Archived: Cornelia Heights

Cornelia Heights 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. Cornelia Heights is registered to provide care for up to 23 people, including people living with dementia and physical frailty. At the time of the inspection, there were 20 people living at the service.

People’s experience of using this service:

Risks to the health and safety of people were not being managed safely.

People’s health was not always monitored effectively and guidance from healthcare professionals was not always followed or requested in a timely way.

Risk assessments in place were not always followed to ensure people’s safety was maintained.

Risks posed by the environment were not managed effectively.

Medicines were not always managed in a safe way and this meant people were at risk of not receiving the medicines they needed safely.

There were not always enough suitable staff deployed to meet people's needs and keep them safe.

Records were not always accurately maintained or up to date. This meant that people were at risk of receiving care which was not appropriate.

There was not a robust process in place to monitor, act upon and analyse incidents, accidents and near misses. This placed people at continued risk of harm.

There was a lack of management oversight in relation to the care and service provided. Quality and safety systems were not adequate and did not identify significant risks to people or service wide failings.

Managers had not acted promptly when concerns had been raised with them.

Managers lacked knowledge and understanding of best practice guidance and CQC were not always notified of significant events.

Systems were not in place to allow continuous learning and improving care.

The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and risks had not been mitigated.

During and following the inspection our findings were reported to the local safeguarding team and fire service.

Why we inspected:

The inspection was prompted by significant concerns raised from the local authority, safeguarding team, healthcare professionals and the Clinical Commissioning Group (CCG). A focused inspection was completed; which looked at both the ‘Safe’ and ‘Well led’ only in line with the concerns that had been raised.

Rating at last inspection:

The service was rated as requires improvement at the last full comprehensive inspection, the report was published on 5 November 2018. After the last inspection the provider sent us an action plan to tell us how they would address the areas we raised on inspection. At this inspection we found the provider had not made sufficient improvements to address all these concerns. We also found additional significant concerns which has resulted in the rating for key questions in relation to ‘Safe’ and ‘Well led’ as being inadequate.

Enforcement:

Five breaches in regulatory requirements were identified at this inspection. You can see what action we asked the provider to take at the end of the report. Full information about CQC's regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special measures:

The rating for this service is Inadequate and the service is therefore in special measures. 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.

The home was based over two floors, connected by a passenger lift and stair lifts. Not all bedrooms had en-suite facilities but there were toilets available on each floor. There was a lounge and conservatory dining room. There was also an accessible garden.

The inspection was conducted on 19 and 25 September 2018 and was unannounced.

Systems and processes used to monitor the quality and safety of the service had not been fully effective in preventing the shortfalls found at this inspection.

There was not always a sufficient number of staff to meet people's needs. At times staff were not present in the communal areas of the home to ensure people’s safety and staff did not always have the time to spend with people in a relaxed and social way.

Oral medicines were managed safely and administered in line with the prescribing instructions. However, systems in place to ensure topical creams were used safety were not effective.

Recruitment procedures were not followed consistently, so the provider was unable to confirm that all staff employed were suitable.

People were provided with enough to eat and drink but staff were not always available to provide them with consistent support were required. People had access to health professionals and other specialists if they needed them. Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

Staff demonstrated an understanding of people's needs and people’s care plans were personalised and reflected the care and support that was required. However, people were mindful of staff workload so were reluctant to ask for additional support. Monitoring records, such as food and fluid charts and daily records of care provided were not always completed robustly to demonstrate that care had been delivered appropriately.

Individual risks to people were managed effectively. Where accidents, incidents, and near misses had occurred processes were in place to help mitigate reoccurrence and future risks.

People were protected from the risk of abuse and staff knew how to identify, prevent and report abuse. Staff understood how to keep people safe in an emergency.

The home was clean and there were systems in place to protect people from the risk of infection. With the exception of the stairlifts all other environmental risks were managed effectively.

Staff were not consistently supported in their roles. Systems in place to monitor staff training were ineffective in identifying training that had been received or when it was required to be updated.

