This inspection was carried out on 13 and 14 September 2018 and was unannounced.

Cornford House is a purpose-built modern building that provides accommodation and nursing and personal care for up to 70 people, in a range of studio or one bedroom suites, with en-suite shower rooms. People living in Cornford House are either owner occupiers or tenants. Nursing and personal care is provided by staff on site although people are able to choose another care provider if they wish; no one received care from another provider at the time of our inspection. If people choose to have their care provided by Cornford House Limited, they will have two agreements with the provider, one for their tenancy and a separate one for their care. At the time of our inspection, there were 53 tenants living in the service. The service provides nursing care across all floors. The second floor supports people living with dementia or mental health needs, some of whom also require nursing care. People had varying care and support needs. Some people were living with dementia, whilst others had diabetes, Parkinson's disease and physical disabilities.

There was a registered manager employed at 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 our last inspection on 13 and 14 July 2017, we found that the registered provider had made improvements to the culture of the service and the care people received. A new management team had been introduced to implement and monitor improvements in the service. However, new monitoring systems needed to be embedded and improvements needed to be sustained over time. At this inspection we found that new systems were embedded and sustained and the service that people received had improved.

People were kept safe and staff were knowledgeable about reporting any incidents of harm. Staff received training in safeguarding people from abuse. Staff demonstrated that they understood the signs of abuse and how to report any concerns in line with the registered provider's procedures. People's needs were met by sufficient number of staff who had undergone safe recruitment checks.

Risk assessments were in place and reviewed regularly to minimise the potential risk of harm to people during the delivery of their care. People's care records were held securely and these records were reviewed and any changes to people's care and support needs had been recorded.

Medicines were administered to people in a safe way. Records for the administration of medicines were maintained and medicines were stored safely.

Before people moved into the service they had their needs assessed to ensure the service could meet them. Once people moved into the service, detailed person centred care plans were prepared, with important information recorded to assist and guide staff to meet people’s needs.

People had access to nutritious food and refreshments. Support was offered to maintain dignity and respect to those who could not fully manage themselves. This included, for example, help with meals, personal care and mobility.

People had access to healthcare professionals and their healthcare needs had been met. Care records seen confirmed visits from healthcare professionals had been recorded.

Systems involving digital technology were used and these enabled the service to provide care and support tailored to people’s requirements and preferences. It also helped the service move forward. People participated in activities they enjoyed and were encouraged and supported to socialise. People were supported to maintain relationships which mattered to them.

Staff understood people's needs and treated them with respect, kindness and dignity. Staff communicated with

This inspection was carried out on 13 and 14 July 2017 and was unannounced.

Cornford House is a purpose-built modern building that provides accommodation and nursing and personal care for up to 70 people, in a range of studio or one bedroom suites, all with en-suite shower rooms. People living in Cornford House are either owner occupiers or tenants. Nursing and personal care is provided by staff on site although people are able to choose another care provider if they wish, although no one received care from another provider at the time of our inspection. If people choose to have their care provided by Cornford House Limited, they will have two agreements with the provider, one for their tenancy and a separate one for their care. At the time of our inspection, there were 70 tenants living in the service. The service provides nursing care on the lower ground floor, ground floor, first floor and the second floor. The second floor supports people living with dementia or mental health needs, some of whom also require nursing care.

At our last inspection on 12 December 2016 we found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in regard to staffing levels, individual risk and mental capacity assessments, protocols relating to some medicines administration, internal systems to prevent harm or abuse, people’s dining experience, social isolation, continence needs and effectiveness of the monitoring systems.

The registered provider sent us an action plan detailing the improvements they would make and confirmed they would be meeting the requirements of the regulations by June 2017. They kept us informed of their progress.

This inspection was carried out to follow up on compliance with these notices. At this inspection we found that the registered provider had met the requirements detailed in the warning and requirement notices and had made improvements to the culture of the service and the care people received. A new management team had been introduced to implement and monitor improvements in the service. However, new monitoring systems that had been introduced need to be embedded and improvements need to be sustained over time.

