This comprehensive unannounced inspection took place on 27 November and 10 December 2018.

Corinthian House 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. Corinthian House provides nursing and personal care for a maximum of 70 older people, some of whom are living with dementia. There were 67 people using the service at the time of this inspection.

There was a registered manager in post. A registered manager is a person who has registered with 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.

At our last inspection in September 2017, we rated the service Requires Improvement. We found at that time, improvements had been made to the service following our previous inspection when we identified several concerns. We used this current comprehensive inspection to check whether the improvements had been sustained. Although some improvements were still needed; we found there had been sufficient progress and the service has now been rated as Good.

A range of audit processes were in place to measure the overall quality of the service provided. However, records did not always show issues identified were acted on and lessons were learnt when shortfalls were identified. The registered manager took action during the inspection to introduce new documentation and systems to ensure this in the future.

People told us they were safe and well supported by staff who knew them well. Overall, people said there were sufficient staff and our observations confirmed this. People's needs were assessed and their care planned to ensure they received the support they needed. Care plans and risk assessments were reviewed regularly and staff had access to up to date information about people's care requirements. Medicines were managed safely.

Staff were trained to recognise potential abuse or discrimination and they knew how to manage and report such concerns. Recruitment was managed safely. Staff felt well supported and received appropriate training which was updated when needed. Staff said they enjoyed working for the service and felt valued.

People lived in an environment that was clean and homely. The home and equipment were maintained to minimise the risk of cross infection. Health and safety checks were undertaken and there were appropriate procedures in place in the event of an emergency.

People told us they enjoyed the food at the service. They received support to maintain their nutritional wellbeing and had a choice in what they ate and drank. There was a varied menu available to people and specialist diets were catered for. People were supported to maintain their health and had access to health professionals as required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to make choices and retain their independence.

People had opportunities to take part in social activities which they told us they enjoyed. People were treated equally and their diversity understood and supported.

Privacy and dignity was protected and staff were kind to people. People told us they were happy with the care they received and were complimentary about the staff who supported them. Overall, we saw individualised caring interactions between staff and people who used the service.

People understood how to complain or raise concerns and these were responded to. People, their relatives and staff all spoke highly about the way the service was managed.

Further information is in the detailed findings

This unannounced inspection took place on 19 and 21 September 2017.

Corinthian House is a large purpose built service set over three floors and provides accommodation for up to 70 older people who require nursing care, some of whom may be living with dementia. The service is close to all local amenities. At the time of this inspection there were 60 people using the service.

The service was last inspected in May 2016 when it was found to be in breach of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always managed safely and there were gaps in the staff training, supervision and appraisals and competency checks of their skills had not always been carried out. The systems used to monitor and assess the quality and safety of the service were not effective or robust.

At this inspection we found improvements had been made to address the above breaches of regulation and the service was now compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have upgraded the rating in the safe and effective domain to reflect improvements in medicines management arrangements and staffing. We have maintained the previous ratings in the well led domain because we noted further improvements were needed.

There was a registered manager for the service. 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 we found arrangements relating to the safe handling of medicines had been improved, although records for these were not always accurately maintained. Care staff had been provided with a range of training and supervision opportunities and had their competencies checked to ensure they carried out their roles in a safe way. Improvements had been made to the operation of the governance systems; this included a programme of regular audits and analysis of trends to enable potential patterns to be identified.

Care staff had received training to ensure they knew how to recognise and report incidents of possible abuse. The needs of people were assessed and care staff were provided with information on the management of potential risks, to ensure people were protected from harm. Incidents and accidents were monitored by the service and action was taken to mitigate these from reoccurring. Care staff had been safely recruited and arrangements were in place to ensure there were sufficient numbers of them available to meet people’s needs. Maintenance checks were regularly carried out, to ensure the environment and equipment was kept safe.

Care staff had received training on the Mental Capacity Act 2005 to ensure they knew how to promote people’s human rights and ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests. People were provided with a range of wholesome meals and their nutritional needs were monitored with involvement from health care professionals when this was required.

Care staff demonstrated compassion for people’s needs and interacted with them in kind and considerate way. People were supported to make choices about their lives and a programme of meaningful activities was available to ensure their health and wellbeing was promoted.

People and their relatives were able to provide feedback on the service and knew how to raise a complaint. Some people told us communication with them should be improved and people were not actively involved or participated in reviews of their support. We have made a recommendation about this.

