Cornelius House

This inspection took place on 8 March 2018. The inspection was unannounced. At the last inspection on 16 November 2016, the service was rated as Requires Improvement with concerns about the safety of medicine management and concerns about the leadership structure at the service. At this inspection we found there had been changes to improve the management structure at the service and medicine management was now safe. We found the service had improved from “Requires Improvement” to “Good”, with the caring domain rated as “Outstanding”.

Why the service is rated as Good:

There was a new registered manager in post. 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.

People and their relatives told us staff were exceptionally dedicated, caring and kind. Staff demonstrated compassion for people through their conversations and interactions. They did special things which made people feel they mattered. Feedback about the caring nature and acts of kindness were excellent. Comments included, “Absolutely fantastic”; “Cared for in such as personal and loving way.” Another person told us, “Lots of my visitors have said what a lovely atmosphere it is here, they don’t feel they are coming into a home. I feel it’s my home; I go about just as I please. If you want anything sorted out you only have to speak to [staff name] and it’s done.”

People told us their privacy and dignity was promoted. People all said they were actively involved in making choices and decisions about how they wanted to live their lives. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the assessment and care planning process. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were very personalised and guided staff to help people in the way they liked.

Risks associated with people’s care and living environment were effectively managed to ensure people’s freedom was promoted. People were supported by consistent staff to help meet their needs in the way they preferred. People’s independence was encouraged and staff helped people feel valued by encouraging their skills and involving them in decisions. The registered manager and provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were safely managed and given to them on time.

People received care from staff who had undertaken training to be able to meet their unique needs. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

People were cared for in a service which was well maintained and invested in. The home was kept clean and smelled fresh. There was a range of activities which people enjoyed to help keep them stimulated and occupied.

Policies and procedures across the service were in place and available for people in different formats when required. People were treated equally and fairly. Staff adapted their communication methods dependent upon people’s needs, for example using simple questions and information for people with cognitive difficulties and information about the service was available in larger print for those people with visual impairments.

The service was very well led by the registered manager and provider and supported by a dedicated team. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which might require improvement. Complaints and incidents were learned from to ensure improvement. The registered manager and provider promoted the ethos of honesty and admitted when things had gone wrong. The service kept abreast of changes to maintain quality care.

The home has a registered manager who has been in post for many years. 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. People and their relatives spoke highly of the care provided at Cornelius House. We found some areas of practice that required improvement.

There was inconsistent practice with some staff who were not clear about how to administer medicines. This meant that people were put at risk of not receiving their medicines safely.

Recruitment systems were not robust. Not all staff records contained a full employment history and where some staff had gaps in employment there was no explanation on record for these gaps. This meant that the provider could not be assured that they were employing staff with all the satisfactory evidence in respect of their employment history.

Communication systems were not always effective. Leadership was inconsistent when senior staff were not on duty. One staff member told us, “There is not always someone to report to.”

People told us they felt safe living at Cornelius House. One person said, “There is always someone around to ask if you need help.” There were enough staff on duty to care for people safely and risks to people were assessed and managed effectively. Staff had a good understanding of safeguarding and their responsibilities with regard to maintaining people’s safety.

Staff received the training and support they needed to be effective in their roles. People said they felt confident in the ability of staff to care for them. One person said, “They are very skilled and know how to provide care really well.”

People told us they enjoyed the food and had plenty to eat and drink. One person told us “I have had good meals here and there is enough choice. So far I have always found something I like.”

People were supported to access health services when they needed them and staff were proactive in seeking help and advice. One person said, “If I need a doctor I know the staff will call them in immediately.”

People spoke highly of the caring attitude of the staff. Their comments included, “The staff are all lovely, it feels really homely here,” and “They couldn’t do any more for you then they do.” Staff were kind and caring in their approach and treated people with respect. People were included in developing their care plans and staff supported them to remain as independent as possible.

People received personalised care that was responsive to their needs. One person said, “The staff know what is important to me and how I like to spend my time.” Staff demonstrated that they knew people well and understood their wishes. People were supported to follow their interests and they told us that they had enough to occupy them at Cornelius House and that they enjoyed the activities that were organised.

People and staff spoke highly of the management at the home and said that the registered manager was approachable. People knew how to make complaints if they needed to and the registered manager took appropriate actions to address their concerns.

There were systems and processes in place to monitor the quality of care provided. The registered manager used this information to drive improvements in the service. Staff and people were encouraged to give their views on developments at the home.