Staff understood and followed the principles of the Mental Capacity Act 2005 (MCA) and were aware of people's rights to refuse care.

People and their families were positive about the care received. Staff had developed caring and positive relationships with people and treated them with dignity and respect. People were encouraged to be independent.

People received mental and physical stimulation and had access to a range of activities. Staff supported people to meet their cultural and religious needs. The registered manager and provider sought feedback from people using the service and had a process in place to deal with any complaints or concerns.

The providers were fully engaged in running the service and their vision and values were clear and understood by staff.

We identified one breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of this report.

Since the last inspection in November 2016 improvements had been made in the management structure within the home. This had resulted in more effective running of the service and increased staff morale. There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

There were systems in place to monitor the quality and safety of the service provided and manage the maintenance of the buildings and equipment. However systems were not always robust. For example, where incidents or accidents had occurred it was unclear if action had been taken to identify cause and prevent recurrence and care plans and risk assessments were not always updated in a timely manner to reflect people’s changing needs.

Staff and the registered manager had received training in respect of MCA and were able to demonstrate an awareness of the principles. Staff understood the need to gain consent from people, however information in relation to who can legally provide signed consent when people lacked capacity was not easily accessible to staff.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

People were supported by staff who had received an induction into the home. Most staff had received appropriate training to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

People were positive about meals and the support they received to ensure they had a nutritious diet. Care plans provided information about how people wished to be cared for and staff were aware of people's individual care needs and preferences.

People and their families were positive about the care received. The quality of staff interactions with people to be varied, but people were comfortable and relaxed in the company of the staff and felt able to ask for assistance and support when required.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire. They were also supported to raise complaints should they wish to.

People’s families told us they felt that the home was well led. They were positive about the registered manager and felt that they understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how these related to their work and spoke positively about the culture and management of the home.

We carried out an unannounced comprehensive inspection of this service in August 2016 where we identified the providers’ were in breach of three regulations. They provided us with an action plan telling us they would be compliant by the 31 October 2016. However, since that inspection we received new information regarding concerns about staffing levels, medicine management and the management of people’s nutritional risks.

As a result we undertook a focused inspection on 30 November 2016 to look into those concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cornelia Heights on our website at www.cqc.org.uk

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. However they did raise concerns over staffing levels. There was not always enough staff available to meet people’s needs which meant that other staff were drawn away from the duties to provide support to the care team.

People and their families told us they felt the service was not well-led. There was a tension between the providers’ and the management team. Both the registered manager and the deputy manager expressed concerns over the intrusive management style of the providers and expressed their frustration at not being able to manage the home. Care staff were aware of the tension between management and the providers and this was affecting their morale and work ethic.

Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and the environment were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. The risk to people of malnutrition and hydration was managed effectively and people were supported to have enough to eat and drink.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence

At our previous comprehensive inspection in April 2015 we found the provider did not have an effective system to ensure the safe management of medicines, care records were inaccurate and not reflective of people’s individual needs, people were not treated with dignity and respect and quality assurance systems were not robust. The provider sent us an action plan telling us how they planned to rectify this. At this inspection we found people were treated respectfully and their dignity maintained and action had been taken to improve the accuracy of care records. However, adequate action had not been taken to ensure medicines were managed safely and quality monitoring systems were not robust.

There was a registered manager at the home. 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 provider had failed to notify CQC about some significant events that happened in the care home involving an allegation of abuse and an injury to a person using the service which resulted in them requiring hospital treatment.

There were limited formal quality assurance systems which meant areas of concern had not been identified. The registered manager regularly worked with care staff providing informal monitoring of the care people received.

Medicines were not always managed effectively and care staff were not consistently following the provider’s medicine management procedures.

There were enough staff to meet people's needs although staff were busy and the registered manager and deputy were working some care shifts. This impacted on their ability to undertake all management functions. Staff received appropriate training and were supported in their work. The recruitment process helped ensure staff were suitable for their role.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly although formal mental capacity assessments had not been completed. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

People, relatives and external health professionals were positive about the service people received. People were positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have taken in the full version of this report.

