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Archived: Cornerways Residential Home Requires improvement

Reports


Inspection carried out on 5 October 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 8 April 2015. At this inspection we found a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to three regulations: Regulation 15 HSCA (RA) 2014 - Premises and equipment. The provider had failed to protect people against the risks associated with in adequate maintenance of the environment. Regulation 11 HSCA (RA) 2014 - Need for consent. The provider had failed to obtain consent from relevant people about their care. And Regulation 17 HSCA (RA) 2014 - Good Governance. The provider had failed to assess, monitor and improve the quality and safety of the service.

This meant people were at risk of receiving unsafe care and treatment because of the risks associated with these three breaches of the regulations.

We also made two recommendations at our inspection on 8 April 2015. We recommended the provider: Reviewed staffing levels, specifically ancillary hours at the home to ensure that the care people received was not compromised, because care staff were also expected to carry out laundry, domestic and kitchen duties during their shift. And reviewed people’s care plans to ensure that the home is able to meet people’s care needs and that risk assessments and management plans for all risks identified were recorded in the care plans.

After the comprehensive inspection, the provider wrote to us with an action plan to say what they would do to meet legal requirements, in relation to the breaches and the recommendations noted above.

We undertook this unannounced focused inspection on 5 October 2015, to check that the provider had followed their action plan and to confirm that they now met with the legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cornerways Residential Home on our website at www.cqc.org.uk.

Cornerways Residential Home is owned by Amocura Limited and is registered to provide personal care for up to 20 people, some of whom may have dementia. Cornerways does not provide nursing care. The home was previously a private dwelling and retains many of the original features. It is situated in a residential area of Harrogate and has parking for several cars to the front of the property, otherwise there is on street parking available.

The home employs a registered manager who had worked at the home for over twelve years. 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.

Since the last comprehensive inspection on 8 April 2015, the provider had taken action to address the environmental shortfalls, consent was being sought from people about their care and auditing had begun to assess and monitor the running of the service. The provider had also addressed the recommendations made about providing additional staffing in the laundry and kitchen and care plans had been rewritten to include relevant information about each individual. Care plans were now person centred and up to date. Risks to people’s health and wellbeing were also being identified.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves.

We received information from Healthwatch. They are an independent body who hold key information about the local views and experiences of people receiving care. CQC has a statutory duty to work with Healthwatch to take account of their views and to consider any concerns that may have been raised with them about this service. We also consulted the Local Authority to see if they had any concerns about the service. No concerns were raised by either Healthwatch or the Local Authority.

Inspection carried out on 8 April 2015

During an inspection looking at part of the service

We undertook this unannounced inspection on the 8 April 2015. We last inspected Cornerways on the 26 June 2014. At that inspection we found the home was not meeting the regulations that were assessed and found breaches of Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which relates to supporting workers. We found that this breach had been addressed at this inspection.

Cornerways Residential Home is owned by Amocura Limited and is registered to provide personal care for up to 20 people, some of whom may have dementia. Cornerways does not provide nursing care. The home was previously a private dwelling and retains many of the original features. It is situated in a residential area of Harrogate and has parking for a few cars to the front of the property, otherwise there is on street parking available.

The home employs a registered manager who had worked at the home for over twelve 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.

The service was not safe. Although most of the people we spoke with told us that they felt safe people had concerns about the home not employing sufficient ancillary staff, for example laundry assistants, maintenance workers and kitchen staff. Care staff were therefore undertaking these duties in addition to carrying their caring role. We have asked the provider to review the staffing levels at the home for ancillary staff. This would ensure that the care people received was not compromised.

People who lived at the home and some relatives we spoke with had concerns about the homes environment and described the home as being ‘cluttered’ and people living there described feeling ‘hemmed in’ by the amount of bric a brac and other items kept in the communal areas. We found the home was cluttered in the main communal areas with various ornaments. We saw that there was unsuitable furniture in the small lounge, that could not be used by people safely. We saw the wallpaper had faded and the paintwork was damaged in the lounges and corridors giving the home a dated and shabby appearance.

