Cornerstones Extra Care Scheme

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Most people said they felt safe with staff. Staff had received training in safeguarding and knew how to report any safeguarding concerns. Risk assessments and management plans lacked sufficient and personalised information to help staff support people safely. There was a lack of evidence to show incidents and accidents were analysed to identify improvements in response to these. Medicines were not managed safely. People were positive about how staff adapted their care and support following safety incidents. Staff told us they effectively supported people to safely transition between services. There were enough staff to support people. The provider had effective systems and processes in place to prevent and control infections.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff learned from incidents to make improvements to their safety. One person said, “I had a mini stroke and went to hospital. The carers were prompt and persuasive with me. I was happy with how it worked. We discussed my risks and now I wait for a carer before I have a shower”. Another person commented, “I do fall out of bed and now I have a different bed with bedrails. Now I am hoisted by two people…the fall incidents were recorded”.

The registered manager was not able to identify the actions they had taken following incidents to improve people’s safety. They told us, “I haven’t got many incident forms which have actually been reported”. The nominated individual gave examples of how safety concerns were reported and learning shared with staff. They also told us about learning opportunities included in staff supervisions and team meetings to help them reflect on practice and make improvements. However, there was a lack of evidence to show staff were being supported to reflect on practice to identify actions which would prevent accidents or incidents happening again. The registered manager, who had been responsible for running the service in the period before the assessment, told us staff meetings had not been held regularly, as it was too difficult to get staff together at the same time. We found one record of a staff meeting held on 19th March 2023 and 21st March 2023 but no other records of meetings held with the staff team. Regional team meeting minutes were only available up until 11th July 2023.

Although incidents were reported there was a lack of evidence to demonstrate the registered manager had identified actions to prevent recurrences. Incident reports contained details of accidents such as falls, however there were no records of staff reflecting on these incidents to improve their practice within these forms. The registered manager had not completed an analysis of accidents and incidents to identify contributory factors and staff training needs to help improve people’s safety. The provider’s investigation into a person contracting pneumonia after staff had failed to administer antibiotics, failed to sufficiently address the concerns raised. The provider had not addressed that staff had not identified signs of deterioration in the person. The investigation records showed provider took some action following the incident however no training had been arranged for the staff involved. In another example, following a fall, another person had declined help from staff. Later that day medical attention was sought by staff at the person’s request due to shoulder pain. The provider had failed to identify any learning from the incident. In the investigation notes staff had written “No investigation required”. The person’s care plan stated they were at risk of falls, however, the falls risk care plan had not been completed.

People told us staff were proactive in ensuring they had access to the appropriate health care services when needed. One person said, “I went to hospital and couldn’t walk. They [staff] called for an ambulance. They did it quickly”.

The registered manager gave us examples of how they had ensured people moved safely between services. One person had moved from Cornerstones to a residential home. To ensure an easier transition for the person the registered manager trialled the move before it became permanent. They told us, “Somebody went as a trial to [residential home]. He was supported when he went with everything he needed to take with him - pictures from the walls. The [residential home] were fully aware of his health history …large items of furniture stayed in flat until he moved permanently”. The registered manager also gave examples of how carers had accompanied people to visits to healthcare professionals to ensure information about appointments was recorded to ensure continuity of care.

External professionals who worked with the service gave positive feedback about how staff liaised with them to help people transition between services. One professional told us, “They contact us frequently if there are changes in function and if the carers need assistance. They contact us if the service user is deteriorating or the carers are struggling to provide the care. They request reviews and assessment when they have concerns.”

The provider maintained up to date records of interactions with external agencies and professionals which evidenced how they supported people to transition safely between services.

People gave us mixed feedback about whether they felt safe with staff. One person said, “The carers are not good people. Why are they picking on us. I don’t feel confident or safe with them” We shared this feedback with the provider and they agreed to take action to address this. Another person told us, “I’m lucky and feel safe. I can tell the carers what I want”.

The registered manager understood their role and responsibilities relating to safeguarding and referred safeguarding concerns to the local authority promptly. Staff had received training in safeguarding and were able to describe different types of abuse and knew how to raise concerns. They stated they treated people with sensitivity and provided reassurance and support when a safeguarding concern was identified.

The provider had systems in place for reporting safeguarding concerns. The registered manager showed us records of safeguarding referrals made to the local authority. Records showed staff had completed their safeguarding training. Staff supervisions included discussions about how to recognise and report safeguarding concerns.

There was a lack of evidence to demonstrate staff involved people in managing risks. One person had given feedback about how they were dissatisfied with how staff had supported them to manage their time-sensitive medication. They stated, “I will go out for the day on Saturday and Sundays to my daughter and do my medication. It gets to the time I'm meant to have it and I have it in my bag ready to take. They come along and do this for me and I will say I have it but they will argue to get me to take this. I explain I will take it at my daughters and we argue about it".