Is the service safe?

This is a summary of what we found-

Is it safe?

We found medication was managed appropriately to ensure people were protected from the risks associated with medication. Procedures were in place to ensure medication was administered, stored and handled safely. However, we found staff did not always follow systems for the handling of laundry. This meant people were not protected from the risk of the spread of infection. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection prevention and control.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

We found risks to people's health had been assessed and action taken to reduce the risk of injury to people. Care plans were specific and clear to ensure staff provided care in a safe manner. Staff were knowledgeable about people's needs and how to meet them.

The manager was aware of their responsibilities under the Mental Capacity Act (MCA) and the majority of staff had completed training in the MCA. No applications had been made under the Deprivation of Liberty Safeguards however, the manager was aware of the procedures to follow should this be necessary. People's human rights were therefore properly recognised, respected and promoted.

Systems in place to administer medication were not effective and failed to identify when a person had received a medicine they no longer required. Staff were unclear about whether to offer "as required" pain relief to people or wait for them to ask for it. The home was clean, however, people were not protected from the risks associated with cleaning chemicals because these were not stored securely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring potentially harmful chemicals are stored securely, and in relation to the effective administration of medication.

Is the service effective?

People we spoke with said they were well cared for and their needs were met. Staff were clear about their duties and how to carry them out. People's care needs were reviewed regularly with them and updated as necessary. Medical assistance was sought when required and a system was in place to ensure staff were kept up to date with people's medical needs. Staff training needs were discussed at regular supervision meetings and training was provided accordingly.

The service was not aware of the Department of Health Code of Practice on the prevention and control of infections and related guidance. Effective systems were not in place to assess the risk of and to prevent, detect and control the spread of a health care associated infection.

Is the service caring?

People were complimentary about the staff. We spoke with seven people. One person said, 'Staff are wonderful'. Another person told us, 'You wouldn't get better staff anywhere on the Isle of Wight'. People we spoke with, and their relatives, told us staff were caring. We observed staff supporting people in a kind and caring manner.

Is the service responsive?

Staff were consulted about care provision and management responded to their feedback. A system was in place to ensure staff were kept up to date with people's changing health and welfare needs. This meant staff took appropriate action when necessary because they were aware of people's needs.

People knew who to talk to if they had concerns, and they felt these would be responded to. Both the manager and the provider were on hand and people told us they could talk with them knowing they would be listened to.

Is the service well-led?

The service sought feedback through questionnaires and meetings with people using the service, their relatives and health professionals. Some of the feedback had been acted on. The manager told us they would be looking at survey responses to identify other actions needed. There were quality assurance processes in place and audits were carried out to identify areas where improvement could be made. Action was taken to address areas highlighted in the audit process. This helped to ensure people received a good quality service at all times.

One person told us, 'If you've got to be in a care home this is probably the best'.

We spoke with two visitors. Both were very happy with the care their relative was receiving. One said they had 'absolutely no problem at all' and that '[their relative] is looked after very well'. We also spoke with three health professionals who visited the home. They said they were contacted appropriately and staff acted on their requests and guidance.

We also spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. Staff knew what care and support people needed and they respected their wishes. Staff were familiar with local procedures for safeguarding vulnerable people. They had completed various training courses relevant to their role in the home.

Our previous inspection In February 2013 found there was not an effective system in place to monitor the quality of the service provided to people living at Cornelia Heights. A compliance action was made. An action plan was received telling us action had been taken to address these concerns.

The two care records we looked at contained relevant and detailed information about people's individual needs and had been updated regularly. We saw several rooms and these were clean and appropriately decorated. Procedures were in place to obtain feedback about the service from people living in the home, their relatives, and from health professionals involved in people's care. However, risks to people's safety and welfare when moving around the building or grounds and in the event of fire had not been assessed. The provider did not have an effective system in place to record and act on concerns raised by staff during supervision. We have asked the provider to send