We inspected Corinthian House on 11 and 20 May 2016. The first day of the inspection was unannounced and we told the registered provider we would be visiting on the second day. At the last inspection in April 2015 we rated the service overall as ‘Requires Improvement’. We found breaches in regulations regarding safe levels of staffing and people who used services and others were not protected against the risks associated with unsafe or unsuitable equipment. We found during this inspection improvements had been made in these areas.

Corinthian House is a large purpose built accommodation set over three floors and provides services for up to 70 older people who require nursing care. The service is close to all local amenities.

The home had a registered manager in place. 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.

Systems in place for the management of medicines; so people received their medicines safely were not always appropriate. For example there were gaps on people’s medicine administration records which meant we could not be sure people had received their medicines as prescribed.

We saw staff had not received regular supervision and not all staff had had an annual appraisal. Some staff had not always been trained or had their competency checked to ensure they had the skills and knowledge to provide support to the people they cared for.

There were systems in place to monitor the quality of the service provided. We saw there were a range of audits carried out both by the registered manager, registered provider and quality manager. We saw where issues had been identified; action plans were not always signed off or known by the registered manager and the same issues were being repeatedly found which meant quality monitoring was not always effective.

Appropriate checks of the building and equipment were undertaken by appropriate professionals to ensure health and safety. Where staff in the service completed health and safety checks we saw they had not always received the training or guidance to do so.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as nutrition and pressure care. This enabled staff to have the guidance they needed to help people to remain safe. Not all of the guidance was reflected in peoples care plans which meant staff members may not have received a full explanation of the hazards when supporting a person.

People told us there were enough staff on duty to meet people’s needs. We found recruitment and selection procedures were in place and checks had been undertaken before staff began work. The registered provider had not always recorded their recruitment decisions. On one occasion they had confirmed employment for someone where a reference from the last employer could not be gained.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

There were positive interactions between people who lived at the home and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well

This was an unannounced inspection carried out on the 8 and 14 April 2015. At the last inspection in October 2014 we found the provider had breached five regulations associated with the Health and Social Care Act 2008. We found people did not receive personalised care on a morning or on an evening. Staff were putting people to bed early and dressing some people then putting them back to bed. Appropriate standards of cleanliness and hygiene were not always maintained. One unit was not clean and there was a strong offensive odour. We saw medicines were not administered safely. Staff sometimes failed to follow the prescribers’ direction fully and people were not given their medicines correctly. We also found that most people’s care plans identified how care should be delivered; however some care plans did not sufficiently guide staff on people’s care needs. We saw there were systems in place to monitor the quality of service provision but these were not always effective, because audits did not always pick up shortfalls.

We told the provider they needed to take action and we received a report in December 2014 setting out the action they would take to meet the regulations. At this inspection we found improvements had been made with regard to these breaches. However, we found other areas of concern.

Corinthian House provides nursing care for up to 70 older people, some of whom are living with dementia. The home is divided into three units.

At the time of the inspection there was no 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 and associated Regulations about how the service is run.

Some people who used the service raised concerns about staff’s competence as they felt some staff, where English was not their first language, did not always communicate well with them and understand their needs. Staffing levels were not sufficient at all times and there was a risk that people’s needs would not be met and their safety compromised. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Checks on the safety of equipment in the home had not been effectively carried out. We found a number of pieces of equipment that required replacement. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People’s views on activity in the home were mixed. Some people said they would like more to do. Our observations showed there were periods of time where people were not engaged in any meaningful activity or stimulation.

People who used the service told us they were happy living at the service. They said they felt safe and knew how to report concerns if they had any. We saw care practices were good. Staff respected people’s choices and treated them with dignity and respect. The home was clean and there were, in the main, no malodours.

People were encouraged to maintain good health and received the support they needed to do this. Overall, medication was managed safely and people received their medication when they needed it.

There were systems in place to make sure people were not deprived of their liberty unlawfully. The

manager was aware of their responsibilities regarding the Deprivation of Liberty Safeguards.

People told us they enjoyed the food in the home and there was a good variety of choices available.

Staff said they felt well supported in their role and knew what was expected of them. They said they received good training which prepared them well for their role. Staff had received training on the Mental Capacity Act 2005 and showed a good understanding of this. There was an on-going training programme in place for staff to ensure they were kept up to date and aware of current good practice. Robust recruitment procedures were in place and appropriate checks had been undertaken before staff began work.

Staff spoke positively about the leadership of the management team; saying they were approachable. They said they had confidence in the manager if ever they reported any concerns.

Records showed that the provider investigated and responded to people’s complaints, according to the provider’s complaints procedure.

There were effective systems in place to manage, monitor and improve the quality of the service provided. The provider and manager showed a commitment to seeking feedback on the service in order for it to continually improve.