Safety checks were not always carried out within the environment and on equipment to ensure it was fit for purpose. We found that of the three bathrooms in the home, only one was currently in use. Two were unsuitable for people who required assistance with bathing and had not been upgraded with specialist equipment to ensure people were enabled to bathe safely. Only one of these bathrooms had equipment to assist people with bathing. However, staff described this bathroom as being ‘difficult’ to access with a person using a wheelchair. There were no shower facilities available at the home. This meant that people did not have choices about how they may wish to bathe.

We found the lift had been out of order for several weeks, which isolated people on the first floor. A fire extinguisher had not been replaced as requested by the fire service until following our visit.

This is a breach of Regulation 15 (Premises and Equipment), 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 end of the full version of the report.

The recruitment processes followed by the home when employing staff were robust, which meant that people were kept safe and that staff were suitable to work with vulnerable people.

Medicines were administered, stored and disposed of safely and people using the service received their medicines as prescribed.

The service was not effective. We found that consent to people’s care had not been obtained from them or their relatives or representatives. This is a breach of Regulation 11 (Need for consent), 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 end of the full version of the report.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves.

People were provided with nutritious food. Assistance and prompting was given by staff where necessary to assist people. Care staff also had the responsibility of the delivery of meals at tea time, in addition to their roles as care assistants as there were no kitchen staff available after 2.00pm. To ensure that the care people receive was not compromised we have asked the provider to review to review the staffing levels at the home for ancillary staff.

Staff were seen to be attentive and kind to people and they respected people’s individuality, privacy and dignity.

Care plans were not always person centred and up to date. Risks to people’s health and wellbeing had not always been identified. These risks required monitoring and reviewing which helped to protect people’s wellbeing.

People had access to suitable and appropriate activities which people told us they enjoyed.

The service was not well led. The registered manager did not have an effective quality assurance system in place which ensured that the home remained a pleasant place for people to live. This is a breach of Regulation 17 (Good governance), 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 end of the full version of the report.

We received information from Healthwatch. They are an independent body who hold key information about the local views and experiences of people receiving care. CQC has a statutory duty to work with Healthwatch to take account of their views and to consider any concerns that may have been raised with them about this service. We also consulted the Local Authority to see if they had any concerns about the service. No concerns were raised by either Healthwatch or the Local Authority.

Inspection carried out on 26 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people including the manager and from looking at records.

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

This is a summary of what we found:

Is the service safe?

People who used the service were protected because the home had taken action to make improvements in response to concerns raised with them for example, about standards of cleanliness and hygiene.

We observed that staff generally recognised and responded appropriately to people�s support however in the case of one person who became agitated and distressed we observed staff who appeared uncertain how to respond.

Is the service effective?

We found staff were not consistently following the care plans to ensure that people�s health needs were met and some of the written information was confusing.

Not all staff had received up-to-date training in relation to mental capacity, dignity and nutrition. As the majority of people were living with dementia they may not be able to speak up about their care needs and this meant people may not receive the correct care.

Is the service caring?

We saw a number of positive interactions between people living at the home and staff who worked there. However, some of the documentation in use did not take account of people�s individual preferences and did not lead staff to focus on person centred care.

Is the service responsive?

The main body of the care plans were detailed and contained information on people�s needs, preferences and risks to their care. However it was not always apparent whether the action taken had been discussed with other people concerned with the welfare of people living in the home such as GPs or community nurses.

Is the service well-led?

Management systems were in place to promote and safeguard people's safety and welfare. This included audits and checks by staff in the home and by other managers from within the organisation. Greater emphasis however needed to be given to make sure that quality assurance system systems for monitoring quality were effective.

Inspection carried out on 19 February 2014

During an inspection in response to concerns

We carried out this inspection in response to some concerns received. We spoke with some people living at the service, and some visiting relatives and health professionals. Those people we spoke with told us they liked living at the home, with comments including �Yes I like it here, it�s alright� and �I like living here, the staff are good and they look after me.� Visiting relatives told us �I find the place ok, the staff are very pleasant.� There was a nice atmosphere at the home, with people appearing settled and happy.

Care records for people contained required information such as mobility, nutritional needs, falls risk assessment, continence and pressure care. In the main, these were detailed and had been reviewed regularly, although we did find some minor issues.

