We undertook an unannounced inspection of this service on 2 February 2018.

Cornfield House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cornfield House accommodates up to 19 people with mental health needs in one adapted building. People using the service require minimal support and supervision to live safely in the community. All bedrooms had a washbasin with three having en-suite facilities. There is a large paved garden including a fishpond and a covered smoking area. Cornfield House is located in a residential area within walking distance of Seaford town centre.

At the time of our inspection, 16 people were using the service.

At our last comprehensive inspection of 13 and 19 January 2017, we found the registered manager did not identify and manage risks to people’s health and well-being. In addition, the quality assurance systems were not sufficiently robust to identify and address shortfalls in care delivery. At this inspection, we found improvements had been made. Environmental risks were identified and addressed to ensure people lived in safe and clean premises. There was an ongoing review of policies and procedures to ensure care delivery met best practice guidelines and legislation.

There was a registered manager in post. 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.

At this inspection, we found people undertook activities of their choosing. However, there was no schedule for people who might require stimulation to undertake individual or group activities.

People underwent an assessment of risks to their health and well-being. Staff followed the risk management plans in place to provide safe care to people, while promoting their freedom. People had access to information they required to improve and promote their welfare and recovery.

People received the support they required to manage and take their medicines safely. Staff followed safe medicines management procedures.

People were cared for by staff who received support, supervisions, appraisals and training required to undertake their roles. Staff learnt lessons from incidents and accidents to minimise the risk of a recurrence.

People’s needs were met because of a sufficient number of staff deployed. Staff knew people well and had developed positive and caring relationships with them.

Staff planned and delivered care in line with each person’s individual choices and preferences. There were regular care reviews to ensure staff provided support appropriate to people’s changing needs.

People received support to maintain their health. Staff ensured people had sufficient amounts to eat and drink. People had their dietary and food preferences met. People were supported in line with the requirements of the Mental Capacity Act 2005. Staff sought people’s consent before they delivered care and treatment and respected their decisions.

People took part in making decisions about their care. People who were unable to make decisions about their care received the support they required through best interests meetings.

People shared their views about the service and the provider made improvements when needed. People knew how to make a complaint and raise concerns about any aspect of the service.

There was a person centred culture at the service. People and staff knew the registered manager and were happy about the running of the service. Staff received support in their roles and had access to advice and guidance to manage complex situations.

People’s health and well-bein

Cornfield House is registered to provide support and accommodation for up to 19 adults living with or recovering from mental health illness. The service caters for people with low physical dependency who need minimal support and supervision to live safely in the community. Cornfield House is located in residential area within walking distance of Seaford town centre. People living in the service were older adults who had lived with mental health illness for most of their lives.

The service had a registered manager in place. 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.

Cornfield House was inspected in October 2015. We found the provider was in breach of a regulation12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were required to ensure all environmental risks were identified and responded to. That recruitment practices ensured only those staff suitable worked in the service. Staffing levels were set according to people’s needs and medicine records supported staff to give medicines safely.

This inspection took place 13 and 19 January 2017 and was unannounced. At the time of this inspection, 14 people were living in the home. This was a full comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements. We found improvements had been made. Recruitment practice was comprehensive and ensured all required checks were completed on new staff. Medicine records were clear and accurate and supported safe administration. The staffing levels had been formally reviewed in conjunction with social care professionals. Risks associated with hot water and legionella had been assessed.

Despite significant improvements the provider had not identified, assessed and responded to all risks in the service. The service was not clean in some areas that could pose a risk for cross infection and the spreading of infections between people. Some risks to safety had not been identified and responded to, including a trip hazard. Although staffing levels had been reviewed staffing at night did not ensure people could be evacuated in case of an emergency. The registered manager was following this safety matter up with the fire and rescue service.

Systems for effective management had not been fully established. Management systems that included quality monitoring did not always ensure safe and best practice was followed. A full health and safety review of the service had not been completed. This would identify all risks or areas for improvement to ensure people’s care needs could be met within the service in a safe way. The provider had not established systems to ensure the service’s policies and procedures were all up to date and adhered to. For example, the legionella policy and procedure was not followed. .

