Archived: Corinthian House

Below is a summary of what we found. The summary is based on observing care, speaking with people who used the service and their relatives, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People did not experience care and support that met their needs and protected their rights. People's needs were not assessed and care and support was not delivered in line with their care plan. Care and support was not planned and delivered in a way that ensured people's safety and welfare.

People we spoke with told us their health needs were met. One person told us when she felt ill, the nurse quickly assessed her and called the Doctor if required. A relative said, 'Staff are quick to call the Doctor if they feel it necessary. We are highly delighted with the staff, management and level of care.'

People who used the service were protected from the risk of abuse. The provider had taken reasonable steps to identify the possibility of abuse but had prevented abuse from happening.

There were not enough qualified, skilled and experienced staff to meet people's needs. We observed staff were busy and people's needs were not always met in a timely way. At times there were no staff in or around communal areas which resulted in people not getting appropriate care and support.

There were not effective systems in place to reduce the risk and spread of infection. We were shown around the home and looked at all communal areas and the some of the bedrooms. The home was not clean and people were not protected from the risk of infection.

Relevant staff had not been adequately trained to understand the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. The management team said they had identified they needed to develop their knowledge and skills in this area and had approached an advocacy service to assist.

Is the service effective?

People's personal care needs were not always met. We noted people's clothing was generally clean but some people's hair looked as if it had not been brushed or combed and some people's hair needed cutting. People's nails were also long and needed cutting. When we looked at care records we could not establish when people had a bath or shower because the information was not always recorded in their notes.

Lunch on each of the three units was observed and in two of the three units people did not get appropriate support from staff. In one of the units people were sat at the table waiting for their meal for over half an hour. Some people started getting agitated, others wandered around and others fell asleep. Some people needed assistance from staff to eat. These meals were placed in front of people and left to become cold before assistance was offered. In another unit some people had to wait 40 minutes for their meal to be served. Some meals were placed in front of people and left to become cold before assistance was offered. People received good support in the third unit.

Staff we spoke with said they had received enough training to equip them with the right skills to do their job. They told us they completed mandatory training and regular updates. Training records showed regular training was being delivered which included fire awareness, manual handling, food safety, health and safety, first aid, safeguarding of vulnerable adults, infection control and dementia.

Is the service caring?

When we spoke with people who about the care provided at Corinthian House we got a mixed response. Some people told us good care was provided whereas others said the care could improve.

We observed staff assisting people who used the service during an activity session and saw some good care being provided. Staff chatted to people around the table and helped everyone to engage in a range of activities. Staff knew the people they were supporting as individuals and therefore were able to instigate conversations around memories. People were very complimentary about the activity worker and said she did a very good job. They said, 'She puts her heart and soul into everything she does.' The activities programme was clearly displayed in reception and consisted of a full and varied range of activities. There was information about outings and celebrations.

We observed care being provided that was not caring and did not meet people's needs. Staff did not always communicate with people when they were assisting them. One person was in their wheelchair at the table and pushed themself away from the table. A care worker did not speak to the person but took the person's hand from the wheel of the chair and wheeled the chair back to the table. One person told a member of staff they did not want to wear an apron for lunch. Staff ignored the person and put the apron on.

Is the service responsive?

At the last two inspections we uncovered regulatory breaches. For example, care plans and risk assessments were not up to date. At the inspection in January 2014 the manager anticipated it would take between three to four months for this process to be completed. At this inspection, five months after the last inspection, we again were told there was still a lot of work to be done with the care records.

We observed care when people did not have a positive experience. For example, one person asked to go to the toilet but had to wait 15 minutes. It was evident the person was desperate to go but was told they couldn't be transferred because the unit only had one hoist. Staff confirmed there were 13 people who needed to use a hoist to transfer. This is insufficient. One person told a member of staff they did not want to wear an apron for lunch. Staff ignored the person and put the apron on. Staff did not always communicate with people when they were assisting them.

Is the service well led?

In January 2013 we reported that the registered manager was no longer in post and a peripatetic manager had been managing the home since November 2013. The peripatetic manager left and a new manager started managing the home in March 2014. At the end of the inspection we discussed the findings with the manager and two senior managers. They said the change in managers had slowed down the process for improvement but anticipated they would be able to make good progress because a permanent manager was now in post. The manager said she would be applying to register with the Care Quality Commission.

The provider carried out regular visits to the home and recorded these in a monthly visit report. During the visits they spoke to people who used the service, visitors and staff. The provider had written detailed reports and identified a number of areas where they needed to make improvements to ensure people benefitted from safe quality care.

Some people told us the management arrangements were satisfactory. Others said they did not see the management team very often and did not feel they were aware of what was happening in the home. One person who spent time in their room said they had, 'Only seen the manager once as she never walked around the rooms.' A member of staff said, 'We're supported by colleagues but you only see the manager when they are showing someone around or investigating a complaint.'

People were made aware of how to raise concerns or make a complaint and the provider responded to concerns raised, however, agreed actions were not always maintained.

The home has three separate units, one on each floor, all provide nursing and personal care. The unit on the middle floor is mostly used for people with dementia. We found the peripatetic manager had implemented new initiatives which had led to some improvements in the care records. However, these had not been fully embedded in practice and we found there were still shortfalls. We found people were receiving the care they required and saw some positive interactions between staff and people who lived in the home. We found some good practices and also some areas where improvement was required. People who lived in the home described the staff as 'wonderful', 'marvellous', 'patient' and 'very good'. Comments included

'(Staff) will go out of their way to help you'

'They look after you very well'

'Staff take me out shopping and to the market. Been on lots of trips'

We checked staff recruitment files and spoke to staff about their recruitment. We found appropriate checks had been completed which ensured staff were safe, qualified and competent before they commenced employment.

We reviewed staffing in the home. There was mixed feedback from relatives and people who lived in the home with some saying they felt there were not always enough staff to meet people's needs. Overall we found there were enough staff to meet people's needs however, the deployment of staff may need to be reviewed and adjusted according to people's changing needs.

We spoke with 10 people who lived at the home and eight relatives who were visiting. We looked at three people's care records and spoke with five staff and the manager.

We found the home was comfortable and tidy, but felt improvements were needed on the dementia unit. We saw that staff treated people with respect, offered them choices and maintained their privacy and dignity. One person said, 'Staff listen to what I say, I like my door open and they always make sure it is open'.

We found people were well cared for but found shortfalls in the care documentation which we considered could impact on the care people received. We found the management of medicines was satisfactory.

We found recruitment procedures needed improvement to ensure that robust checks were completed before staff were employed. We found there were sufficient staff to meet people's needs. We found there was an effective complaints system in place. Relatives we spoke with said they felt able to raise concerns with the manager and felt they would be dealt with.