Corinthian House

Corinthian House is a care home that can accommodate up to 70 people who require support with nursing or personal care needs, some of whom are living with dementia. At the time of our inspection, 33 people were living in the home.

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

The provider had worked to address the concerns raised at the last inspection and there were clear signs of improvement, although quality assurance systems needed to be more thoroughly embedded. Recording of people’s daily care needed to be more consistent and detailed.

We received mixed information about staffing levels. Some people, relatives and staff raised some concerns about how many staff were available on each floor. At the last inspection, we made a recommendation for the provider to review their staffing levels and staff deployment. We requested the provider review this more thoroughly as a matter of priority, to ensure people’s care needs were being appropriately met in a timely way.

People and relatives shared positive feedback overall about the quality of care in the home.

Medicines were managed safely. Individual risks to people were effectively assessed and monitored. More robust processes were in place to monitor people’s risk of choking and weight loss. Risks to people’s skin integrity was being managed in line with their care needs. Recruitment procedures were safely followed. Infection prevention and control measures were thoroughly implemented.

Staff told us there had been some improvement in the way they were supported to carry out their roles. The provider was improving the support available for nurses.

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.

The home had a friendly, welcoming atmosphere and staff were professional, kind and caring.

Some people and relatives said there were not always opportunities for regular baths or showers. There were regular planned activities being offered to people. We noted many people remained in bed or in their own rooms and it was not clear whether this was based on individual choice or assessed need. Where they did so, there were fewer opportunities for good quality and consistent interaction. We recommended the provider reviews each person’s abilities and choices and continuously keeps this under review.

There was a manager in post who was not registered with the Care Quality Commission. They were absent at the time of the inspection. The deputy manager was in charge with support from the senior management team. People, relatives and staff reported recent improvements in relation to the running of the home.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 December 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations 9 and 12, although remained in breach of regulation 17.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Corinthian House is a care home that can accommodate up to 70 people who require support with nursing or personal care needs, some of whom are living with dementia. At the time of our first visit, 48 people were living at the service. On our second visit, there were 47 people living at the home.

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

People shared mostly positive feedback about living at the service. Relatives told us they had concerns in relation to several areas of care provided. During this inspection, we were not assured the service provided was always safe and we found widespread shortfalls in the way the service was managed.

The provider failed to implement effective processes to monitor the quality of the service, drive the necessary improvements and to identify the issues found during our inspection. We continued to identify some issues found at previous inspections, and we found new concerns in relation to safety of people and lack of person-centred care. Records were not always complete or contemporaneous.

Medicines were not always managed safely. Most risks to people's care were assessed, however we found concerns in relation to how some risks were managed. We identified concerns about people who were at risk of choking not being safely positioned while having their meals. Several people living at the home had lost weight and evidence reviewed did not evidence action had always been taken in a timely way. Risks to people’s skin integrity was not always well managed in line with people's care needs and plans. Recruitment was managed safely and infection and prevention measures were followed by staff.

People, relatives and staff raised concerns about staffing levels. The provider was using a tool to assess the level of staff required on shift. After reviewing all the information, we made a recommendation for the provider to review their staffing levels and staff deployment.

People were not always supported in a person-centred way during mealtimes. We observed instances when staff did not display the skills to appropriately support people living with dementia. Although staff’s training was up to date, this covered only basic aspects of care and did not cover other clinical needs of people living at the home. Staff told us they did not feel supported in their roles. The home manager told us about their ongoing plans to provide staff with additional training.

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.

We received mixed feedback about staff’s approach; some people and relatives told us staff were kind and caring, others told us staff were not always responsive.

We found concerns in relation to people not being offered and provided with frequent baths or showers. There was no evidence of regular and meaningful activities being offered to people. Care plans had information about people’s needs, but we found examples where this was not consistent or complete.

There was a manager in post; they had not yet submitted an application to register. We received mixed feedback from people, relatives and staff in relation to the management of the home. During this inspection, we found a substantial deterioration in the level of care people were receiving.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published on 19 November 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service, namely concerns received about staffing levels, medicines management and safeguarding. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care received by people, safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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, which will help inform when we next inspect.

Corinthian House provides nursing and personal care for a maximum of 70 older people, some of whom are living with dementia. There were 46 people using the service at the time of this inspection.

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

The registered provider did not have effective governance systems in place to maintain and improve the quality and safety of the service. Analysis of accidents and incidents were brief and did not identify any patterns or trends to help mitigate risk and prevent reoccurrence. We also found quality assurance audits were very limited in content, where actions were identified there was no specific confirmation of when staff were required to action these by. The provider had recently recruited a Quality Excellence Partner (QEP) to support effective governance arrangements and oversight at the service.