Staff had been trained in safeguarding and knew how to raise an alert should abuse be suspected. Staff had sufficient training in relevant subjects such as manual handling and dementia awareness, and attended regular supervisions.

We did find issues with the cleanliness of the premises and equipment, and have asked the provider to take action to fix this. The home carried out regular audits in subjects such as health and safety and medication, and had a complaints system available.

Inspection carried out on 25 June 2013

During an inspection looking at part of the service

Our inspection of 20 April 2013 found that on the whole, people�s care plans contained a level of information that ensured their needs were being met. However, not all information was being followed up in relation to people who had lost weight. This meant that peoples care needs could be overlooked. We also observed staff supporting two people to eat their meal, but they were not following the persons care plan in relation to their specific needs. Following this inspection the provider wrote to us and told us what they were going to do to address these shortfalls.

We found at this inspection improvements had been made and this was confirmed by the people and staff we spoke with. We also saw written evidence that systems had been put in place to support staff to carry out their duties properly.

People who used the service told us �It�s grand here; the staff are marvellous and really look after us a treat."

We found people�s care and welfare needs were identified and they were given the support they needed to meet these needs. People had access to a range of NHS services including a community matron and district nurses.

We observed the meal service at lunchtime and saw people were offered a choice of food. People who needed help or encouragement to eat were given appropriate support.

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

Inspection carried out on 20 April 2013

During a routine inspection

This inspection was done on a Saturday.

Before people received any care or treatment they were routinely asked for their consent. People told us they were happy with the care provided and were involved in decisions about their care needs.

On the whole, people�s care plans contained a level of information that ensured their needs were being met. However, not all information was being followed up in relation to people who had lost weight. This meant that peoples care needs could be overlooked. We also observed staff supporting two people to eat, but they were not following the persons care plan in relation to their specific needs. Despite this, people told us they were happy with the care provided. One person told us, �I settled in really quick, it is nice here.�

We observed that people were cared for in a clean, hygienic environment. There were systems in place to reduce the risk and spread of infection. The people we spoke with told us that they had no concerns with the cleanliness of the home. One person told us, �My room is kept nice and clean and tidy.�

There were enough staff on duty to meet people�s needs. Staff were receiving training on a regular basis and this was monitored by the manager.

There were quality monitoring programmes in place, which included people giving feedback about their care and treatment. This provided a good overview of the quality of the service�s provided. This meant the quality of the service was being kept under review.

Inspection carried out on 20 August 2012

During an inspection looking at part of the service

We spoke with four people and four members of the staff team. People told us that they enjoyed living at Cornerways. One person said, "I am very happy. I have no complaints." Another person told us, "The staff do all they can, I use my bell and they come to see what I want." Another person summed up their view, saying, it is a 'nice place with nice people.'

Inspection carried out on 11 July 2012

During a routine inspection

People told us that they enjoyed living at Cornerways and that they were supported to make choices in their daily routines, according to their wishes. Some people said they knew about their care plans and had been involved in developing them. People told us that the food was good and that they looked forward to mealtimes.

Two visitors were very positive about the care provided to their relative and told us about the improvements to their relative's health and welfare since admission to the home. They went on to say that their relative looked well, had put on weight and seemed happy. One of the visitors concluded that, �I would stay here." One person said that when they used the nurse call bell to summon help that staff responded quickly and that that made them feel reassured.

People we spoke with said they could talk to their relative, a member of staff or the manager if they had any concerns. One person who used the service said, �If I want anything sorting out it�s never a problem.�

Inspection carried out on 4, 27 January 2011

During a routine inspection

We did not speak directly to people who use this service. However, the provider carries out regular quality assessments, by using a survey, which is completed by people using the service and their relatives. The most recent survey was in 2010 and we looked at that document. Overall people were reported to have a positive view of the service and described standards within the home as �very good�.

At the last inspection we carried out, in May 2009, people were judged as experiencing good outcomes. Since that time the provider has applied to be included on the CQC register and during the transitional period declared they were not compliant in five outcome areas. At the same time, the provider gave information stating how they would achieve compliance and these actions were included in this review.

As part of this planned review we also spoken to North Yorkshire County Council contracting department and the local LINks organisation. Neither organisation had anything significant to add.

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