals consistently commended staff knowledge and competence. Relatives repeatedly told us they were confident and assured that people who used the service were supported by competent staff that went the extra mile.

There was great emphasis on creating positive health outcomes for people who used the service. Health care needs were proactively met. Good practice guidelines were constantly referred to when providing care and treatment. People told us their wellbeing had improved since they started living at the home. Relatives praised the ways in which people’s quality of life had increased since their family members moved into the home.

The service worked in partnership with other care professionals to meet needs. Health professionals we spoke with repeatedly praised the standard of care provided and described the service as professional and reliable.

There was a strong emphasis on ensuring people’s dietary needs were consistently met. A health professional with an interest in diet and nutrition spoke confidently about the skills of the staff and their ability to meet people’s dietary requirements. They told us the service worked innovatively and consistently to meet people’s nutritional needs within a person centred way. The service had taken part in a Tele-swallowing project to reduce hospital admissions and to promote safe swallowing. Staff knowledge was praised in regards to meeting people’s dietary needs.

People who lived at the home were supported to attend activities of their choosing. People were enthusiastic about the activities and the opportunities made available to them and repeatedly said there was plenty to do. There were active links with the local community and people were encouraged to be citizens in their own community.

There was a welcoming, homely atmosphere within the home where visitors were encouraged. Links with family members were promoted and nurtured.

The service championed equality and diversity. Staff had received training to enable them to be champions who promoted equality and diversity. Staff were understanding of the needs and committed to promoting people’s individuality.

There was an emphasis on developing staff potential within a positive learning environment to create a high quality service. Staff were encouraged to become champions in their field of interest. There were multiple champions in post at the time of the inspection visit, including champions for dignity, safeguarding, tissue viability, end of life care, moving and handling and equality and diversity. Champions had received additional training and skills in their specific areas. Skills were then shared within the staff team to create more positive outcomes for people who used the service.

Training was provided for staff to enable them to carry out their tasks proficiently. Staff training was monitored and training was provided when training needs were identified. Staff praised the training on offer and said they were encouraged to develop their own interests within the workplace. Staff were eager to learn and improve their knowledge in order to provide more effective care. Staff had clear knowledge of roles and responsibilities and knew how to seek advice and guidance if they required support and guidance.

Staff were consistently positive about ways in which the service was managed and the support received from the management team. Staff praised the positive presence of the senior management team at the home and repeatedly described the management team as, “Excellent.” And, “On the ball.”

Staff described a positive working environment with high levels of job satisfaction. Staff spoke highly about the good teamwork which took place within the home and said this contributed to positive outcomes for people who lived at the home.

Communication within the service was described as ‘good.’ Staff told us regular team meetings took place to discuss concerns and improvements. Staff said they were able to contribute to making suggestions to improve service delivery and felt their opinions were listened to.

Leadership within the organisation was exceptionally strong. Managers had a clear vision of what was required of a quality service and this spread throughout the organisation. All staff were respectful of management and demonstrated a commitment to working towards the shared values of the organisation.

The service worked proactively with other organisations to ensure they were implementing and following best practice guidelines. Information was willingly shared with other providers to assist improvements within other services.

The service had received beacon status within the gold standards framework for end of life care. This demonstrated the service worked innovatively to provide outstanding end of life care so people could experience a pain free and dignified death.

The registered manager had implemented a range of assurance systems to monitor quality and effectiveness of the service provided. Audits were carried out by different members of staff within the organisation by staff who had specific knowledge and skills. This was overseen by a member of the senior management team and the registered manager.

There was an open and transparent culture within the home. Feedback was continuously gained from all parties as a means to develop and improve the service. People who lived at the home and relatives told us they were consulted with on a regular basis.

People told us staff responded to their needs in a timely manner. Staff told us staffing levels were flexible and responsive to need. Call bell data was analysed and reviewed and changes to staffing were made as a result of call bell analysis.

People were protected from risk of abuse. People told us they felt safe and secure. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. Suitable recruitment procedures meant staff were correctly vetted before starting employment.

Care plans strongly emphasised the importance of promoting independence and empowering people. Staff promoted a person centred approach to risk. This enabled people to take calculated risks which enhanced their well-being.

Suitable arrangements were in place for managing and administering medicines. Regular medicines audits were carried out to ensure medicines were administered appropriately to promote safe and effective care.

Staff retention was good and people said they benefited from staff who knew them well. Agency staff were rarely used as it was recognised this could have a negative impact upon people who received the service. When agency staff were used they were checked prior to employment and were supported by a more senior member of staff.

The home was maintained to a high standard. People who lived at the home praised the environment and the high standards maintained. The registered provider had worked hard to refurbish the home to the required standard following significant storm damage.

Is the service safe? Service user call bells were found to be responded to promptly.

Is the service caring? Staff members ensured that service users were quickly responded to when requests were made in order to ensure their needs were met.

Is the service well led? The current manager has been registered with the Commission, and service provider had effective quality assurance, polices and procedures in place.

Is the service responsive? The service provider has installed an effective call bell system to ensure that service user requests for help and assistance were efficiently responded to.

Is the service effective? The service provider had effective and robust systems in place to ensure that service users needs were met, and to ensure service users were supported by staff that were well trained and safe to work with vulnerable adults.

"The staff are very good at explaining what they need to do."

"I like it here...They really encourage my independence...I see my care plan each month...They won't hesitate to ring the G.P. if I'm ill...I get to see the optician and the physio comes round often."

"If there was something wrong, I'm happy I could speak with any of the staff...I'm confident they'd sort it out."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People experienced care, treatment and support that met their needs and protected their rights.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. This included amendments to the recruitment process to ensure candidates were fit to work with vulnerable people.

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment and were protected against the risks of unsafe or unsuitable premises.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was an effective complaints system available.

We found staff to be well supported and appropriately trained and those living at Cornmill looked comfortable in their presence. We also spoke with several relatives who were all very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been established and systems had been developed in order to protect the health and safety of those living at the home.

Comments from those living at Cornmill and some relatives included:

'The staff are marvellous." One service user commented, who was enjoying a manicure.

'It's been very successful."

'They are very good. If you need something in the night, you just press the buzzer and they come.'

'The nurses are very good. The care is tremendous.'

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to staff training and monitoring the quality of service provision were also inspected.