Risks to people’s safety had not always been assessed and recorded. We found improvements regarding these in the new care plans we reviewed. We made a recommendation for all care plans and risk assessments to be reviewed and updated by 31 December 2021, starting with the care records for people with more complex care and support needs.

There were mixed responses around staffing levels from people and their relatives. The home had a dependency tool which showed there was enough staff to support people. The home had been using agency staff to cover vacancies. We discussed the deployment of staff and agency staff with the management team. We were made aware the home had recently recruited permanent staff to support the home without having to rely on agency.

Some improvements had been made in relation to medicine management since our last inspection. We did however find some gaps in medicines administration records (MARs).

We were somewhat assured the provider was adhering to infection control practices. Infection prevention and control measures were in place and staff understood how to prevent the spread of infection. Staff wore personal protective equipment as necessary, although there was the occasional touching of face masks observed.

Staff knew people well and people and their relatives felt they were looked after by the staff who genuinely cared.

People told us the food overall was good and they could have a choice.

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

Rating at last inspection

The last rating for this service was Good (report published 11 January 2019).

Why we inspected

This inspection was prompted in part due to concerns received about staffing levels, medication, care records and overall management of the service. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from some of these concerns, however we did not find evidence that harm had occurred.

This report only covers our findings in relation to the Key Questions of Safe, and Well-led which contain those requirements and concerns. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Prior to the inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link Corinthian House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to good governance, systems were either not in place or were not robust enough to demonstrate people’s safety was effectively managed. This placed people at risk of harm. We have also made a recommendation in the responsive domain of the report. We made a recommendation for all care plans to be reviewed and updated identifying high risk people first by 31 January 2022.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the local authority and clinical commissioning group to monitor their progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Risks of visiting professionals spreading infection were reduced. Visitors had their temperature taken and were asked about their health before entering the service. This was observed during the inspection.

There was signage around the home encouraging the use of personal protective equipment (PPE) and good hand hygiene. Hand sanitiser stations were available near the entrance and throughout the service.

People stayed in contact with their families by phone and video calls to prevent isolation and promote people's mental wellbeing.

Staff were provided with the appropriate PPE. Additional clinical waste bins had been purchased to dispose of PPE safely.

The provider had appropriate arrangements to test people and staff for COVID- 19 and was following government guidance on testing.

The cleaning of touch points such as door handles, phones, lap tops, taps and switches had been increased and documented.

The home's layout meant staff could be assigned to specific areas, meaning staff movement was easily controlled and managed to prevent cross infection.

Staff said they were well supported and felt there were good systems and processes in place to help to keep them safe.

Further information is in the detailed findings below.

Corinthian House 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. Corinthian House provides nursing and personal care for a maximum of 70 older people, some of whom are living with dementia. There were 67 people using the service at the time of this inspection.

There was a registered manager in post. A registered manager is a person who has registered with 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.

At our last inspection in September 2017, we rated the service Requires Improvement. We found at that time, improvements had been made to the service following our previous inspection when we identified several concerns. We used this current comprehensive inspection to check whether the improvements had been sustained. Although some improvements were still needed; we found there had been sufficient progress and the service has now been rated as Good.

A range of audit processes were in place to measure the overall quality of the service provided. However, records did not always show issues identified were acted on and lessons were learnt when shortfalls were identified. The registered manager took action during the inspection to introduce new documentation and systems to ensure this in the future.

People told us they were safe and well supported by staff who knew them well. Overall, people said there were sufficient staff and our observations confirmed this. People's needs were assessed and their care planned to ensure they received the support they needed. Care plans and risk assessments were reviewed regularly and staff had access to up to date information about people's care requirements. Medicines were managed safely.

Staff were trained to recognise potential abuse or discrimination and they knew how to manage and report such concerns. Recruitment was managed safely. Staff felt well supported and received appropriate training which was updated when needed. Staff said they enjoyed working for the service and felt valued.

People lived in an environment that was clean and homely. The home and equipment were maintained to minimise the risk of cross infection. Health and safety checks were undertaken and there were appropriate procedures in place in the event of an emergency.

People told us they enjoyed the food at the service. They received support to maintain their nutritional wellbeing and had a choice in what they ate and drank. There was a varied menu available to people and specialist diets were catered for. People were supported to maintain their health and had access to health professionals as required.

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. People were supported to make choices and retain their independence.

People had opportunities to take part in social activities which they told us they enjoyed. People were treated equally and their diversity understood and supported.