There was a new general manager in post since 27 March 2017, whose application to the Care Quality Commission for registration was in progress at the time of our inspection. Their registration was confirmed shortly after our visit. A registered manager is a person who has registered with the 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were appropriately recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to consistently meet people’s needs and respond to call bells in a timely manner. Staffing levels had been increased and calculated taking into account people’s specific needs and dependency levels. These improvements needed to be sustained over time to ensure people remained safe in the service. Thorough recruitment procedures were in place which ensured staff were suitable to work in the service.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. A new system of medicines management had been introduced that was effective and that minimised risks of errors.

Staff knew each person well and unders

This inspection took place on 12 and 13 December 2016 and was unannounced. Cornford House is a purpose-built modern building and provides accommodation and nursing and personal care for up to 70 people. Cornford House is registered with the Care Quality Commission (CQC) to provide accommodation for up to 70 people but a total of 81 can live and receive support within the building. Cornford House also provides personal care and/or nursing care for people who rent or buy their accommodation within Cornford House. There were 73 people living at Cornford House during our inspection; of which 25 people were receiving accommodation and nursing care and 48 people were renting their accommodation and receiving nursing and/or personal care. The service provides nursing care on the lower ground floor, ground floor, first floor and the second floor. The second floor supports people living with dementia or mental health needs, some of whom also require nursing care.

The service has a registered manager, who was present throughout the inspection. 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.

Cornford House was last inspected in January 2016 where a number of breaches of the regulations were identified in staffing, nutrition, person-centred care, and governance and it was rated Requires Improvement. The provider sent us an action plan to tell us what actions they were taking to implement those improvements. At this inspection, we found the provider had made improvements to person-centred care and meeting people’s nutritional needs but the provider continued to breach the regulations relating to the other areas. Further areas of concern were also identified at this inspection. We also found a new breach of person-centred care.

Staffing levels had been increased since the last inspection. However, people continued to have concerns over response times to call bells. The deployment of staff and visibility of staff on certain floors was not sufficient. This added to people’s risk of social isolation.

The management of medicines was not consistently robust. Risk assessments for self-administration of medicines were not in place. Pain assessments had not been completed and protocols for the use of ‘as required’ medicines were not consistently in place. Checks were not in place for the use of emergency equipment.

The principles of the Mental Capacity Act (MCA 2005) were not embedded into practice. Assessments of capacity had not been considered for decisions such as the use of bed rails, inability to use call bells and consent to care plans. Where people had lap belts done up whilst using wheelchairs, the rationale for this restriction was not consistently recorded.

Where people could not safely use their call bells, robust risk assessments were not in place. The management of continence required improvement. Person centred care plans and risk assessments were not in place to manage people’s continence needs.

The risk of social isolation had not adequately been addressed across all floors. Some people commented they felt lonely. One person told us, “Yes, I am lonely.” Improvements were required to make care plans person centred.

End of life care plans were in place. However, these were not consistently personalised. We have identified this as an area of practice that needs improvement and have made a recommendation about the review of end of life care plans.

Fire evacuation procedures were in place. However, people’s individual ability to evacuate the building had not been assessed and consideration had not been given to the factors which may prevent a safe evacuation. The provider had identified this as a concern and was in the process of implementing n

Cornford House provides accommodation for people with nursing care needs and offers a choice of either studio or one bedroom care suites, or nursing home bedrooms. The service has 70 beds registered with CQC but can accommodate 81 people overall for people who choose a tenancy care agreement. The concept of a tenancy agreement is nursing care within your own home

Cornford House is registered to provide both personal and nursing care to the people of the suites. The in-house team of registered nurses and carers is available 24 hours a day to respond to the persons’ care needs when required. With registered nurses available on-site, the suites offer a permanent home where people do not need to worry about moving when their care needs increase.

