Cornerstones Extra Care Scheme

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There was a lack of a shared direction and culture in the service. Although there was a clear management structure in place, staff had mixed views about the capability and compassion of leaders. Staff did not always feel they would be listened to if they spoke up. There were widespread issues with governance. The provider’s processes and systems were not used effectively to monitor quality and safety in the service. Staff worked well with external social and health care professionals to promote good health and wellbeing outcomes for people. The provider promoted a fair and equal culture in the service and staff felt their cultural needs and preferences were met.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from staff about the culture of the service was mixed. Some staff told us there was a culture of trying their best to ensure people received safe care. Other staff shared concerns about poor staff morale and an unsupportive culture from senior leaders.

The provider’s policies stated there was a vision to deliver high quality, person centred care and support based on the values of embracing continuous learning and growth and championing diversity and inclusive working practices. However, there was a lack of evidence to demonstrate systems and processes were being effectively used to monitor whether these values were embedded in service delivery.

We received mixed feedback from staff about leaders within the service. Following the site assessment visit the registered manager left the service and interim management arrangements were put in place. Some staff stated the registered manager was supportive and knowledgeable and they felt well supported by the provider. Other staff did not feel well supported by management. Some staff stated the service had not been well managed since the registered manager’s departure and working conditions had become more disorganised.

The registered manager left the service soon after our assessment site visit. The provider’s management team had assumed responsibility for managing the service in the registered manager’s absence. The provider had recruited a management team which consisted of skilled regional managers, and the operations director. The registered manager was accountable to the regional managers and the regional managers to the operations director. There was a lack of evidence to show a range of training and development opportunities were available to the registered manager. There was a lack of evidence to show how the provider reassured themselves the registered manager had used their skills and knowledge to lead the service effectively

We received mixed feedback from staff about whether they felt they would be heard if they spoke up. Some staff commented they felt leaders listened to them, and acted on what they said. Other staff did not feel leaders would act upon their concerns.

We asked for staff meeting minutes for the 12 months leading up the inspection, however, these were only available for February and May 2023. There was a lack of evidence to show the provider had used staff surveys team meetings or staff supervisions to seek feedback from staff on ways to adapt and improve the service or regarding any concerns staff had regarding the service.

The provider told us they valued diversity in their workforce and promoted a fair and inclusive culture. They gave examples of how they made reasonable adjustments to support staff with protected characteristics and identified needs. The provider had a recruitment drive in place to ensure the staff team was diverse and able to support the specific needs of people using the service through delivering person centred care. Staff spoke positively about the ways in which the senior team supported their cultural and religious needs. They gave examples of how staff supported each other to cover shifts so their colleagues could attend religious festivals for example.

The provider had processes in place to ensure equitable treatment of staff, including fair and equal access to learning opportunities.

Staff gave mixed feedback about the management structure at the service. Some staff told us roles and responsibilities were clear and there was a management presence in the service. Other staff told us managers were not sufficiently aware of people’s needs and did not plan and arrange support visits in a manageable way, which meant timings did not align with people’s needs and led to staff being rushed and unable to take sufficient breaks. During our assessment site visit the registered manager told us they had not been able to maintain audits of different aspects of the service due to having an unmanageable workload. After this the provider put an interim management team in place to manage the service in the registered manager’s absence. They told us about arrangements they had made to monitor and improve quality and safety in the service. However, not enough time had passed to show if these arrangements had been effective.

There were processes in place to monitor quality and safety in the service. However, these were not being used effectively to make a comprehensive assessment of the service to improve quality. There was a lack of evidence the provider effectively monitored their established quality monitoring systems were effectively used at the service, including prioritised actions, timescales for completion and those responsible. The registered manager had not completed audits of the service to monitor quality, safety and improvements needed. The provider’s branch manager regional visit records included different aspects of the service which could be audited, such as care plans, staff files and safeguarding concerns. There was however, a lack of information in the reports to demonstrate these had been used to thoroughly assess areas for improvement. For example, we reviewed branch visit reports from August 2022 to July 2023. There were no reports available between July 2023 and March 2024. The reports contained basic information and a lack of information to show different areas of the service had been audited. In addition, there was a lack of evidence to show identified actions had been followed up on. Medicines administration records were audited monthly by senior staff. Errors and omissions had been identified and actions logged on audits. However, the provider told us there was no analysis of themes or trends by managers to help the provider identify necessary improvements to medicines management.

People and their relatives told us they were able to access community activities if they chose to, as staff supported them to do so. People commented positively about the community and activities programme which had been developed at Cornerstones Extra Care Scheme. Comments included, “Yes, they invite the church in. We had a carol service and there will be an Easter event. We have bring and buy sales. There was a party for the Coronation. They hold a coffee morning every Monday” and “[Relative] goes down to watch films or play bingo. When the weather is better they take him down to the garden for an hour or so. He’s taken down in his wheelchair”.

Staff gave examples of how they worked collaboratively with professionals from health and social care to help people have good health and wellbeing outcomes.

Professionals confirmed staff supported people to access services and activities in the local community.

Records confirmed staff worked in partnership with external agencies including health and the safeguarding team in order to provide safe care and support. Staff sought advice promptly and made referrals appropriately to promote good continuity of care.

Whilst staff gave us examples of the actions they would take following incidents to help keep people safe such as informing other staff about the incident and checking the person’s flat for environmental hazards, we found the processes to proactively share learning and monitor trends were not fully established.

There was a lack of evidence to show the provider had used monitoring systems effectively to identify and action areas for improvement. Although there was some evidence of learning and improvement, records did not show consistent practice in this area. For example, there was a lack of evidence to show accidents and incidents themes and trends were analysed to help make improvements to the service.