The inspection took place on 17 April, 2018 and was unannounced, which meant that nobody at the service knew we would be visiting. The last comprehensive inspection took place in February 2017 when we identified three breaches of Regulation. The monitoring of the service was ineffective as the registered provider had not identified concerns within the service. There was a lack of mental capacity assessments and best interest decisions had not been recorded and risks associated with people's care had been identified but not always addressed appropriately. The service was rated as Requires Improvement.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions safe and well led, to at least Good.

At this inspection we checked if improvements had been made. We found that the registered provider had addressed the concerns raised at our last inspection and the service was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘The Cornerstone’ on our website at www.cqc.org.uk.

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

The Cornerstone provides care for up to eight people with learning disabilities or autistic spectrum disorders. The home is situated close to Rotherham town centre.

At the time of our inspection the service had 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 were safeguarded from the risks of abuse. Risks associated with people’s care had been identified and appropriately managed. People’s medicines were administered as prescribed and stored safely. We observed staff interacting with people and found there were enough staff to meet people’s needs in a timely way.

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. Consent was sought in line with current legislation.

People’s needs were assessed and care delivered was in line with their preferences. Staff received support and training and the registered provided ensured they were knowledgeable about their role and responsibilities. People were supported to maintain a balanced diet which incorporated their choices and preferences. People had access to healthcare professionals as and when required.

We observed staff interacting with people and found they were thoughtful and caring. We saw lots of friendly and appropriate banter between staff and people who used the service. Staff ensured people’s dignity was maintained.

People received person-centred care as detailed in their care records. This took in to account levels of independence and supported people to follow their interests. The registered provider had a complaints procedure and people felt able to raise concerns and felt listened to.

A range of audits took place to ensure policies and procedures were being adhered to. People who used the service, their relatives and staff were engaged and involved in the running of the home. A range of meetings took place to facilitate this. Management tools had identified that ground floor toilet required a new seat and the downstairs bathroom required attention to the bath seal.

The inspection took place on 21 February 2017 and was unannounced. The last comprehensive inspection at the home took place in February 2015, when a breach of legal requirements were identified. The provider sent us an action plan outlining how they would meet the breach. We inspected the service again in June 2015 to look at the progress and found they were meeting requirements. However, the rating of the service remained as requiring improvement as we needed to ensure that the actions taken were embedded into practice. You can read the report from our last inspections, by selecting the 'all reports' link for ‘The Cornerstone’ on our website at www.cqc.org.uk.

The Cornerstone provides support and accommodation for up to eight people who have a learning disability. The home is situated near to Rotherham town centre and local amenities.

The service had a registered manager in post at the time of our inspection. 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.

The day to day running of the service was the responsibility of the home manager. The home manager told us that the registered manager was based at the home Monday to Friday every week, and was available to support the staff and service when required.

Risks associated with people’s care had been identified but the service did not always address them adequately. For example, some people had been assessed as being at risk of accessing the building during the night. However the service had not adequately reduced the risk.

During the day there was enough staff available to meet people’s needs and to support people to engage in community activities when required. During the night the service had one sleeping in member of staff and we asked the home manager to look at the risks associated with this.

We identified some concerns with the safe handling of medicines. For example the temperature of the room where medicines were stored was not checked. Also protocols in relation to medicines prescribed on an ‘as and when’ required basis, were not always clear.

The provider had a safe and effective system in place for employing new staff. We looked at three staff files and found that pre-employment checks had been satisfactory completed.

Staff we spoke with said they received appropriate support and training to do their job. However, we saw that the training records did not always support this. We spoke with the home manager who told us that the training they accessed had minimum places.

We looked at care records and found that they gave a short paragraph about the person’s capacity. However, this was not decision specific and did not give any further detail on how to support the person.

People were supported to eat a healthy diet based on their nutritional requirements. People who used the service spoke with us about their meals.

The core values of the service were privacy, dignity, independence, choice, rights and fulfilment. These values were used to create, implement and monitor care plans. The staff we spoke with were aware of these values and told us that they aimed to provide an environment where people were supported to develop skills.

We saw people had support plans in place. These were reviewed and updated and reflected people’s changing needs. Care plans reflected people’s choices, wishes and decisions.

We saw that people were supported to maintain community interests and staff were available to provide social support.

The service had a complaints procedure and people told us they would talk to staff if they were worried about anything.

We saw that audits took place to check if policies and procedures were being implemented and to check on the quality of service provision.

We carried out an unannounced comprehensive inspection of this service on 3 February 2015 in which a breach of the legal requirement was found. This was because people were not protected against the risks associated with the unsafe use and management of medicines. This was a breach of Regulation13 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 12 (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an unannounced focused inspection on 30 June 2015 to check that they had made the improvements in regard this breach.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘The Cornerstone’ on our website at www.cqc.org.uk.’

The Cornerstone is a care home without nursing. It provides care for up to eight people with learning disabilities or autistic spectrum disorders. The home is situated close to Rotherham town centre.

