This inspection took place on the 5 and 6 June 2018 and was unannounced for the first day. The inspection started at 7am to allow us to meet with the night staff and see how duties were allocated for the day.

The inspection was prompted in part by notification of an incident following which a person died. The incident is subject to investigation by another agency. As a result this inspection did not examine the circumstances of the incident. However the information shared with CQC about the incident indicated potential concerns about the management of the risks of falls. This inspection examined those risks.

Cornerways is a ‘care home’, operated by Peninsula Care Homes Ltd, a small local care provider with 4 other services in the Devon area. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People living at Cornerways were older people, living with physical health conditions associated with older age and/or dementia. The service accommodates up to 50 people in one adapted building, with lifts to access the rooms on the first and second floor. 42 people were living at the service at the time of the inspection.

The home 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.

At the last inspection on 11 July 2016, Cornerways was rated good in all areas. On this inspection we found this had been maintained.

The home continued to be well led. The management team promoted open communication with people, their relatives and healthcare professionals involved in their care. Healthcare professionals were involved at an early stage to monitor and support people’s health. Staff at the service were alert to changes in people’s behaviour which might indicate physical ill health. Staff understood their roles and had daily opportunities to contribute to care practice and developments at the service.

The management of the service carried our regular audits of practice. Incidents and accidents were analysed and lessons learned to improve practice and safety. People were protected from abuse and neglect. We found staff had access to information about risks to people and how to avoid foreseeable harm. Risks related to people's care were assessed, recorded and reviewed. Medicines were stored and administered safely.

People and relatives told us the home was safe and they felt well cared for and supported.

People's privacy and dignity were respected. Staff ensured people were encouraged to maintain their independence and had a say in the way their care was delivered. As many of the people at Cornerways were living with dementia, staff had a good understanding of the way people’s life and past history affected their behaviour at this stage of their life. Staff used this knowledge to help support people well.

We found enough staff were on duty to meet people's needs and staff had been subject to a thorough recruitment process to make sure they were suitable to work with people. People and relatives told us staff were kind and caring. Staff were attentive when people asked for assistance and had clear understanding of strategies to support people when they became distressed or anxious. The home had a busy but cheerful atmosphere. Although the building was not ideal to support people with dementia the service had made efforts in line with good practice guidance to make it more suitable. This included use of coloured doors, easy read directional signage, a themed dining room and a newly developed secure garden with sensory areas.

Staff had the training and suppor

Cornerways is a care home registered to provider personal care and accommodation for up to 50 people older people. Most of the people who lived in Cornerways were living with a form of dementia.

This inspection took place on 11 July 2016 and was unannounced. At the time of our inspection there were 41 people living in the home.

The service 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous unannounced comprehensive inspection of this service on 27 May 2015. The service was rated as requires improvement overall. Breaches of legal requirements were found in relation to risks to people not being well managed, people being at risk of cross infection, and people’s food and fluids not being sufficiently well monitored.

The provider sent us an action plan which detailed how they were planning on meeting the regulations and told us these actions would be completed by the end of September 2015. At this inspection we found action had been taken to respond to our concerns and the service was no longer in breach of these regulations.

Cornerways is a care home which provides accommodation for up to 50 people. Nursing care for people was provided by local district nursing teams. People who lived in Cornerways were older people with a variety of needs including mobility needs, personal care needs and needs relating to dementia.

Following our previous inspection, action had been taken to review the infection control practices at the home. Work had gone into re-organising the laundry area and the storing of cleaning equipment. Audits had been carried out and new processes had been put in place in order to protect people from the risk of cross-infection.

People were supported to have enough to eat and drink. People were supported to make choices about what they wanted to eat. Each meal consisted of a number of alternative dishes to meet people’s preferences. Where people required changes to their diets, the consistency of their food, or required support from staff this was provided. Where people required closer monitoring of their food and fluid intake because of identified risks, this was being completed and people were referred to specialist healthcare professionals where required.

