Archived: Cold Springs Park Care Home

At our last comprehensive inspection of this service in September 2015, we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. We asked the provider to send us a report to tell us what action they were going to take. We did not take formal enforcement action at this stage.

We carried out a focused inspection in January 2016 and found continuing breaches of these regulations. We also found breaches in relation to staffing relating to the competencies and skills of staff and notifications of other incidents of the Care Quality Commission. These matters were dealt with outside of the inspection process.

Following that inspection the service was rated as inadequate and placed in special measures. We also issued three Warning Notices. A Warning Notice tells a registered provider or a registered manager that they are not complying with a regulation.

We undertook a further focused inspection in May 2016 to check that the registered provider had complied with the requirements of the Warning Notices. During the inspection we found that the registered provider had met the requirements of the Warning Notices in relation to the previous breaches of the regulations. However, we also found new concerns relating to breaches of other regulations in relation to Regulation 9 – Person Centred Care, Regulation 11- Need for Consent and Regulation 14 – Meeting Nutritional and Hydration needs of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our inspection of 20 September 2016, everyone we spoke to about Cold Springs Park was very positive about the improvements to the service and the current situation at the home, including the management arrangements. However, we found areas where further work was still required.

We have judged that the overall rating for the service is Requires Improvement and in line with our guidance, the service will no longer be in special measures. Although some breaches in the regulations had been addressed some concerns still remained. We need to be confident that the registered provider can demonstrate consistent good practice over time. We will check this again during our next planned comprehensive inspection.

Cold Springs Park Residential Home (Cold Springs Park) is located in the town of Penrith and is owned by BUPA. The home provides residential care for 60 elderly people and is divided into two units, Cold Springs unit and Spring Lakes unit. Spring Lakes unit supports people living with dementia.

There was a registered manager employed at the service. 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.

During our inspection of this service we received positive feedback from visitors and from people who used this service. One person told us; “This is lovely place. The girls (staff) are very nice to me.” Another person said; “I am looked after very well thank you.”

Visitors to the home also commented on the better standard of care they had experienced and the improvements they had noticed at the service since the appointment of the registered manager.

We found that staff had been provided with training updates since our last visit to the service. Staff had also received support and supervision from their line manager to help ensure they understood and carried out their roles safely. There were times when appropriate staffing levels were not maintained but these had improved recently and new staff were being recruited. We have made a recommendation about the induction and support of agency workers at the service.

The information we held about the service and information we received from health and social care professionals showed that there had been a significant number of accidents and incidents at the home. We looked at a sample of risk assessments and mobility plans for people who used the service. Information designed to keep people safe was not always accurate or sufficiently detailed.

Following our inspection, the registered manager carried out an analysis of the accidents and incidents that had occurred at the home over the last year. The registered manager sent us a copy of the findings together with a plan of what actions would be taken to help reduce the risks of further incidents. We have made a recommendation that the service considers current guidance about supporting people who have been identified as being at risk of falling and takes action to update their practice accordingly.

We looked at the way in which medicines were managed at the home. The sample of medication administration records we checked were accurately completed and we could see that people had been given their medicines correctly. There were minor issues about the way in which “when required” medicines were managed. Not everyone had a clear plan to help staff understand when and why these medicines should be used. We have made a recommendation that the service considers current guidance on the use of “when required” medicines and takes action to update their practice accordingly.

There were some concerns regarding the cleanliness of areas of the home and the protocols for managing infection control and prevention. Housekeepers had been provided with appropriate training and told us that they were provided with suitable cleaning equipment and materials. However, there were discrepancies in the understanding of cleaning procedures within the housekeeping team. We observed some poor infection control practices within the staff team, particularly with regards to the use of protective clothing.

We reviewed the records in relation to the Deprivation of Liberty safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). Protocols had generally been followed and applications had been made appropriately by the registered manager. However, we noted that there were gaps in the knowledge of some of the care staff with regards to mental capacity assessments and best interest agreements. The principles of the MCA had not been followed with any consistency.

Mealtimes at the home had been reviewed and observed to help identify what worked well and where the service could improve the dining experience for people who used this service. People were supported with eating and drinking in a dignified and discreet manner by staff when needed. However, where people had been identified at risk of malnutrition, we found that their food and fluid intake records had been poorly completed making it difficult to tell whether they had received sufficient food and drink. We have made a recommendation that the service finds out more about training for staff based on current best practice, in relation to supporting people with their nutritional needs, particularly people living with dementia.

Everyone living at Cold Springs Park Care Home had a plan of their care and support needs. We found in the sample we reviewed, that although personal preferences had been recorded, staff did not always respect people’s individuality.

We found breaches of regulation in relation to:

Regulation 11 Need for Consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The human and legal rights of people who used this service were not protected because staff did not have a good working knowledge of the principles of the MCA 2005 and DoLS.

Regulation 9(1)(a)(b) Person centred care of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to providing care that is appropriate and meets people's needs.

Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the systems in place had not fully identified and addressed the impact on the wellbeing and continued safety of people who used this service.

You can see what action we told the provider to take at the back of the full version of this report.

Following the focused inspection in January 2016 we issued three Warning Notices. A Warning Notice tells a registered provider or a registered manager that they are not complying with a regulation. We undertook this focused inspection to check that the registered provider had complied with the requirements of these Warning Notices.

This report only covers our findings in relation to those requirements. You can read the full report from our last comprehensive inspection, by selecting the 'all reports' link for (Cold Springs Park Care Home) on our website at www.cqc.org.uk.

Cold Springs Park Care Home (Cold Springs Park) is located in the town of Penrith and is owned by BUPA. The home provides residential care for up to 60 elderly people and is divided into two units, Cold Springs unit and Spring Lakes unit. Spring Lakes unit supports people living with dementia.

At the time of this inspection the service did not have a registered manager. 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.

There was a new manager in post who had been appointed at the home following our last inspection in January 2016. At the time of this inspection of the service the new manager had already commenced an application to become a “registered manager’’.

During this inspection we found that the registered provider had met the requirements of the warning notices in relation to the previous concerns we found in January about the safe management of medications in Regulation 12 Safe care and treatment and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However during this inspection we found new concerns relating to breaches of other Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following this inspection visit we wrote to the provider about some of the concerns we had found to ask for further information and for them to provide reassurances on the immediate actions they would take. This was to prevent any repetition of the concerns we had found and to mitigate any risks associated with them.

You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider remains ‘Inadequate’. This means that it was been placed into ‘Special Measures’ by CQC following the inspection in January 2016. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Another inspection will be conducted within six months from the last inspection in January, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s

Concerns found during this inspection on 12 May 2016 were about the assessments and plans of care about people and not being person centred in identifying specific risks or individual needs. We saw that where some people lacked capacity to make certain decisions and the need for consent was required it was not always obtained from the appropriate person. We also found that where risks relating to weight loss had been identified we could not see that appropriate actions had always been taken to address them.

We saw significant improvements had been made in the management and records relating to medications. All staff that had responsibility for managing medications had undergone training and new competency checks.

The new manager and registered provider had improved systems in place to monitor the safety and quality of the service. These had been effective in identifying areas of concerns and actions still to be taken in continuing to improve the service.

You can see what action we told the provider to take at the back of the full version of this report.

Following the comprehensive inspection in September 2015 the provider wrote to us to say what actions they would complete in order to meet the legal requirements in relation to the breaches. They sent us an action plan setting out what they would do to improve the service to meet the requirements in relation to the breaches and identified a date by when this would be completed.

During this inspection in January 2016 we found continuing breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found two new breaches one in Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and in Regulation 18 Notifications of other incidents of the Care Quality Commissions (Registrations) Regulations 2009.

The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

Cold Springs Park Residential Home (Cold Springs Park) is located in the town of Penrith and is owned by BUPA. The home provides residential care for 60 elderly people and is divided into two units, Cold Springs unit and Spring Lakes unit. Spring Lakes unit supports people living with dementia.

There was a registered manager employed at the service. 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special

Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s

Concerns found during the inspection about the safety and wellbeing of some people in the home led the inspectors to share information with the local authority and the service’s commissioners.

Medications and the management of them had not always been completed in a safe manner. As we found in the last inspection the records for the management of prescribed creams in the home were still not always accurate.

The registered manager and registered provider had systems in place to monitor the safety and quality of the service but these had not always been effective in identifying areas of concerns.

When accidents and incidents had occurred these had not always been reported by the registered manager to the appropriate authorities. Incidents requiring notifications to be made to CQC had not always been done.

We found that there were a number of un witnessed falls at the home which had resulted in people being injured. We saw that trends in falls had been identified at the end of December 2015 and as a result night time hourly checks for some people had been implemented in January 2016.

We saw improvements had been made in the records for the assessments of risks that had been completed and where changes in the management of risks had occurred this had been accurately recorded.

You can see what action we told the provider to take at the back of the full version of this report.

We found that issues we highlighted previously around Do Not Attempt Resuscitation Orders had been resolved which meant people's legal rights were protected. Care plans and risk assessments were being regularly reviewed and updated and the home was working with other providers to facilitate good outcomes for people who used the service. People were receiving the correct levels of nutritional assessment and support by sufficient numbers of staff and there were plans in place to increase staffing levels across the home. Records were accurate and fit for purpose. The manager was closely monitoring the quality of service being provided which was demonstrated by the improvements that had been made.

We found that where people did not have the capacity to consent, the provider had not acted in accordance with legal requirements. We also found that people were not protected from the risks of inadequate nutrition and dehydration. People had not experienced care, treatment and support that met their needs and, at times, there were not enough staff to support them. We noted that accurate and appropriate records were not maintained across both units in the home. However people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.