The service had a registered manager in post at the time of our inspection. 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.

At this inspection we found the provider had made appropriate changes to manage medicines safely, although these required embedding in to practice. The provider’s medication policy and procedure had been updated, however still needed to reflect the procedure for medicines given on an ‘as required’ basis.

The inspection took place on 3 February 2015 and was unannounced. Our last scheduled inspection at this service took place in November 2013 when no breaches of legal requirements were identified.

The Cornerstone is a care home without nursing. It provides care for up to eight people with learning disabilities or autistic spectrum disorders. The home is situated close to Rotherham town centre.

The service had a registered manager in post at the time of our inspection. 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.

At our inspection on 3 February 2015, we found a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The provider did not have appropriate arrangements in place to manage medicines. The provider’s medication policy and procedure did not include instruction for medication which was given as required or the safe management of controlled drugs. Therefore, some risks were not identified and there was no guidance on current best practice.

We spoke with staff who had a clear understanding of safeguarding adults and what action they would take if they suspected abuse. One care worker said, “I would report anything of this nature straight away, it would have to be sorted out.”

Care and support was planned and delivered in a way that ensured people were safe. The support plans we looked at included risk assessments which identified any risk associated with people’s care. We saw risk assessments had been devised to help minimise and monitor the risk.

We spoke with staff and people who used the service and we found there were enough staff with the right skills, knowledge and experience to meet people’s needs.

People were supported to have their assessed needs, preferences and choices met by staff who had the necessary skills and knowledge.

We found the service to be meeting the requirements of the mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The house manager had some knowledge of this and said they would contact the local council for further advice if needed.

People were supported to eat and drink sufficient to maintain a balanced diet. Meals were appropriately spaced throughout the day with snacks in-between. Meals were flexible to meet the needs of the people who used the service.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support. We looked at people’s records and found they had received support from healthcare professionals when required.

People who used the service were supported to maintain friendships. Support plans contained information about their circle of friends and who was important to them.

We saw staff were aware of people’s needs and the best ways to support them, whilst maintaining their independence.

People’s needs were assessed and care and support was planned and delivered in line with their individual support plan. The support plans were person centred and some contained pictures to assist in the person understanding their plan. Support plans included healthcare, communication, personal hygiene, mobility and activities.

We saw that people had their own interests and hobbies and took part in several activities and events on a weekly basis.

The service had a complaints procedure and people knew how to raise concerns. The procedure was also available in an ‘easy read’ version.

Staff we spoke with felt the service was well led and the registered manager and house manager were open and transparent. Staff confirmed they knew their role within the organisation and the role of others. They knew what was expected of them and took accountability at their level.

Staff we spoke with felt the service was well led and the registered manager and house manager was open and transparent. They felt people were involved and that their opinion counted. One care worker said, “I can discuss anything with my manager and they will listen and offer support and guidance.”

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. The appropriate procedure was followed where people were not able to give consent.

People who used the service had a care plan which was person centred and relevant to their individual needs. We spoke with most people who used the service, and three staff. One person who used the service said, “I wouldn’t live anywhere else I love it here and we all get on well.” Another person said, “I have been here that long I am part of the furniture. I like it.”

People were supported to eat and drink sufficient amounts to meet their needs. People we spoke with said that the food was really nice and they enjoyed helping to prepare it.

People were cared for in a clean and hygienic environment.

We found that the provider had an effective recruitment procedure in place. Appropriate checks were undertaken before staff began work.

The provider had a complaints procedure and people knew how to make a complaint if they needed to.

We found that people who used the service gave consent to their care and treatment. The appropriate procedure was followed where people were not able to give consent. One person who used the service said, “Staff always ask me what I want and I choose.”

People who used the service had a care plan which was relevant to their individual needs. People were able to participate in appropriate activities throughout the day. People were happy living at the home and one person said “It’s a lovely atmosphere here and people are very friendly.”

We saw that people had a choice of meals and people told us that they were happy with the food provided. Snacks and drinks were available throughout the day. One person said, “We discuss the menu each week and decide between us what we are having.”

The environment was clean and comfortable and people were happy. One person who used the service said, “I like my bedroom, and staff help me to keep it tidy.”

We found that there was enough staff to meet the needs of the people living in the home. Staff told us that they felt trained and supported to do their job. One care worker said, “There is enough time to meet people’s needs and to spend time with people.”

People knew how to complain if they needed to. The complaints procedure was available. People who used the service told us that any concerns are discussed and resolved. One person said, “I can talk to any of the staff and they sort things out.”

People told us they had confidence in the staff and were “Well looked after”.

People told us that staff explained all procedures and treatment to them and respected their decisions about care. They said that their interactions with staff were positive and they were treated as individuals.

People we spoke with understood about safeguarding of adults and told us that they felt safe within the service. People said they were aware of their rights and choices and were confident in the systems set up by the service to enable them to voice any concerns.