Archived: North Corner

North Corner was a large domestic-style house which had been extended to one side. It was set in its own grounds on a residential street in Lewes. Accommodation was provided over two floors in the older part of the building and on the ground floor only in the newer extension. A chair lift was available for part of the way to the second floor rooms. A lounge and separate dining room were provided on the ground floor.

North Corner had a registered manager. 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 registered manager was also the owner of North Corner, in partnership with another person.

The last inspection was on 30 June and 1 July 2015. At that inspection, we found a number of breaches in the HSCA Regulations 2014. We rated the home as ‘Inadequate’ and warned the provider they must make improvements. The provider sent us an action plan following the inspection in which they stated how they would make improvements and that all areas would be addressed by 30 October 2015. In February 2016, they sent us their Provider Information Return (PIR) in which they outlined how they were currently meeting the needs of people living at North Corner and areas they wished to further develop.

We found, while the provider had addressed some areas, they had not taken effective action to meet all of the breaches in regulation identified at the last report. We also found further additional areas where they needed to take action.

At the last inspection, we found risks to the health and safety of people were not assessed and all actions had not taken place to mitigate such risks. We also found the proper and safe management of medicines was not ensured. At this inspection, the provider continued to not ensure accurate assessments took place, for example for people who were at risk of pressure damage. The provider continued not to take appropriate action to reduce people’s risk, for example where people were at risk of dehydration. Staff were not always following guidelines on administration and recording of medicines, including ‘as required’ (PRN) medicines. The provider had taken action to ensure all people were assisted to move in a safe way. They had also set up clear systems in some areas relating to medicines, for example administration and recording of prescribed skin creams. They had also ensured they contacted external healthcare professionals about people’s healthcare needs in a timely way.

At the last inspection the care of people was not always appropriate, did not meet their needs, and reflect their preferences. At this inspection, we found people’s needs were not consistently assessed, for example where they had continence needs. Also care was not designed to meet people’s needs, including for people who were living with dementia. Care was not always provided in a way which reflected people’s preferences, including their recreational needs. The provider had taken action in some areas. They had developed a programme of activities from external providers, which took place during the afternoons. Some people’s care plans were very individual and set out clearly the person's likes and preferences.

The provider continued not to ensure the quality and safety of services people received was assessed, monitored and improved Risks relating to the health, safety and welfare of

people and others were not mitigated. Also each person’s documentation about their care continued not to be accurate, complete and contemporaneous. The provider had audited some areas, for example the safety of the building and staff training needs. However the action plans they reported on were not always in writing. Progress where issues had been identified, such as tripping risks to people, were not always evident. Some records remained inaccurate. The provider continued not to ensure relevant records were completed to assist in assessment of people’s needs, for example where people showed behaviours which may challenge themselves or others.

The provider had not identified the risks to people of having only one member of waking staff on duty at night. There were no protocols to ensure the safety of people in the event of a fire could be met at night, by only one waking member of staff.

The provider had taken full action to meet the breach identified at the last inspection where people were unable to give consent when they lacked mental capacity to do so. People had clear assessments and plans relating to how they were to be supported in consenting to care. Staff were fully aware of their responsibilities under the Mental Capacity Act (2005).

People said staff were both kind and gentle when supporting them. People said they were happy living at North Corner and felt safe there. They said they could raise issues of concern if they wanted to. People commented positively on the meals provided. The chef was keen to work with people and ensure they could have the meals they liked and enjoyed.

Staff were positive about the service provided at North Corner. They said they felt supported both by managers and by their training. All of the staff we spoke with were fully aware of how to support people who may be at risk of abuse. Staff spoke positively about the homely atmosphere of North Corner.

The overall rating for this provider remains ‘Inadequate’. This means that it remains in ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found five breaches of the HSCA 2014 Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us 'My mother is happy here and we are certainly happy that she is safe and well cared for.'

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The registered manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people's needs are always met.

Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs.

