Archived: Cornerstone Care

Updated 18 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

This inspection took place on 24 April 2018 and was announced. We gave the service one days’ notice of the inspection site visit because it is small and we needed to be sure that someone would be in the office, and also to check who we could speak with people from the contact list they had supplied. The inspection site visit was completed by two inspectors and an expert by experience telephoned people in their homes. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. After the site visit the two inspectors also made telephone calls to additional people who used the service and to staff who worked there.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used it to assist us to plan our inspection and to make our judgement. We also reviewed other information that we held about the service such as notifications (events which happened in the service that the provider is required to tell us about) and information shared by other organisations, including safeguarding teams.

We used a range of different methods to help us understand people’s experiences. We spoke with three people who used the service and with relatives of three other people about their experience of the care that the people received.

We spoke with the registered manager, the care manager, the office manager, and seven care staff. We also received written feedback from two social care professionals and spoke with three others about their relationship with the provider and their opinion about the standard of care.

We reviewed care plans for four people to check that they were accurate and up to date. We also looked at the systems the provider had in place to ensure the quality of the service was continuously monitored and reviewed to drive improvement. We reviewed audits and quality checks for medicines management, health and safety checks and care plan reviews. We reviewed complaints, minutes of meetings and the results of surveys. We looked at six staff recruitment files during the site visit.

During the inspection we asked the provider to send us information about staff rotas and staff training by 5pm the following day. We did not receive it by this time and needed to ask the provider again and we then received it early the next morning. In addition, we formally wrote to the provider after the inspection to ask for additional recruitment information for new staff who had been identified to us. This was sent to us within the agreed timeframe; although we had to ask for them to then send more evidence regarding their statements.

Updated 18 December 2018

The inspection took place on 24 April 2018 and was announced. We gave them one days’ notice to ensure somebody would be available in the office for the inspection visit. It was the provider’s first inspection since registering with us.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It currently provides a service to 12 older people and younger disabled adults.

There was a 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.

At this inspection the overall rating for this service is Inadequate which means it will be placed in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Safe recruitment procedures were not followed to ensure that staff were suitable to support people in their own homes. When the provider had assessed a risk around staff they did not put any additional checks in place to ensure they were safe. There were not enough staff to meet people’s needs and this resulted in people having late and reduced calls. It also meant that risk was not managed for some people. When people had been assessed as needing two staff to move them safely this was not always provided putting them at increased risk of harm. People and staff were also at risk because staff were sometimes working for excessive hours without break. Medicines were not always managed and administered to ensure that people had them as prescribed. Staff had not received the training and checks to ensure that they could administer medicines safely. There were limited checks in place to learn from previous mistakes or to avoid repetition. When abuse allegations were made these were not always fully investigated or reported to ensure that people were protected.

Staff did not always have the training and support required to ensure they could do their jobs effectively. New staff did not receive an induction to support people in line with national guidelines. Competence checks were not regularly completed to ensure that standards were being met. Other quality improvement systems were either not implemented, not regularly reviewed or not effective in highlighting and addressing concerns.

The provider was not always open and transparent with us when we conducted the inspection. We needed to request additional information from them after the inspection visit.

People’s ability to decide about restrictions was not always assessed which meant that they were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. They were not always supported in line with their preferences and could always participate in activities and interests as requested.

People told us that they had been involved in planning their care. However, the care plans at the registered address were not current or reviewed. Other management information was not fully completed to take account of all staff. We found that the provider did not always respond to complaints in line with their procedure. They did not always respond to feedback from people about the quality of the service.

People did not always receive compassionate care from staff when they were rushed or needed to leave early to attend to other people. When they had regular relationships they developed caring relationships based on respect and upholding their dignity. When staff were responsible for people’s meals they ensured that they had enough to eat and drink. Relationships were developed with other professionals to ensure that their healthcare needs were met.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.