We carried out a review of the data available to us about Cornerstone Care Services Professionals Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cornerstone Care Services Professionals Ltd, you can give feedback on this service.
Cornerstone Care Services Professionals Ltd is a domiciliary care agency and is based in the London Borough of Havering. The service provides personal care to people in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
The service was supporting 14 people with personal care at the time of the inspection.
People’s experience of using this service and what we found
Systems and processes were in place to support people’s safety. People’s needs, including their safety were assessed and monitored. People using the service were being supported by consistent staff who had been safely recruited and knew them well. Feedback was positive from the person and their family regarding the support they received.
The registered manager undertook assessments before agreeing to support people to ensure that their individual needs and preferences could be met. People's support plans were developed in partnership with them and/or their family. Staff received an induction and were trained in areas that were relevant to people they were supporting.
Medicines were managed safely. Staff were provided with personal protective equipment (PPE) to protect people from the risk of cross infection.
There had been no incidents or accidents, but there were systems in place to ensure lessons were learned when things went wrong.
Care plans were person centred and staff knew what people liked. People's communication needs were met. There had been no complaints, but people were provided information on how to complain, if they wanted to.
Systems to monitor the quality and safety of the service were in place. Staff reported having a positive relationship with the provider and felt communication was effective.
People and staff were pleased with how the service was managed. The provider was open to change and improvement and promoted what was best for people. The registered manager knew about their duty of care and regulatory requirements. People were able to engage with the service and provide feedback about the care. Staff could provide input into the service through meetings and supervision.
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 24 April 2020). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection in April 2020. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Cornerstone Care Services Professionals Ltd is a domiciliary care agency that provides personal care to older people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection, five people were using the service.
People’s experience of using this service and what we found
Following our last inspection, the provider had put an action plan to improve the service in areas such as staff training, assessment of people's needs and medicine management.
Risk assessments were not managed appropriately. There was conflicting information in the recordings of risks to people. This put people's health and wellbeing at risk.
The auditing systems were not always effective. The provider did not pick up gaps in the records of risk assessments. However, the provider sought feedback to make improvements to the quality of the service.
The provider worked with CQC and other professionals. However, we made a recommendation about being transparent.
People's needs had been assessed before they started using the service. Each person had a personalised care plan, which described their needs, preferences and how they wanted staff to support them.
Staff recruitment processes were robust ensuring staff were checked before they started work. Staff also received support, training and supervision, which enabled them to carry out their roles effectively. There were enough staff to meet people's needs.
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.
Staff were caring and treated people with respect and dignity. They developed positive relationships with people and ensured their privacy.
Equality and diversity was part of the service, which meant staff understood their responsibility to provide people with a service that reflected their needs and preferences without discrimination.
Staff had received training in infection controls. The provider supplied staff with personal protective equipment (PPE).
Where needed, staff supported people with their medicines and meals, and assisted them to access health professionals.
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 inadequate (published 2 October 2019) and there were multiple breaches of regulation. 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.
Follow up
We will work alongside the provider and local authority to monitor progress in improving the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Cornerstone Care Services Professionals Ltd is a domiciliary care agency that provides personal care to people living in their own homes. At the time of our inspection the service was supporting five people.
People’s experience of using this service and what we found
The service did not appropriately respond to and report allegations of abuse to keep people safe. Staff were not recruited in a safe manner to ensure they were fit to provide care and support to people. The deployment of staff did not meet people’s needs. Accidents and incidents were not recorded and analysed to prevent recurrence. We found that medicines were not always managed in a safe way and people’s risks were not recorded to ensure staff knew how to keep people safe.
The systems in place did not ensure staff were supported and had access to training to enable them to provide effective care and support. 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. Assessments were not undertaken to determine people's needs before they moved into the service. The service did not work with other relevant healthcare professionals to ensure people were safe.
It was not always clear that people were involved in the planning and reviewing of their care. Care plans did not ask questions about all the protected characteristics relating to equality and diversity. Staff were not aware of how to protect people from discrimination. People were not always encouraged to be as independent as possible.
We recommended the provider review procedures to ensure equality and diversity is considered at all levels of care and ensure people’s independence is promoted.
Staff were not equipped with the skills to provide end of life care to people and people were not given an opportunity to discuss their end of life wishes.
The governance systems in place did not identify the shortfalls we found during our inspection.
People were protected from the risk of harm associated with the spread of infection.
People's nutritional needs were met.
People told us they were treated in a caring manner by staff. Staff understood how to support people in a way that respected their dignity and privacy.
People told us they received individualised care that met their needs. The care plans discussed people's preferences. People’s care plans were recently reviewed to ensure their needs were documented and up to date. Information could be made available to people in an accessible format. People told us they felt able to make a complaint and were confident that complaints would be listened to and acted on.
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 requires improvement (published 28 September 2018). The service is now rated inadequate.
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the full report.