We asked the registered manager how they worked with people to help them take risks to pursue their chosen activities, such as smoking. They gave us examples of how people engaged in activities such as smoking or eating their preferred foods, however they were unable to give any information about how staff had supported people to understand the risk of engaging in certain behaviours whilst respecting their right to do so. Staff understood how to work with people to keep them informed about risks and help prevent harm. The nominated individual told us staff worked with people, their family members and advocates when planning care and support and writing risk assessments.

There was a lack of evidence in people’s records to demonstrate staff worked with them to help them manage risks. Risk assessments were not always individualised, and lacked specific details about how staff could support people to manage risks for themselves. One person took their time sensitive medicines whilst outside their home. In the person’s care plan staff had written “[Person] needs to take her medication at specific times each day, due to suffering with Parkinson’s Disease. Although [person] is able to take her prescribed medication and has capacity to do so, it is felt that she may not. The care workers support [Person] to take her prescribed medication safely and at the correct time, each day”. There was no evidence of a risk assessment in the person’s care plan to support them to do this safely.

People made positive comments about how staff helped them maintain a safe environment. One person said, “The carers keep the floor clean. They hoover and mop the floor daily”. Another person told us, “They [staff] do the housework and keep it tidy. It’s quite good and very safe to walk around. We have lifts and the furniture is kept out of the way”.

Staff gave us examples of how they helped maintain safe environments for people, including regular equipment checks, removing any trip hazards and ensuring electrical appliances were turned off when not in use. The nominated individual told us the provider worked closely with the housing team to manage risks to people’s health and safety. They also gave an example of how staff had supported a person to clear items from their flat to help them maintain a safer home environment.

People’s care plans contained environmental risk assessments as well as risk assessments for hazardous substances. Cleaning and tidying tasks were included as part of people’s support calls.

People and their relatives made positive comments about the support they received from staff. Comments included, “He has regular carers and he gets on well with the majority of them. They know his food needs to be cut up and almost blended. He is monitored, so that he doesn’t choke” and, “They can be different carers but they are fantastic. But their time is a little short and I could do with more time. They look out for any sores and put cream on”.

We received mixed feedback from staff about whether there were enough staff to do their jobs effectively. Staff commented they felt there were not enough managers in the office to support them. One staff member commented rotas had not been well managed after the registered manager left as covering managers were not as familiar with people’s needs resulting in people’s care calls being allocated at the wrong times and staff not getting consistent or enough breaks Staff told us they received the training they needed to do their jobs effectively. We saw evidence of staff supervisions, appraisals and competency checks.

The registered manager told us they used an electronic scheduling system to ensure people received support from the same staff. The provider’s electronic system included recurring calls to allocate care and support visits for people. This showed wherever possible the same staff were allocated to the same calls to ensure continuity of care and support. Staff files showed relevant pre-employment checks were completed as part of the recruitment process, including proof of identity, evidence of conduct in previous employment, employment histories with explanations for gaps in employment, and a police check.

People and their relatives made positive comments about staff’s infection prevention and control practices. These included, “His room is kept tidy...the carers wear protective equipment”, “I have cleaning every two weeks and the whole floor in the flat is washed...the carers are very clean” and, “They [staff] change gloves regularly and wear them. The place is kept clean by staff. The bath, toilet and shower are kept clean”.

Staff gave us examples of how they supported people to maintain good personal hygiene to prevent the risk of infection. They confirmed they had access to and used personal protective equipment (PPE) when delivering care and support.

Training records showed staff had completed training in infection control and prevention. Records of staff spot checks showed staff’s infection control practice was regularly reviewed.

People commented they received support from staff to take their medicines. Comments included, “[Staff] give me my medicines. They stand and watch me take them…there’s been no changes…they put it down in the record book” and, “In the morning the carers give me medicines ...they put the medicines in my hand and give me a drink of water. Then they record”.

Staff raised concerns about the management of medicines. Following our assessment site visit the provider informed us the registered manager had stored medicines in an unlocked and accessible cupboard in the housing provider’s office. This practice was not safe and went against the provider’s policy, which stated medicines should only be stored in people’s own homes. After our assessment visit the provider sent us information about the actions they would be taking to address this issue. We received feedback from staff regarding unsafe medicines management practices. A staff member commented the registered manager demonstrated unsafe medicines management and had not made the procedure for handling medicines delivered by the pharmacy clear to staff. The staff member stated if medicines were delivered early by the pharmacy these were stored by the registered manager prior to being delivered to people. The staff member raised concerns this would lead to errors including people being given the wrong medicines.

Prior to our assessment visit a person had been admitted to hospital after contracting pneumonia. Their prescribed antibiotics for a chest infection had not been administered by staff. The provider’s investigation report showed a staff member had not updated the medicines administration record accurately, or shared the information about the medicine with staff. However, there was a lack of evidence to show the provider had taken sufficient action to mitigate any further risks to people, such as staff training, competency checks or reflections. Senior staff completed monthly audits of people’s medicines administration records to check for any errors or omissions. Audits showed issued were identified and corrected. However, there was a lack of evidence to show the provider had sufficient oversight of these audits and that errors and omissions had been analysed to identify patterns or trends to help prevent recurrences.