North Corner Residential Care Home

North Corner Residential Care Home is a residential care home providing accommodation and personal care to up to a maximum of 16 people. The service provides support to older people who require support with some aspects of their daily living. At the time of our inspection there were 8 people using the service.

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

The systems and processes followed by the provider failed to identify that care and treatment was unsafe. We identified several safeguarding incidents that had not been reported to the local authority or to the CQC. There was no oversight of safeguarding incidents by the provider.

Risks were not managed safely, or fully identified. Where risks were identified there was not always guidance to inform staff how to support people safely and consistently. Environmental risks were not managed safely, for example, there had been no recent fire risk assessment and there were no regular fire safety checks. The home was not clean and tidy and needed general maintenance throughout. Improvements were needed to ensure medicines were managed safely. Recruitment procedures were not robust and did not ensure staff were suitable to work at the home.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.

A quality assurance system had previously been in place, but there had been no recent audits or oversight by the provider for a number of months. Records were not completed accurately and there was an apparent lack of commitment by the staff to improve and develop the home. Although the provider was aware of some of the concerns we identified, action had not been taken in a timely way to address these.

We observed staff engaging with people and supporting them with kindness. People approached staff freely. People told us the staff were kind and relatives spoke highly of the staff team.

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 (published 01 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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 for North Corner Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding, fit and proper persons employed, need for consent, premises and equipment, good governance and notifications of other incidents.

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

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

People were supported to maintain contact with their family and friends. In line with government guidelines at the time or inspection, each person was allowed one named visitor. In addition, people were able to receive window visits and as the weather improved garden visits were being re-introduced.

Where people were considered to be end of life, they were able to receive regular visits from family in their bedrooms. Throughout the pandemic people had been supported to keep in touch through the use of phone and video calls and this was continuing to happen.

All visitors were required to have a rapid COVID-19 test before the visit. During the visit they wore the appropriate personal protective equipment (PPE).

Staff had access to PPE. They had received infection control and specific COVID-19 training, and this included guidance for staff about how to put on and take off PPE safely. Regular testing for people and staff was taking place.

North Corner is a large domestic-style house which has been extended. People's bedrooms were provided over two floors. There was a sitting and dining room on the ground floor.

This was North Corner’s first inspection since its purchase by North Corner Lewes Limited. There was a registered manager in post, she had been appointed by the new provider. 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 new provider purchased the business on 20 September 2016. People who had lived in the home while it was managed by the previous provider continued to live there. Many of the staff also continued working at the home under the new provider.

The provider had made a wide range of improvements to the environment since they purchased the home. This included key areas such as fire safety, improvements to the kitchen, heating and hot water systems. When they took over the business, the new provider continued to use the previous provider’s documentation. The new provider had identified some areas of documentation needed improvement. This was because some risk assessments were not accurately completed, some matters relating to people’s care were not documented and records were not consistently maintained of when action had been taken to address matters. The provider was trialling different records to ensure accuracy of record keeping.

The provider had reviewed systems for medicines. Staff supported people with taking their medicines in a safe way. Accurate records about medicines were maintained.

People and staff confirmed there were enough staff to ensure people’s needs were met. New staff had been recruited in a safe way. All staff had a clear understanding of their responsibilities for protecting people from risk of abuse. They also knew what actions to take if they had concerns about people’s safety.

The provider had reviewed training and support needs for staff and developed a training and supervision plan. Staff knew how to meet people’s care needs, including when they had additional healthcare needs. Staff understood their responsibilities under the Mental Capacity Act (2005).

People said staff were caring and supported their independence and dignity. Staff were consistently polite and helpful to people. Staff knew about people as individuals and provided care in a person-centred way.

The new registered manager had revised menus together with people, their relatives and staff. People received the support they needed to ensure they could eat and drink what they both wanted and needed, to maintain their well-being.

The new provider had made developments in the provision of recreational activities for people. People and their relatives spoke warmly about the changes made by the new provider, particularly in encouraging people to choose how they wanted to spend their days.

People and their relatives made positive comments about the management style of the providers. They said they could raise issues with the provider or registered manager and any concerns they had would be addressed. Staff spoke about the supportive and inclusive management style of the new provider and registered manager.

The provider had set up effective systems for audit of the quality of service. Since they purchased the business, they had developed an action plan to make improvements across a wide range of areas. The provider and registered manager were open to working with a range of professionals to ensure improvements in the provision of service to people.