Staff had developed links with the local community and the registered manager and deputy manager were committed to making improvements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of this report.

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

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and from looking at records.

As part of this inspection we spoke with five people who use the service, the registered manager, three care staff, one cleaner and one member of the administration team. We also reviewed records relating to the management of the home, which included six care plans, complaints book, minutes of staff and residents meetings, staff rotas and records, medicine sheets, maintenance records and audits.

Is the service safe?

People we spoke with told us they felt safe. One person told us "It's lovely to be here, I feel lucky, the staff are quality". People who used the service and staff told us that people's care was regularly discussed and planned with them. This meant that staff had the information they needed to keep people safe, by ensuring they were up to date with care needs and risk assessments.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do. No DoLS applications had needed to be submitted. The manager understood when an application should be made, and how to submit one. Care staff undertook training in MCA, DoLS and safeguarding of vulnerable adults. This meant that people would be safeguarded as required because staff had the knowledge to assess people and undertake an application if necessary.

We saw that there was sufficient staff to ensure people's care needs met. Staff had training so that they had the qualifications and skills to deliver care, and told us they felt supported. One staff member told us; "I feel supported here, I have done extra training for my NVQ (National Vocational Qualification) and I can always approach my manager for advice". This meant staff had the skills they required to meet people's needs.

We saw that systems were in place to make sure that staff learned from events such as falls, accidents or complaints. This had helped the service promote the safety of people.

Is the service effective?

We saw people had detailed care plans, that identified risks and highlighted personal preferences. This meant that staff had up to date guidance on how to meet people's needs.

People's health and care needs were assessed with them, and other professionals contributed towards information in their care plans. Care plans showed the involvement of other professionals such as district nurses and chiropodists. We saw the care plans of five people and saw up to date information from other professionals, these were dated and signed. For example one person was having visits from the district nurse. There were recommendations for support of the person in their care plan. This meant that the home care staff had access to relevant and updated care plans so they were able to meet changing needs effectively.

We saw that staff not only had a verbal handover at beginnings of shifts, they also had one to one meetings with people to discuss their needs and ensure care given was effective.

We found that people's health care needs were met and that staff had the right skills and knowledge and knew when to seek advice. One member of staff told us; "we have regular meetings with people and their families, so we can get ideas about what they want and if we need to do anything different or better"

Is the service caring?

People were treated with respect and dignity by the staff. We saw staff interacting with people in a gentle and caring way. Explanations were given as to what staff were going to do and how they would do that for people before they did it. We saw staff knocking on doors before entry to rooms and addressing people in the way in which they had requested.

One person told us: "I am very happy here, staff help me if I need it. I can do quite a lot for myself but it is good that they are there whenever I want. They never make a fuss and I don't have to wait when I want something"

Is the service responsive?

People's health needs and care were assessed with them. We found that the provider had regularly asked and acted on the comments and views of people who used the service and their families.

We saw staff were responsive to people's choices, for example people could choose to have their meals in the main dining area or in their rooms.

There were daily activities at the home, and people had the choice of participation. One person told us "I can do activities if I want, but I like my own space". We saw staff made the time to sit and chat or do a one to one activity with people. This meant that staff responded to people's emotional needs by allowing them to choose an activity which suited their requirements.

While inspecting the home, the manager dealt efficiently and calmly with an emergency, that required the transfer of a person to hospital via ambulance. The person was supported in a calm, caring way to alleviate anxiety.

Is the service well-led?

The service had a full time registered manager and deputy. They shared the responsibility for the home on a day to day basis and would overlap shifts to ensure there was safe and continued senior cover. We saw that systems were in place to ensure good standards of care. For example, staff had regular mandatory updates organised by the provider and training was encouraged and supported. Staff had appraisals and opportunities to discuss their training and have performance reviews.

Systems were in place such as feedback sessions, meetings and evaluation to make sure that managers and staff learned from events such as accidents and incidents, complaints or concerns. This reduced the risks to people and helped the service to continually improve.

Everyone expressed satisfaction with the service provided. For example, one person told us, "I am very happy here. The staff are great, very polite and always say 'No problem' when I ask for help".

People and their family members also expressed satisfaction with the standard of meals and drinks provided at the service.

The provider's recruitment practices were robust and protected people.

Everyone that we spoke with said that they felt confident that issues would be resolved if raised with management of the service. One person said, 'The manager is excellent at her job, she has a surgery and we can go and see her if we want to raise anything'. A relative told us, "It's about trust. The manager is very approachable and I do trust the manager and the home".