Enforcement
We have identified breaches in relation to safeguarding people from abuse; recruiting staff that are suitable for the role; providing safe care and support to people; obtaining consent from people to receive care and support; ensuring staff are well supported and trained to provide effective care; person centred care and overall governance.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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 checked what actions the provider had taken to address the breaches and improve the service. We found the provider still needed to make improvements on risk assessments, care pans and quality assurance systems. However, we found the provider had made improvements in providing new staff with induction and shadowing opportunities when they started work.
Cornerstone Care Services Professionals Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It is registered to provide a service to adults 18-65 years old, people living with dementia, people with learning disabilities or autistic spectrum disorder and older people. At the time of the inspection, 16 people were using the service.
Not everyone using Cornerstone Care Services Professionals Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of this inspection 16 people were using the service.
The service did not have a registered manager. However, a new manager had been employed by the provider and had applied to CQC to be a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered care homes, 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 always well-led. The provider did not have effective systems to manage the service. The systems for staff recruitment were not fully implemented to ensure people were supported by who were appropriately checked. Care plans were not organised in such a way that they were easily available to staff to use them effectively, and the staff rotas were not produced for people to know the times the times their support began and ended.
The service was not always safe. The provider did not complete risk assessments for some people. This meant staff did not always have enough information and guidance to ensure people were safe.
Although people's assessments of needs had been completed, care plans did not give details of how, when and for how long staff should support them to meet their needs.
Staff were aware of how to identify and report abuse, both within and outside the organisation. People knew how to make a complaint if they had concerns about their care.
The service had enough staff to meet people’s needs. The staff had attended training relevant to their roles. They had supervison and support from senior staff.
People had positive relationships with staff and their relatives. Relatives told us staff were caring, compassionate and treated them with respect. Staff knew how to ensure people’s privacy. Staff promoted people's independence.
People and relatives were involved in their care. There was a policy on equality and diversity and staff told us they did not make a discrimination in the delivery of the service.
Staff monitored incidents and accidents and drew from lessons so future similar incidents and accidents were avoided.
Staff understood the principles of the Mental Capacity Act 2005 (MCA) and people’s capacity to make decisions was assessed when required. They encouraged and promoted people's rights to make their own decisions about their care.
This was the first inspection of the service and took place on 22 August 2017 and was announced. There was no registered manager at the service. The provider was managing it at the time of writing this report. 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.
Staff supported people at home with their care needs and the service had assessed some risks. However, not all risks associated with personal care tasks had been assessed to ensure people were safe at all times when staff carried out personal care.
Records relating to the recruitment of new staff showed relevant checks were not always completed before staff worked unsupervised at the service. They did not always carry out relevant checks such as Disclosure Barring Service(DBS) checks and character references before they employed staff in order to make sure they were of good character and suitable to work with people who used the service.
The provider had not developed person centred care plans for people, following an assessment of people’s needs and commencement of the service.
The provider held information about complaints, compliments and comments, as well as accidents and incidents. We found this information was lacking in detail and the provider told us that no formal complaints had been received. However, we found that complaints/concerns had been made by the relatives of people who used the service which had not been recorded.
The provider monitored the quality of the service by carrying out spot checks on staff and carried out an annual stakeholder survey. Although both methods were undertaken, the results were not analysed and actions were not documented to address any shortfalls. Similarly, audits were carried out, but these were not robust and had not identified the issues we highlighted to the provider during our inspection.
The relatives of people who received support spoke highly of the provider as did the staff who worked for the provider. They felt that their family members were safe and happy with the staff who visited their homes and they felt the provider delivered a good service.
Training was provided to staff by an external training provider. The training ensured that staff did their job effectively and provided support to people in the way they preferred. Staff told us that they had received the training that was required to meet people's needs and to keep them safe.
Relatives told us that staff did not rush people when they delivered care. Staff confirmed that they generally had enough time to complete the tasks required. The provider manually devised the rotas based on her own knowledge and experience of each individual's needs, staff availability and geographical locations. We found the provider employed enough staff to manage the service effectively.
CQC monitors the application of the Mental Capacity Act (2005). We saw that staff understood their responsibilities under this act and training related to this had been provided to them.
The provider informed us that staff were not responsible for providing meals to people because they lived with their relatives who were responsible for maintaining people’s diets.
Staff had undertaken equality and diversity training and told us that they treated people individually and provided care according to their needs and wishes. Staff understood people's likes and dislikes, although these preferences were not recorded in people's care plans.
The relatives of people who used the service told us the staff were caring, compassionate and treated them with dignity and respect. They confirmed that staff respected people's privacy and dignity when providing care.
The provider had experience in care services and staff told us they found her supportive and approachable. The provider personally managed all of the daily operations and was in the process of handing over some responsibilities to administrative staff, once appointed.
We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of sufficient risk assessments and guidance for staff about how to mitigate these and a lack of person centred support plans to meet people’s individual needs. We also had concerns about a lack of sufficient pre- employment checks and adequate quality monitoring of the service to ensure they operated in an open and transparent manner. You can see what action we told the provider to take at the back of the full version of the report.