Cornerways

Cornerways is a care home without nursing registered to provide care for up to eight people who may have learning disabilities, behaviour that may challenge, physical disabilities, mental health needs and/or autistic spectrum conditions. At the time of our inspection there were eight people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

We have recommended that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.

People felt safe living at the service. Relatives felt their family members were kept safe in the service. The registered manager and staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks.

Staff recruitment and staffing levels supported people to stay safe while working towards their goals and going about their lives. The management of medicines was safe, and people received their prescribed medicine on time. There were contingency plans in place to respond to emergencies. The premises and equipment were cleaned and well maintained.

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 received effective care and support from staff who knew them well. The registered manager had planned and booked training to ensure staff had appropriate knowledge to support people. People enjoyed the food and could choose what they ate and where to eat. People had their healthcare needs identified and were able to access healthcare professionals such as their GP.

We observed kind and friendly interactions between staff and people. People confirmed staff respected their privacy and dignity. The registered manager was working with the staff team to ensure caring and kind support was consistent. People and their families were involved in the planning of their care.

The registered manager encouraged feedback from people and families, which they used to make improvements to the service and protected against the risks of receiving unsafe and inappropriate care and treatment. The staff team recognised and responded to changes in risks to people and ensured a timely response and appropriate action was taken. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

The registered manager had quality assurance systems in place to monitor the running of the service, the quality of the service being delivered and took actions promptly to address any issues. The registered manager appreciated staff’s contribution to ensure people received the best care and support. Staff felt the registered manager was supportive and open with them and communicated what was happening at the service and with the people living there. People and relatives felt the service was managed well and that they could approach the management and staff with any concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated good (Report was published 27 August 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cornerways is a care home, which is registered to provide care (without nursing) for up to eight people with autistic spectrum conditions and learning disabilities. There were eight people in residence during our visit.

The home is a detached building in Winnersh Wokingham and is close to local shops and other amenities. People have their own bedrooms and have use of communal areas that include an enclosed private garden that is accessible for wheelchair users. The people living in the home need care and support from staff at all times and have a range of care needs.

The home has 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.

People received their medicine safely. The registered manager had taken action during our visit to ensure people's medicine remained within the labelled packaging as dispensed. The recruitment and selection process helped to ensure staff of good character supported people. There was a sufficient number of qualified and trained staff to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse. However, some staff had been unsure of who to go to if the organisation did not listen to concerns about people’s safety.

Staff had received health and safety training that included basic first aid and infection control and were supported to achieve health and social care qualifications. People’s nutritional needs were met with support from external professionals when nutritional risks were identified. People were helped to see their GP and other health professionals to promote their health and well-being.

People were provided with effective care from a staff team who had received support through supervision and training. Their care plans detailed how they wanted their needs met and these were regularly reviewed to ensure they were person centred. Risk assessments identified risks associated with personal and health related issues. They helped to promote people’s independence whilst minimising the risks.

The service had taken the necessary action to ensure they were working in a way that recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and consent issues, which related to the people and their care.

People used a range of communication methods. These included non-verbal to limited verbal communication. Individual methods were supplemented by the use of pictures and objects of reference to indicate their needs and wishes, which were clearly understood by staff.

People received good quality care. Staff treated people with respect and kindness and provided a service that was person centred. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

There were effective systems to regularly assess and monitor the quality of service that people received. Various formal methods included visits by one of the organisation's operations managers.

The registered manager also completed health, safety, and environmental audits. However, a person’s privacy was jeopardised when a wheelchair sensor was not repaired until six weeks after initially being noted within an environmental audit. This was rectified at the time of our visit when action was taken by the provider to minimise the risk of recurrence.

We considered all the evidence we had gathered under the outcomes we inspected, which related to people's care and welfare, cleanliness and infection control, supporting workers, assessing and monitoring the quality of service provision, and records. We used the information to answer five key questions; is the service safe, effective, caring, responsive and well-led.

This is a summary of what we found.

Is the service safe?

People who use the service told us they felt safe at the service. Personal evacuation plans were in place for each person to ensure their safety in the event of a fire at the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to this type of service. The service was safe because requirements in relation to the DoLs had been met. The deputy manager had received training in relation to DoLs and was aware of the recent case law. They told us most of the people they provided care for did not have the capacity to determine where they wanted to live and all received a high level of support and supervision within the service. The deputy manager informed us that they had started the process of submitting DoLs applications for these people following consultation with three local authorities. This was confirmed in records we looked at during the inspection.