Improvements were needed in relation to making the environment and the activities more appropriate for people living with dementia. The registered manager had identified these areas as needing improving and was working towards implemented some changes, however, at the time of the inspection significant improvements were needed. Cornerways is a large three story building with many staircases and narrow hallways. Adequate steps had not been taken to assist people with finding their way around the home with the use of distinguishing colours and signage. What signage was available was unclear and often written in small print people would not be able to see. There were few activities which did not involve memory testing and these can have a negative impact on some people living with dementia.

We have made recommendations for the provider to seek further guidance in relation to providing an environment which promotes independence for people living with dementia and into an activities programme which caters for people’s individual needs.

All the people who lived in Cornerways required support with taking their medicines and staff had been trained to administer medicines safely. People, relatives and staff confirmed medicines were safely managed and people received their medicines as prescribed by their doctor. We found some issues with the recording of medicines and have made a recommendation for the registered manager to r

This inspection was unannounced and took place on 27 May 2015.

Cornerways is a care home without nursing, which provides care for up to 50 people. People who live at the home are older people, some of whom were living with a dementia or physical disabilities.

There is a 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 2008 and associated Regulations about how the service is run.

People were not always protected from risks at the home as some risk assessments had not been completed. These related to supporting people with behaviours that presented challenges to the home or could put the person themselves at risk.

People were not protected from the risks of cross-infection. The laundry area was cluttered and cleaning equipment was not being stored correctly. An audit of the infection control practices at the home had not been carried for nearly a year, and had not been reviewed following the recent outbreak of an infectious illness.

The amount that people ate and drank was not sufficiently well monitored to ensure they received the food and fluids they needed. Food and fluid balance charts had not always been completed and totals were not being balanced for a 24 hour period. There was no system in place to review the levels of fluid people were taking in over several days or what actions needed to be taken if people were not taking in sufficient fluids to maintain their health.

The systems for managing medicines were safe. People received the correct medicines at the correct time.

There were clear systems in place for managing safeguarding concerns. Staff understood what constituted abuse and what actions they needed to take to raise concerns. There were robust systems in place for recruiting suitable staff. Sufficient staff were on duty to meet people’s needs. Staff received the training and support they needed to carry out their role.

People’s rights were protected and staff understood the Mental Capacity Act 2005 and about capacity and consent to care. People had access to community healthcare services, such as community nurses and GPs.

Although the premises were not ideal to support people with dementia, work was underway to develop the premises in line with good practice in dementia care.

Staff had developed good and trusting relationships with people living at the home. They engaged appropriately with people and anticipated people’s needs, giving information in ways that people could understand. People’s privacy and dignity were respected.

People’s needs were assessed prior to their admission and care plans identified how to support people with their care needs. Plans were reviewed regularly, and included information on people’s interests and life histories. Activities were provided to help meet people’s interests, and there was visiting entertainment provided. The home had an activities organiser five days a week.

Complaints and concerns were managed well, with clear systems and policies in place.

People spoke highly of the registered manager. Changes were being made by her to the ethos and philosophy of the home to reflect best practice in dementia care. Staff, people living at the home and relatives was all being involved in the developments.

People were consulted about the operation of the home and how improvements could be made. Quality assurance systems were in place and learning took place from incidents to improve safety and quality.

Records were well maintained and kept up to date. Improvements were being made to the records to make them more personalised and reflective of people’s experience of care.

We found a number of breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.

This was a scheduled inspection. We also followed up on concerns,that people had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained, from our inspection on 22 February 2013. On 29 August 2013 we found the home had made improvements.At the time of our inspection 43 people lived at Cornerways.We spoke with seven people who lived at the home, two relatives, three care workers and the manager.

People who lived at the home told us they were well looked after and were happy. One person said "I really like living here".

People told us they were happy with their care. People were supported to access different areas in the home.

We saw that staff respected people's wishes and people told us they felt respected. People's privacy was protected by staff.

