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Vision MH - Cornerstone House Outstanding


Inspection carried out on 10 - 11 October 2017

During a routine inspection

We rated Vision MH – Cornerstone House as Outstanding because:

  • The service had robust, detailed and comprehensive environmental and ligature risk assessments in place. Managers updated these regularly.
  • The service had a range of rooms and equipment to support treatment and care. This included a clinic, treatment room, therapy kitchen, gym, art room and a group therapy room.The service had achieved a five star food hygiene rating. Patients could make hot and cold drinks when they wanted. Snacks were available throughout the day.
  • All staff assessed risks to patients who used the service on a daily basis. This included physical health, mental health and behaviours that challenged.
  • There was good medications management, which included regular audits of equipment and records.
  • Staff reported all incidents in line with policy. The senior management team reviewed every incident. Openness and transparency in relation to safety was encouraged. Staff understood and fulfilled their responsibilities to raise concerns. Senior staff discussed lessons learnt with the staff and patients in different forums, to minimise a re-occurrence. 
  • All staff had a holistic approach to assessing, planning and delivering care and treatment to patients. Every patient had a comprehensive assessment upon admission to the service. Staff placed real emphasis upon the physical healthcare of patients. Nursing and medical staff monitored the physical health of all patients from the point of admission. 
  • All staff undertook a comprehensive induction to the service. Staff received annual appraisals. Staff received supervision in line with policy. Senior managers encouraged the continuing development of staff skills, competence and knowledge. Managers recognised that this was integral to ensuring high quality care.
  • All staff had a good working knowledge of the Mental Health Act. Where patients were subject to Mental Health Act detention, their rights were protected. Staff complied with the Mental Health Act Code of Practice. All staff had a good working knowledge of the Mental Capacity Act and the Deprivation of Liberty Safeguards. Senior staff regularly monitored consent practices and records. Staff completed capacity assessments for patients who might have had impaired capacity in relation to specific decisions.
  • Staff who were exceptionally caring, extremely compassionate and very kind supported patients. Staff demonstrated considerable pride in their work and supported patients in the most appropriate manner to meet their needs. Patients and families shared with us their positive experiences of the care they received at the service. Staff consistently empowered patients to have a voice and realise their potential through different forums.
  • Information on treatments, local services, advocacy and patients’ rights were visible in communal areas. Interpreters and signers were accessible as and when required.
  • The service was led well by the senior management team. Staff, patients and carers told us that they were visible and accessible.
  • A sufficient number of staff of the right grades and experience covered shifts.
  • There was an open and transparent culture across the service. Staff were honest with patients when things went wrong.
  • The service was proactive in capturing and responding to patients concerns and complaints. Patients and families knew how to make a complaint. Managers investigated all complaints fully in line with their policy and responded in a timely way.


  • We observed one ligature risk in the new building, which had not been identified. The manager took immediate action when we highlighted this.
  • Some portable electrical equipment testing was just outside of the time frame for expected annual checks. These had been booked to be undertaken.

Inspection carried out on 09, 10 May 2016

During a routine inspection

We rated Vision MH – Cornerstone House as good because:

  • Care records and plans were all up to date, personalised, holistic, recovery orientated. Staff offered patients copies of their care plans and signed to say that had received or declined a copy. Care records showed that a physical examination had been undertaken and that there was on-going monitoring of physical health problems, which included monitoring of patients on medication.
  • Staff completed a risk assessment of every patient on admission which was reviewed and updated after incidents.
  • The service had its required established levels of staffing to meet the needs of the patients and offer 1:1 time with staff. Staff rarely cancelled escorted leave for patients due to staff shortages.
  • Patients reported that they felt safe at all times. Staff were always in the day area and very supportive. When on 1:1 observations, staff treated patients with complete respect and care.
  • Staff interacted with patients in a caring manner, remained engaged and interested in providing good quality patient care. We saw that staff were responsive to patient needs, discreet and respectful.
  • Staff could not observe all parts of the wards due to its layout. Managers mitigated this risk by placing mirrors in corridors. Managers had identified ligature risks by carrying out a ligature audit; managers reduced these risks through a comprehensive refurbishment plan. A ligature point is a fixed item to which a person could tie something for the purpose of self-strangulation.
  • There had been a total of 24 incidents of restraint between 26 August 2015 and February 2016 involving eight patients. Staff told us that the use of restraint was a last resort and that de-escalation techniques were used to distract and engage patients as a first response, this was evidenced in case records.
  • Medicines were stored securely and in accordance with the provider policy and manufacturers’ guidelines. We reviewed all medication administration records (MAR) and found no errors or omissions of nurse signatures when the medication had been administered.
  • Staff followed the National Institute for Health and Care Excellence (NICE) guidance when prescribing medication and provided psychological therapies recommended by NICE.
  • Staff had access to supervision every two months in line with the service policy. Staff attended weekly reflective practice meetings weekly which they found supportive, and enhanced their knowledge and clinical practice.
  • Patients had access to the independent mental health advocacy (IMHA) services.
  • The service had a range of rooms and equipment to support treatment and care. This included treatment rooms to examine patients, a gym, therapy kitchen, art room, group therapy room, and quiet room. Patients also had access to a large garden. Patients had individual therapy timetables that provide then with occupational and recreational activities.
  • Managers completed comprehensive audits to ensure the service improved the care that staff provided to patients.
  • Staff had the ability to submit items to the services risk register. The register highlighted control measures that were in place to mitigate the risk and planned measures to meet in order to reduce the risk within a set time frame.
  • Staff reported that they were proud of their team and that they enjoyed their job. The team, including senior staff, were supportive and welcomed feedback and new ideas. Staff were able to describe their duty of candour as the need to be open and honest with patients when things go wrong.
  • Managers ensured that staff met the minimum target of 80% forall mandatory training