At present there are 42 people who have a tenancy care agreement and 33 people with a nursing care agreement living at Cornford House. There is no difference in the care provided and the care is delivered by the staff of Cornford House.

The accommodation provides nursing care and support for physically frail older people who live with health problems such as diabetes, strokes, Parkinson’s disease and end of life care. There is also a specialist unit for up to 18 older people whom live with a dementia type illness. Peoples’ spouses can also be accommodated, so that couples can stay together even when one develops the need for on-going care.

This inspection took place on the 28 January and 01 February 2016 and was unannounced. There were 75 people living in Cornford House.

People commented positively about the care and support received and their experience at Cornford House. However, the inspection highlighted shortfalls that had the potential to compromise the safety of people in the service.

Care plans did not all reflect people’s assessed level of care needs and care delivery was not always person specific or holistic. We found that people with specific health problems such as end of life care and diabetes did not have sufficient guidance in place for staff to deliver safe care. This had resulted in potential risks to their safety and well-being. Staffing deployment and levels had impacted on people receiving the support required to keep people safe. Whilst accidents and incidents had been recorded, strategies to eliminate risk and manage risk such as recurrent falls in the evening and at night were not in place.

Auditing had not been totally effective in highlighting shortfalls in the quality and safety of the service. Feedback had been sought about the quality of the service, but had not been acted upon.

Staff meetings were not as regular as staff wanted. They felt that meetings should be held so that they the staff could contribute to the running of the home.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.’

The home had an activity programme and staff who were part of an activity team. We observed that the activities were specific to each unit for small groups, guided by their specific social needs. There were also larger group activities for all units to join if they should choose to.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed in regard to enabling people to choose to walk independently and therefore promoting people’s independence. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and applications were in progress.

Essential training and updates were provided for all staff, including safeguarding people, moving and handl

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not able to tell us about their experiences. We observed how people spent their time during the day, how staff met their needs and how people interacted with staff. We spoke with 14 people, seven relatives and with 10 members of staff.

People told us they were treated with respect and dignity. People and relatives told us that people received the care and support they needed and that people were able to make choices about their lives. A relative told us “privacy and dignity, you can’t fault it”.

Another relative told us that the service “caters for Mum’s every need. “

People told us that they felt safe living at the service. Staff demonstrated that they understood what action to take if they suspected that a person may have been subject to abuse.

There were enough staff on duty to give people the support that they needed. We saw that people were comfortable with staff. The interactions between staff and people were positive and respectful. Staff did not rush people when supporting or speaking with them and respected when people wished to exercise their independence.

The provider had systems in place to monitor the quality of the service provided. These included internal audits and systems for consulting people who used the service and their relatives.

The interactions we saw between staff and people using the service were positive, friendly and respectful. People told us that “they are all very kind here.” People using the service and their relatives told us that they were invited to meetings to discuss how care was delivered in the home, and they were given choices.

The people we spoke with, and their relatives, spoke positively about the care they received. Some relatives told us about problems they had had, but said these had been resolved when raised with the service .People using the service told us “we are well catered for”, “everything is very good here” and “I really like it here.” One of the relatives we spoke with said “we as a family are very happy with the care provided”. People told us about the range of activities saying that “there is a choice of things to do” and “I take part in activities when I want to.”

The people we spoke with said the building was usually clean. We saw that people who used the service and their relatives had previously raised the issue of unpleasant smells in the home. During our inspection the home looked clean and tidy, and we did not detect any unpleasant odours.

The people we spoke with and their relatives were positive about the staff. The told us “the staff are marvellous” and “anything I ask for is not too much for them”. One of the relatives we spoke with said “all carers deal with (my relative) with kindness and care.”

Most of the people we spoke with, and their relatives, told us that they would complain if they needed to, and that they knew or would be able to find out how to do this. One person told us “if I needed to, I would complain to the Unit Manager, who would do something about it” and another said “If I have a problem my (relative) sorts it out”.