People told us that they felt safe and knew what to do if they had concerns. Staff knew what to do if they suspected abuse or poor practice.

People told us that they would not hesitate to report any issues to any member of staff. We saw people being encouraged and supported to take part in activities; on the day of the inspection some people took part in a quiz and bingo.

The home was clean and staff had a good understanding of infection control procedures.

The home had a robust recruitment policy and procedure which meant that people were protected from the risk of harm.

This was a scheduled inspection. We also followed up on concerns from our inspection on 19 January 2012. These included limited activities, inadequate documentation processes for mental capacity and consent, unsafe medicines process, ineffective quality checking systems and non person centred care plans. On 22 February 2013 we found the home had made improvements.

People who lived at the home told us they were happy. One person said "I'm very happy. I like it here." People told us they were happy with their care. We found that staff administered and recorded medicines safely.

People were supported to access different areas in the home. One person said "They (the staff) help me walk." We found staff had an understanding of the Mental Capacity Act (2005) and obtained consent from people when providing day to day care.

We saw that staff respected people's wishes and people told us they felt respected. People's privacy was protected. We saw staff knock or doors before entering rooms.

People told us that they felt safe and knew what to do if they had concerns. One person said "Oh yes, I feel safe." Staff knew what to do if they suspected abuse or poor practice.

We found that the home had an activities co-ordinator and activities programme in place. We saw that people were enjoying activities.

We saw that the home had a system in place for checking on and monitoring the quality of the service. We found that care plans were not individualised or person centred.

We (the Care Quality Commission) spoke in some depth with four people who told us they were treated with respect. People spoke highly of the staff, telling us, “They are all very friendly here”, “Everyone is kind and helpful” and “I can’t speak too highly of them (staff)”.

People also told us they felt well cared for and that staff were always available to assist them. One person said, “You only have to mention something and they do it”. Another person told us, “I would recommend this place”.

One relative told us “I can’t fault it here”, another said, “I think it’s wonderful, staff are really caring”.

Visiting professionals told us that the standard of personal care delivered to people was high, which promoted their dignity. They also told us they were confident that staff had the skills and competence to meet people’s needs and carry out instructions. One professional told us staff were always respectful and mindful of people’s dignity.

The manager talked about their difficulty with appointing an Activities Co-ordinator as the post had been unfilled since August 2011. A care worker was due to take on the role of in late January 2011. One person told us they would like the opportunity to go out; they couldn’t remember the last time they had been out of the home.

Three people we spoke with were not aware of their plan of care. Staff told us they rarely had time to look at care plans and that they received information about people’s needs and preferences from “the residents themselves”, hand over, other staff, or relatives.

We met a service user who had recently moved into Cornerways. They had been pleased to have a choice of rooms, and felt very much in control of the decision as to whether to move in for a long stay.

One person told us that though they knew who the manager was, they only met them in the corridor. They said they would appreciate the manager visiting them in their room, to keep in touch.

Several people praised the skills of the staff in giving personal care. One said their morning wash was 'as good as a bath'.

'Very nice people, you couldn't wish for any better. They look after you here. Some of the old people can be very awkward.'

On the first day of our visit, one person told us; 'the staff are very kind, but not as attentive as they used to be, as there is a full house, and not enough staff'. They recently had not been brought a cup of tea at 7.30am, and staff had been arriving later to get them up - 'I was stuck here till dinner-time yesterday'.

People who live at Cornerways and people who work there all praised the food and meals provided. At lunch time one service user told us, ‘The food is good, though I have no appetite. They remember food I don't like and don't put it on my plate’.

One resident, sitting in the lounge, said they get upset when residents are rude to staff. They said, 'this is a nice place, the people are smashing'. Another person told us, 'I would not know who to tell if there was something wrong.'

One service user said that they would be able to tell Senior staff if they heard anything amiss, such as staff shouting – which they never had. They said the staff were, ‘very pleasant with them all.'