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to maintain their independence and psychological welfare. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service, and the approach of the staff. Visiting professionals were positive about the care and support provided. They told us staff worked with them to improve people’s health and emotional well-being.

People’s medicines were stored, administered and disposed of safely by staff that were suitably trained. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of

During our inspection we spoke with four people who used the service. We also spoke with one care worker, the registered manager, the deputy manager and the provider. We looked at care documentation, staff records, audits and minutes of meetings.

People who used the service told us that they liked living at the home, they were happy with the care and support they received and the service met their needs. One person told us, “I like it here – it is very good – everything is on hand here – everything is laid on for us. I think this is the best place for me at the moment. I want to stay here.” Another person told us, "I love this place I would give it 10 out of 10 it is brilliant. I have been here for 10 years, this is my home now.” We saw that individual care plans provided guidance for care workers, to ensure that the assessed current and on-going support needs of people using the service could be met consistently and safely.

People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

We saw that the service had effective recruitment procedures in place. Staff told us that they had received regular training and supervision. They said they felt valued and were supported to carry out their roles and meet the needs of people who used the service.

The service had effective systems in place to deal with people's comments and complaints.

During our inspection we found that the premises were clean and well maintained and the atmosphere was relaxed and homely.

We found that comprehensive person centred support plans enabled care workers to meet people's assessed needs in a structured and consistent manner.

Risk assessments and safeguarding policies, procedures and staff training ensured that people using the service were safe.

In accordance with their individual care plans, people were supported to make choices about their daily lives. They had input into how the service was run and were able to influence decision making processes.

Positive comments from people using the service and their relatives indicated a high level of satisfaction with the home and the services provided:

“I like it here. I did move out a little while ago but I didn’t like it, so I came back and I’m very happy here”.

“I couldn’t be happier with the care that my daughter receives. I have every confidence in the manager and all the staff here. I also have the peace of mind knowing that she is safe and well while I’m away”.

We found that there were enough qualified, skilled and experienced staff in place to meet people's needs.

Care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

Cornfield House is registered to provide accommodation for up to 19 adults living with or recovering from mental health illness. The service caters for people with low physical dependency and need minimal support and supervision to live safely in the community. Cornfield is located in residential area within walking distance of Seaford town centre. People living in the service were older adults who had lived with mental health illness for most of their lives.

At the time of this inspection 17 people were living at the service.

This inspection took place on 9 and 12 October 2015 and was unannounced.

The service had a registered manager in place. 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.

Despite having positive feedback from people on the safety of the service. We found areas that could impact on people’s safety.

The recruitment practice was not thorough and did not ensure required checks had been completed before staff worked in the service. The provider had not assured himself that people were suitable to work in the service. Some systems for the administration of medicines did not ensure consistent and safe administration. For example records were not accurate and guidelines for staff to follow were not complete. Risks associated with hot water and the risk of legionella’s disease had not been measured and responded to on a regular basis to ensure peoples safety.

Staffing levels were set and there was no formalised system to review the staffing numbers to ensure a suitable number of staff were deployed for people’s safety and well-being during the day and night.

Staff had not received training on how to support and care for people with mental health illness or with behaviours that may challenge people on a regular basis. This lack of suitable training could mean people were not supported appropriately.

Care documentation was not full in all areas and did not provide full and up to date information for staff to reference in order to provide a person centred approach to care. For example, One plan had not been updated since 2013 and did not refer to specific behavioural patterns.

Systems for effective management had not been fully established in all areas. Up to date policies and procedures were not readily available to provide clear guidelines for staff to follow.

Feedback received from people their relatives and visiting health professionals through the inspection process was positive about the care, the approach of the staff and atmosphere in the home. One relative said, “I would award this home five stars or a gold star.”

People told us they felt they were safe and well cared and had their choices respected. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. People had access to health care professionals when needed.

Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Staff enjoyed working in the service and were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the registered manager and provider.

People were very complementary about the food and the choices available. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

There was an open culture at the home and this was promoted by the staff and management arrangements. People were encouraged to share their views though ‘residents meetings’ and satisfaction surveys.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.