People had been cared for in an environment that was safe, clean and hygienic. People were protected from the risk of infection because protocols based on current Department of Health guidelines were followed.

A system of staff supervision and appraisal was in place to support workers. Staff

received appropriate training and professional development to enable them to deliver care and treatment to people safely and to an appropriate standard.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents. There was a system for monitoring and learning from incidents. The provider could identify possible trends that may require additional actions, such as risk assessments and the implementation of appropriate actions. This meant they took appropriate steps to minimise the risk of occurrences to people and others.

There were processes in place to ensure staff and people's confidential records were stored securely and could be located promptly when requested. People's records were accurate and fit for purpose.

Is the service effective?

The service demonstrated effective practices through the assessment of people's health and care needs. People's views about the type of care they wanted had been sought. People confirmed their involvement in the development of their care plan. We noted people's involvement in annual reviews of their care. We found staff had a good understanding of people's care and specific support needs, for example, in relation to autism, asthma and diabetes.

All three people and a relative of another person we spoke with were complimentary about the care received. One person said 'Staff know what to do. They know me well.'

Is the service caring?

People were supported by kind and supportive staff. People and a relative told us staff were very caring. One person told us 'Staff are nice when they are helping me.' All interactions we observed between the staff and people were respectful and courteous. We saw that support workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded in their support plans. Care and support had been provided in accordance with people's wishes, for example arranging preferred activities, holidays and colour schemes in bedrooms.

The compliments folder we looked at recorded three responses from health and social care professionals visiting the service. We saw feedback was positive. Visitors rated staff support and care for people highly. All three visitors commented that they were made to feel welcome when visiting the service.

Is the service responsive?

We found the service was responsive to people because their needs had been assessed before they used the service. In records we looked at we saw people met with their key workers monthly to discuss what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs had been documented. Daily notes confirmed that care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

People knew how to make a complaint and who to go to if they were unhappy. We looked at how complaints had been dealt with by the provider, and found that the responses had been thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

We found the service was well led because the provider acted on feedback received to improve the service. We saw people's and relative's feedback was sought through meetings and surveys. The provider was responsive to comments from people, such as a planned refurbishment of people's rooms to meet their wishes and suggestions. One person told us 'If I want to talk about anything they (staff) listen to me.'

Audits and checks ensured people's safety and wellbeing was promoted. Where issues were identified, an action plan was formulated. Progress and completion of this was monitored. We saw issues were identified and actions completed appropriately.

Staff we spoke with understood the importance of supporting people to make their own decisions, and listened to them to ensure they acted in consent with people's wishes. One support worker said "I ask if they're ready to get up, and go with what they want. I give them options about food and clothes."

We saw people's care and support needs were appropriately assessed and recorded. Plans were in place to manage identified risks, for example by using suitable equipment and maintaining staff training to support people safely. One care worker said 'The residents are the focus of this home.'

The home was suitable for the needs of the people who use the service. Corridors were wide enough for wheelchair use, and door locks and identity checks ensured people were protected from unwanted visitors. One person told us 'This home is lovely, I like living here.'

The provider conducted appropriate pre-employment checks to ensure people who use the service were supported by appropriate staff. People who use the service explained they helped to interview to select new staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. The service sought feedback from people who use the service to ensure the support they provided was appropriate to meet people's needs.

We saw people using the service being treated with dignity and respect throughout our inspection. Staff checked with people before undertaking any intervention with them.

We looked at people's care plans and saw that these contained detailed information regarding the person, their individual needs and the choices made about how they wanted to spend their time and any risks associated with these. One person using the service told us "I have two key workers and they help me decide how to spend my time."

We were shown an electronic version of the policy on safeguarding. We also saw a poster, prominently displayed in the room where medication was stored, which identified the local safeguarding team contact details.

One member of staff who told us "I'm in my seventh month here. It's nice to work here, they're a very good staff team and they're able to help you learn."

We were shown annual questionnaires which had recently been completed by people using the service, family members, a visiting professional and the members of the staff team. We were told of some changes which had already been made as a consequence of comment received.