  • We found two errors in the controlled drug book. The error was an inputting error not a medication error, the service’s pharmacist and staff rectified the error quickly to ensure that that the medication was reconciled.
  • During the inspection, the registered manager reported that a medication error had taken place. The registered manager sought medical help for the patient immediately and provided a plan of the action taken to prevent this incident from reoccurring.
  • Managers did not hold specific team meetings with nursing staff. Information was shared with them in the morning handover.

Inspection carried out on 19 October 2014

During an inspection to make sure that the improvements required had been made

We carried out an unannounced focused inspection of this service following concerns identified to the Care Quality Commission.

We do not rate services that we inspect as part of a responsive inspection. We found that action was required by the provider because:

  • Staff could not observe patients effectively in all parts of the ward. The service had installed mirrors to aid observation, but staff had not placed where needed. As a result, lines of sight were not clear.
  • Staff did not seek appropriate levels of medical attention when patients harmed themselves.
  • Managers undertook ligature risk assessments and staff had identified ligature points throughout the service, where patients might be able to harm themselves.. However,staff had taken no action to minimise the risks to patients.
  • The ward did not comply with mixed-sex accommodation guidelines, as there were no separate day spaces for women.
  • Staff were nursing one patient in long-term segregation to prevent the risk of harm to other patients and to themselves. Staff had not completed management plans or multidisciplinary reviews of this to ensure the patient was safeguarded in line with the Mental Health Act code of practice.
  • Cleaning records showed that cleaning took place regularly; however, some areas of the service were not clean. Three bedrooms inspected were dirty and had an unpleasant odour. Ensuite facilities in two bedrooms had stained toilets and flooring.
  • The emergency drugs held in the clinic room were out of date. Staff did not check medication regularly or effectively as this error was unnoticed.
  • The service did not manage stock medication or controlled drugs in line with Nursing and Midwifery Council standards. We found errors in both the dispensing of, and recording of, controlled drugs. Staff did appropriately manage the recording of stock medication.
  • Medication was stored in a fridge, which staff records showed, had temperatures that were higher than the accepted range. The fridge also contained solid ice. This could have changed the effectiveness of the medication. Staff had taken no action to address this.
  • The service used blanket restrictions, such as limiting patients’ access to mobile phones and to the internet. This was not individually risk assessed.
  • Staff knew how to report incidents and used an electronic system to do this. However, those report records reviewed were incomplete and lacked information about the incident and the lessons learned.


  • There were alarm call bells in patients’ rooms, which meant they were able to call for help if they needed it.
  • Staff completed risk assessments and updated them when the risk to patients changed.
  • The hospital had enough staff on shifts to meet the needs of patients on the ward. Managers could adjust the staffing levels if required.
  • Eighty-one percent of staff had completed mandatory training.
  • Staff interacted with patients in a positive way and showed good understanding of individual needs.

Inspection carried out on 7 November 2013

During a routine inspection

We spoke with six of the 21 people who were being treated at Cornerstone Hospital. They told us that they had their treatment discussed with them and explained to them. Some told us that while they may not always agree with their treatment, they understood that it was to promote their health and welfare. One person told us that this was the best place they had been admitted to and they said that the staff were respectful and listened to you. They also said that they felt free and had a better quality of life. One person told us that the hospital had a system in place where there was a patient’s representative who took the people’s views to the management of the hospital. We were told that this system worked well.

We found the people to be cared for in a manner that promoted their dignity and was respectful. We saw care plans and risk assessments were in place and the people had access to therapies that promoted their mental health. The people we spoke with told us that they feel safe at Cornerstone.

We found that there was a sufficient mix of trained and qualified care staff to recognise and to meet the people’s needs.

Inspection carried out on 19 November 2012

During a routine inspection

During this review we spoke with six people who lived at Cornerstone House and four people being supported by Vision Mental Health staff in the community. While people expressed different feelings, about the reason for their stay at Cornerstone House, the consensus was that the staff provided the support they needed and people felt safe. People told us about the wide range of therapies and recreational activities that made up their individual treatment plans. These included opportunities to make use of community recreational and educational facilities as people’s mental health improved. One person told us they had been encouraged to take part in activities they had not experienced before. Another person told us their relatives felt this was the best place they had been to. People living in the community told us that they got on well with staff who were approachable and listened to them. One person, living in the community, said when they had a problem they told the manager who was very easy to get hold of and things were sorted out. Another person told us they were “very satisfied”. One person who lived at Cornerstone House remarked that they would have preferred to be nearer their own home.

We noted that people had good access to psychiatric and community health services.

It was the view of the Mental Health Act Commissioners who visited the service, on 21 February 2012 that Cornerstone House provided a successful rehabilitation service for vulnerable people.

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

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.