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'Everyone here is so kind and helpful. They know what help and support I need and they couldn't do more for me ' I'm very satisfied.' A relative told us 'My sister and I visit regularly and can't fault the place. Right from when mum first moved in we've been very happy with everything here, and very impressed with how caring and professional the staff are.' Another relative told us 'We'd been looking for quite a while when this home was recommended to us and we couldn't have found anywhere better. It's comforting to know that she is safe, happy and so well cared for.'

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed. A local GP had written 'You provide excellent care for your residents, of a significantly above average standard, often going above and beyond to meet residents' needs.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One relative told us 'We are regularly involved in reviews and feel our views are listened to. The staff here have been wonderful and we are so grateful for all they do.'

Is the service responsive?

People had the opportunity to take part in a range of activities in and outside the service regularly. The home has its own adapted minibuses which help to keep people involved with their local community. A care worker told us 'Because it's quite a small home, we can spend time with people and get to know them individually, their interests, what they like and how they like to spend their day.'

We were told by the manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people using the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the manager told us they operate an 'open door policy' so visitors to the home can discuss any issues they may have. People and their relatives, who we spoke with, knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

On this inspection we spoke with the registered manager, the administrator (by 'phone) and four care workers. We also spoke with four people who used the service and four relatives/friends (two by 'phone).

People were satisfied with the service at North Corner. One person who used the service said, "The staff are very good and I like it here.' Another commented, 'They are wonderful here, caring, understanding. They reassure me.'

We found that people's needs were assessed and care was planned and delivered to meet identified needs. People had access to healthcare professionals when required. A relative reported, 'They were concerned about her not getting enough sleep so they informed us that they had called the doctor who has changed her medication.'

We found that appropriate standards of hygiene had not been maintained. However, progress had been made in implementing government guidance.

We found that the premises needed some refurbishment and identified a number of hazards. We found there was a comprehensive maintenance programme of works that was being delivered and the hazards had been identified and plans made to address these in a timely manner. A relative commented, "It may not be the most modern place but it's homely and the residents are all happy and well looked after.'

We found that people were receiving medications as prescribed but that some recording and care planning issues that relate to this were not fully resolved.

We found that appropriate checks were carried out before staff started work to ensure they had relevant experience and were of good character. A relative said, 'We think they know what they are doing and people are very well looked after.'

We found that people were offered choices about their care and these were respected. A person who used the service told us, 'We are allowed to do what we want. We are not told where to go or what to do'. We found that care was respectful and people's dignity was maintained.

People's needs were assessed, care planned to meet those needs and care was delivered in accordance with those plans. A relative told us, 'I trust them to pay attention to my mother's needs; I'm not worried about my mother not being looked after properly'.

We found that some areas of the home were not kept in a clean and hygienic condition. We also found that some of the systems to ensure cleanliness and the control of infection that form part of government guidance were absent.

There was a system for obtaining and disposing of medicines and they were stored securely. However, we identified concerns relating to the handling and recording of medicines.

We found that although there were systems to recruit suitably skilled and experienced staff, the required pre-employment checks had not always been fully carried out.

We found that consent was obtained for major decisions and for day-to-day activities. Staff were working within the framework of the Mental Capacity Act.

People had a comprehensive assessment and care plan which met their needs and ensured their safety. Care was delivered in line with their plan. A relative reported they were 'very happy ' very impressed ' very good.' One person said 'by and large the carers are excellent. If I want something I ask them and it comes in due course.'

We found that people who use the service were protected from the risk of abuse because staff had received adequate training. They were confident to report abuse and engage in safeguarding procedures. One person said 'I feel safer here than I do at home.'

The provider had systems in place to assess the quality of service through regular questionnaires to a range of stakeholders. There was robust accident reporting and management. People and workers knew how to raise concerns. All necessary safety checks were completed.

The provider had a system in place to check potential staff were of good character. These systems were not robust and some essential checks were not completed.