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CQC report explained · a nursing home, run by Royal Masonic Benevolent Institution

Cornwallis Court

Hospital Road, Bury St Edmunds, IP33 3NH

Outstandingpublished 25 August 2023, 3 years ago

Rated Outstanding: inspectors found the service performing exceptionally well.

The five questions inspectors ask
Safe?
Good
People were protected from abuse and avoidable harm. Risks were generally well assessed and managed, medicines were administered safely, and infection control arrangements were effective. Inspectors found gaps in repositioning records and missing risk assessments for some people with access to stairs, with immediate action taken.
Effective?
Good
Care needs were assessed and care plans were kept up to date. Staff had relevant training, people received suitable food and healthcare support, and consent and best-interest processes were followed.
Caring?
Good
Staff treated people with kindness, dignity and respect. People were involved in decisions about their care and supported to remain as independent as possible.
Responsive?
Outstanding
Care was highly personalised and responsive to people's needs, preferences and communication styles. The home provided varied activities seven days a week, supported community trips and planned carefully for the move of the dementia unit.
Well-led?
Outstanding
Leadership was open, inclusive and strongly focused on quality. Audits, feedback, incident reviews and staff suggestions were used to improve care, and staff felt well supported.
The latest report, explained

What inspectors found, August 2023

Rated Outstanding overall; inspectors found exceptionally responsive and well-led care, with safe, effective and caring care rated Good.

This was an unannounced comprehensive inspection. Inspectors visited on 19 and 25 July 2023. They spoke with people, staff, relatives and a health professional. They reviewed care records, medicines records, staff records and quality checks.

The home was rated Outstanding overall. Responsive and well-led were rated Outstanding. Safe, effective and caring were rated Good. Inspectors found kind staff, personalised care, strong activities, good healthcare support and a clean, pleasant environment.

Inspectors found two record-keeping shortfalls during the visit. Some repositioning records were incomplete, and some people who could access stairs did not have risk assessments. The home took immediate action after inspectors raised these points.

The overall rating improved from Good at the previous comprehensive inspection. The ratings for Responsive and Well-led improved from Good to Outstanding. The other three ratings remained Good.

What inspectors praised
  • Personalised care

    Care plans included people's wishes, life histories, preferences, interests and important relationships. Staff focused on helping people keep their independence.

    Care records showed people's wishes, needs, life history, preferences, interests and key relationships had been considered in the planning of their personalised care.from the report
  • Kind and respectful staff

    Inspectors saw compassionate and respectful interactions. People and relatives spoke positively about the care and the atmosphere.

    Without exception the interactions between people and staff at all levels were kind, compassionate and empowering.from the report
  • Activities and social life

    Activities were planned around individual interests and were available throughout the week. People could choose whether to join in, including trips into the community.

    Activities staff were employed to provide a wide range of personalised activities covering 7 days a week.from the report
  • Strong leadership

    The management team used audits, meetings, surveys and feedback to monitor quality and improve the service. Staff described an open culture where mistakes could be discussed.

    There were detailed and robust governance systems in place to monitor the service closely to ensure people received an excellent level of care and support.from the report
  • End-of-life support

    People's wishes for end-of-life care were recorded and staff worked with healthcare professionals. Relatives described compassionate support at difficult times.

    They, [staff] look after people at the end of their life very well here. They communicate with the hospice team and ensure people are comfortable and end their days well.from the report
What inspectors were concerned about
  • Repositioning records

    needs fixing

    Inspectors found some gaps in records showing when people had been repositioned. The home introduced a new system immediately after the feedback.

    We identified some gaps in repositioning records. Following our feedback immediate action was taken to instigate a new system to ensure improved management oversight of this.from the report
  • Risk assessments near stairs

    needs fixing

    Some people, including people living with dementia, had access to stairs without a risk assessment to guide staff. Risk assessments were put in place immediately after inspectors raised this.

    We noted where people had access to stairs, including those living with dementia not all had risk assessments in place to guide staff.from the report
  • Occasional call-bell waits

    minor

    One person said there were infrequent occasions when they had to wait for staff to answer their bell. The report also says staffing had improved and levels were regularly reviewed.

    There is the odd occasion when you have to wait for staff to answer your bell, but this is infrequent.from the report
Questions to ask them, based on this report
  1. 01How are the new repositioning records checked each day, and what happens if a record is missed?
  2. 02Which residents can access the stairs, and how are their new risk assessments kept up to date?
  3. 03What are the current staffing levels on each unit, and how often are bank or agency staff used?
  4. 04How quickly are call bells usually answered, particularly during busy periods?
  5. 05How will planned building works and the future new home affect residents, including people living with dementia?

This was an unannounced comprehensive inspection covering all five key questions, including infection prevention and control under Safe; the overall rating improved from Good to Outstanding. This explanation was written from the published report of 25 August 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.

The story over the years

Every inspection of Cornwallis Court

2 rated inspections over 5 years: the service has improved, from Good to Outstanding.

  1. August 2023Outstandingcurrent ratingup from Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Outstanding

    Read what inspectors found at Cornwallis Court

  2. March 2018Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    We are reading this report · the original is on cqc.org.uk

  3. June 2017

    Registered with the Care Quality Commission on 22 June 2017.

Ratings and report dates from the Care Quality Commission. A service can also be visited without a new rating being published, so the timeline shows published inspections, not every contact the CQC has had with the service.

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Other services run by The Royal Masonic Benevolent Institution Care Company

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