Cornwell House, Beehive Care

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. At the time of our assessment no person had a requirement for a DoLS authorisation, however, the management team understood their responsibility to assess people’s mental capacity and apply where required.

People told us they felt safe living at the service. Staff were aware of their safeguarding responsibilities and knew how to escalate concerns if needed. Risks were assessed and mitigated, these included environmental and where people had risks to their health. For example, staff followed care plans to mitigate the risk of pressure area breakdown and the risk of complications in diabetes. Staff worked within best practice guidelines for the storage and administration of medicines. Medicines rounds were person-centred and timings were discussed with people to ensure their preferred routines were considered. This included adjusting pain relief administration timings for a person who liked to go to sleep early.

People were supported by enough staff who had completed training relevant to their role and were supported to learn further. One staff member told us, “If there is a new topic I will go for it, we all need refreshers, it is important to keep doing it (training).” Staff told us they received regular supervisions and they felt supported by management.
People had full access to the service including the garden which had been adapted with a sloped pathway, flat lawn, shelter and shaded areas. Seating was laid out for people to enjoy the garden and raised planters were utilised by the gardening club. People continued relationships and interests that were important to them and were free to come and go as they pleased. There was a range of planned activities and events to keep people engaged, socially stimulated and physically well.

People's needs were assessed and reviewed, and people were involved in decisions about their care. The service worked with healthcare professionals including GPs, district nurses and specialist services. Staff monitored people's health and wellbeing and sought healthcare support when needed. A visiting healthcare professional told us, “I feel that the manager, deputy manager and all other care staff have always demonstrated a holistic proactive approach to each resident, focusing on a person-centred approach. The systems I have seen, are robust and are continually reviewed to ensure that the processes in place are safe and appropriate for all. The care staff communicate effectively with me in a consistent and professional manner always putting the resident at the heart of all that they do. I feel that care staff always collaborate in working within partnership with key stakeholders and agencies, in my professional role this has been evidenced by regular update meetings to ensure a seamless support for the residents and families through an inclusive and integrated approach.”

Staff and managers treated people with respect and dignity. Staff were observed to knock on people’s doors and wait for a response before entering their bedrooms. Staff were seen to respond to people in the way they preferred and described how they may change their approach depending on the person’s personality. We saw staff knew people well and shared jokes and appropriate banter with them.
Consent was sought formally in writing and informally on a day to day basis. People were consistently offered choices and asked for permission to be supported throughout our visit; staff ensured their decisions were respected.

People's preferences were reflected in their support and daily lives. Bedrooms were personalised and adaptations were made to meet individual needs. People provided feedback through meetings, surveys and directly to managers. They were listened to and their feedback resulted in changes, including improvements to food provision and the remodelling of communal spaces.
People were assessed prior to moving into Cornwell House and assessments were ongoing to reflect changing needs. People had the opportunity to stay for respite and trial periods before deciding whether they wished to move into the service permanently.

The two registered managers promoted an open culture; staff and people told us they felt able to raise concerns and make suggestions. Governance arrangements included audits, trustee oversight and systems for monitoring people's care, incidents and risks. The service worked with local health professionals and community organisations and demonstrated learning through changes to practice, staff development and improvements to the environment.

Staff meetings were held to provide updates on the service and surveys were used to capture staff views, which were responded to by managers. The registered managers and management team were well regarded by staff, people, their relatives and professionals. A staff member told us, “The manager and deputy manager are very approachable, they can read a room really well and have been so supportive if there are any concerns. They treat things seriously, check things out and have your back. Anything I have ever raised they have always listened to me and they give feedback too.”