Privacy and dignity was protected and staff were kind to people. People told us they were happy with the care they received and were complimentary about the staff who supported them. Overall, we saw individualised caring interactions between staff and people who used the service.

People understood how to complain or raise concerns and these were responded to. People, their relatives and staff all spoke highly about the way the service was managed.

Further information is in the detailed findings below.

This unannounced inspection took place on 19 and 21 September 2017.

Corinthian House is a large purpose built service set over three floors and provides accommodation for up to 70 older people who require nursing care, some of whom may be living with dementia. The service is close to all local amenities. At the time of this inspection there were 60 people using the service.

The service was last inspected in May 2016 when it was found to be in breach of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always managed safely and there were gaps in the staff training, supervision and appraisals and competency checks of their skills had not always been carried out. The systems used to monitor and assess the quality and safety of the service were not effective or robust.

At this inspection we found improvements had been made to address the above breaches of regulation and the service was now compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have upgraded the rating in the safe and effective domain to reflect improvements in medicines management arrangements and staffing. We have maintained the previous ratings in the well led domain because we noted further improvements were needed.

There was a registered manager for the service. 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.

At this inspection we found arrangements relating to the safe handling of medicines had been improved, although records for these were not always accurately maintained. Care staff had been provided with a range of training and supervision opportunities and had their competencies checked to ensure they carried out their roles in a safe way. Improvements had been made to the operation of the governance systems; this included a programme of regular audits and analysis of trends to enable potential patterns to be identified.

Care staff had received training to ensure they knew how to recognise and report incidents of possible abuse. The needs of people were assessed and care staff were provided with information on the management of potential risks, to ensure people were protected from harm. Incidents and accidents were monitored by the service and action was taken to mitigate these from reoccurring. Care staff had been safely recruited and arrangements were in place to ensure there were sufficient numbers of them available to meet people’s needs. Maintenance checks were regularly carried out, to ensure the environment and equipment was kept safe.

Care staff had received training on the Mental Capacity Act 2005 to ensure they knew how to promote people’s human rights and ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests. People were provided with a range of wholesome meals and their nutritional needs were monitored with involvement from health care professionals when this was required.

Care staff demonstrated compassion for people’s needs and interacted with them in kind and considerate way. People were supported to make choices about their lives and a programme of meaningful activities was available to ensure their health and wellbeing was promoted.

People and their relatives were able to provide feedback on the service and knew how to raise a complaint. Some people told us communication with them should be improved and people were not actively involved or participated in reviews of their support. We have made a recommendation about this.

Corinthian House is a large purpose built accommodation set over three floors and provides services for up to 70 older people who require nursing care. The service is close to all local amenities.

The home had 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.

Systems in place for the management of medicines; so people received their medicines safely were not always appropriate. For example there were gaps on people’s medicine administration records which meant we could not be sure people had received their medicines as prescribed.

We saw staff had not received regular supervision and not all staff had had an annual appraisal. Some staff had not always been trained or had their competency checked to ensure they had the skills and knowledge to provide support to the people they cared for.

There were systems in place to monitor the quality of the service provided. We saw there were a range of audits carried out both by the registered manager, registered provider and quality manager. We saw where issues had been identified; action plans were not always signed off or known by the registered manager and the same issues were being repeatedly found which meant quality monitoring was not always effective.

Appropriate checks of the building and equipment were undertaken by appropriate professionals to ensure health and safety. Where staff in the service completed health and safety checks we saw they had not always received the training or guidance to do so.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as nutrition and pressure care. This enabled staff to have the guidance they needed to help people to remain safe. Not all of the guidance was reflected in peoples care plans which meant staff members may not have received a full explanation of the hazards when supporting a person.

People told us there were enough staff on duty to meet people’s needs. We found recruitment and selection procedures were in place and checks had been undertaken before staff began work. The registered provider had not always recorded their recruitment decisions. On one occasion they had confirmed employment for someone where a reference from the last employer could not be gained.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

There were positive interactions between people who lived at the home and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People had their nutrition monitored in various ways and referrals were made where issues were identified. People were supported to maintain good health and had access to healthcare professionals and services.

We saw people’s care plans were being transferred onto a new electronic system and staff were not fully competent in its use which meant not all records used to monitor people’s health and wellbeing were fully completed. The person centred detail staff knew about people was due to be incorporated into the system and would involve people who used the service.

We received mixed feedback about the level of activity on offer for people. We were told about a wide range of events and planned events which people who were able could access. However, no monitoring was in place to ensure people were not socially isolated.

The registered provider had a system in place for responding to people’s concerns and complaints. People and their families knew how to raise concerns and records showed they were dealt with appropriately.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.