About the service:

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.

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. The home is registered to provide accommodation for up to 23 people. There were 19 people living at the home at the time of the inspection.

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.

We carried out an unannounced inspection of Cornelia Heights on 2 and 4 August 2017. Cornelia Heights provides accommodation for up to 23 older people with personal care needs. There were 18 people living at the home when we visited. All areas of the home were accessible via a lift or stair lifts and there was a lounge and conservatory dining room. There was also an accessible garden. Most bedrooms were used for single occupancy and some had en-suite facilities.

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.

Cornelia Heights is a residential care home registered to provide accommodation for up to 23 people, including people living with a cognitive impairment. At the time of our inspection there were 21 people living in 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

This inspection took place on 11 and 15 August 2016 and was unannounced. The home provides accommodation for up to 23 older people with personal care needs. There were 22 people living at the home when we visited. All areas of the home were accessible via a lift or stair lifts and there was a lounge and conservatory dining room. There was also an accessible garden. Most bedrooms were for used for single occupancy and some had en-suite facilities.

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

An adult social care inspector carried out this inspection. We considered all the evidence we had gathered under the outcomes we inspected. We spoke with three people using the service. We also spoke with five staff and the registered manager. We used the information to answer the question we always ask;

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.

We spoke with eight of the 23 people who were living at the home. They said they were happy with their care and the staff were friendly. One person told us the staff “are wonderful”. People received a varied diet with a choice provided at each meal. Everybody said they enjoyed the meals.

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.

During this inspection we used a variety of methods to understand people's experiences. We observed care being given and we spoke with two people who used the service and one visitor. People we spoke with said they were very happy with the care they received and their care was discussed with them regularly. One told us they had “no problem at all” in the home. People made choices about how to spend their time and what they wanted to eat. There were enough staff to care for people’s needs and we observed that staff communicated well with people and were attentive to their needs. We spoke with a health professional involved in the care of people. They said the care at Cornelia Heights was very good and they had no 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

Cornelia Heights is a privately run residential care home providing care for a maximum of 23 older people. The last inspection of the home took place in October 2014, which identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to tell us what action they were taking and they sent us an action plan stating they would be meeting the requirements of the regulations by 10 February 2015.

This inspection was unannounced and carried out on 27 and 29 April 2015. During the inspection we found the provider had completed all the actions they told us they would take in respect of meeting the Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

At the time of the inspection the manager was not registered because they had only been in post for four months. The new manager had started the process to become the registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered provider’s, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

People told us they felt safe. However, we found that there was not an effective system in place to ensure medicines were administered safely and they were not always stored and disposed of effectively.

Staff did not always interact with people in a positive way or treat them with dignity and respect. Although, on other occasions we saw staff providing positive support to people who were anxious and distressed.

People were at risk of receiving unsafe or inappropriate care because care records were not always up to date and did not contain sufficient information to inform staff as to people’s individual needs.

Risks relating to people’s care and welfare were not always managed effectively and risk assessments were not up to date. We pointed these out to the deputy manager and by the end of our inspection all of the risk assessments were updated and relevant.

There were not sufficient staff available on the morning shift to meet people’s individual needs. Staff were task focused and did not have time to respond to people effectively. We pointed this out to the provider and following our intervention, additional staff had been rostered from within their team to support the morning shift.

There were systems in place to monitor quality and safety, however, these were not always effective and drive forward improvements within the service.

The provider had arranged for a structured activities programme, which was delivered by an activities coordinator who also supported people on a one to one basis, particularly those who chose to stay in their rooms.

People were supported by staff who had received the appropriate training, professional development and supervision to enable them to meet their individual needs. Staff and the management team 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 provider had established a safe and effective recruitment process, which meant staff were knowledgeable, skilled and safe to work with older people. There were processes in place to manage short term absences of staff.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the home to be meeting the requirements of DoLS

People and visitors told us they felt the service was well-led and were positive about the management team. The provider was proactive in promoting good practice, and had developed links with organisations such as ‘Research Ready Care Home Network’ and the ‘National Institute of Health Research’. Healthcare professionals such as GPs, chiropodists, opticians and dentists were involved in people’s care where necessary.

The provider had assessed the health and environmental risks related to supporting people at the home and sought regular feedback from people in respect of their experiences and the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence. There were suitable arrangements in place to deal with complaints.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of the report.