Cold Springs Park Care Home

People’s experience of using this service: People and relatives praised the staff for the care and kindness they showed to them and to their families. They commented, “I never knew people could be so kind” and “The level of care here has been amazing and my family member is thriving again.”

People said the home was clean, warm and comfortable. They described the food as “very good” and they had lots of choices. People said there were lots of interesting activities and the chance to go out into their local community.

There were enough staff to assist the needs of the people who lived there. People said when they requested help, staff came straight away. Staff were vetted to make sure they were suitable to work at the care home. Staff said they were well trained and supported in their roles.

Staff knew how to protect people from avoidable harm. People at risk of falls or poor health were provided with the assistance and equipment they needed. People’s medicines were managed safely. The accommodation was well-maintained and a safe place to live.

People’s needs were assessed before they came to the home. People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

There was a friendly, welcoming atmosphere in the home. People and staff enjoyed good relationships and spent time chatting together. Staff made sure people were treated with dignity and respect, and their privacy was protected. People were offered choices and their decisions were respected. There was a good range of activities, exercises and opportunities to go outside.

At the last inspection some care plans did not always reflect people’s needs. We made a recommendation about that. During this inspection we found care plans had been improved so staff had the right guidance to assist people in the right way. Staff were sensitive and compassionate about the care they provided to people at the end stages of their lives.

People said the home was well-run. They were asked for their views at meetings and in surveys. They had information about how to raise issues and were happy with the way these were dealt with. Staff said the management team were open, approachable and supportive.

The manager and provider worked well with other services and local groups. They carried out regular monitoring checks of the service and had plans to continuously improve the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (report published in April 2018).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At the last comprehensive inspection in June 2017 we found the provider had breached Regulations 8, 9, 10, 11, 12, 13, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people did not receive safe care and treatment and were not always protected against the risks of harm or abuse. Medicines had not always been safely administered and managed. People did not always receive the support and monitoring they needed to ensure their nutritional needs were met. There was insufficient equipment to support people in a timely manner with their mobility needs. Complaints had not been responded to appropriately and accidents and incidents had not always been reported. Staffing levels were not always sufficient to meet the needs of the people who lived at Cold Springs Park. This meant the provider’s own system to assess, monitor and improve the quality and safety of the service were ineffective because they had not addressed these concerns.

The service was rated as Inadequate and placed into special measures by the Care Quality Commission (CQC). We imposed an urgent condition to suspend admissions to the home on the provider’s registration. This meant new people could not move to the home until the service was deemed to have improved. We asked the provider to complete an action plan to show what they would do and by when to improve the service. Following the inspection, the provider sent us an action plan showing how they would address the breaches and concerns we had identified.

We carried out a focused inspection in August 2017 because of concerns about night staffing levels. At that inspection we found staffing levels were appropriate to meet people’s needs. We also looked at a sample of records, including accident and incident reports, and checked whether staff were aware of out of hours safeguarding reporting processes. We found some improvements in these areas but we could not change the rating at that time because it had only been a short time since our previous visit and to do so requires consistent good practice over time.

Since the last inspection this home and many others operated by the previous provider (BUPA) had been taken over by another provider (HC-One Oval Limited). The running of the service and the employment of the staff transferred to the new provider in December 2017.

We carried out this inspection in February 2018 to check whether the provider had complied with the imposed conditions and had met the breaches which were identified at our last inspection. During this inspection we found improvements had been made with only a small number of areas for additional attention. We concluded that sufficient action had been taken to make sure people were safe. We agreed that the conditions imposed upon the provider's registration could be removed. The service was also taken out of special measures.

Cold Springs Park is a ‘care home’. People in care homes receive accommodation and 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.

The care home can accommodate up to 60 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. There were 35 people living at the home at the time of this inspection. All the accommodation is on ground level and it has level access throughout.

There was 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.

People said they felt safe and comfortable at the home. Staff knew how to recognise and report any suspicions of abuse. The management team acted on any concerns to make sure people were protected.

Potential risks to people’s safety were assessed and managed. People’s medicines were managed in a safe way. The premises were clean, warm, comfortable and well-maintained. There were lots of different seated areas for people to spend time in and there was level access out into the secure patio gardens from all areas of the home.

Staff felt they were trained, supervised and supported in their roles. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People received good support with their meals and the dietitian services felt people’s nutritional well-being had significantly improved. Some people did not get enough choices because they had special textured food, for example pureed. The management team agreed everyone should have meal choices. People were assisted to access health services when they needed them and the staff team worked well with health care professionals.

People and relatives told us all the staff were friendly, caring and helpful. They said staff treated them with dignity and respect. Staff reassured people and protected their privacy when supporting them with personal care.

Staff engaged people in discussions and activities, and supported them in a way that upheld their dignity. Relatives said staff were kind and were also supportive of family members.

There were care plans in place to guide staff in meeting people individual needs. However, some of the information was inconsistent so staff might have provided the wrong care. We made a recommendation about this. All the staff, including care staff, cooks and cleaners, were very familiar with people’s preferred lifestyles and daily well-being.

There were opportunities for people to go out into their local community as well as social activities and events in the home. People and staff felt that the number of activities had much improved because there were now two activity staff, one for each unit.

People, relatives and staff felt there an open and friendly culture within the service. They were asked for their views about the home and felt these were listened to. The new provider was introducing its robust quality assurance system at the home to make sure the service remained safe for people.

Cold Springs Park Care Home provides personal care and accommodation for up to 60 people, some of whom have a dementia type illness. On the day of our inspection there were 44 people using the service.

The home had a registered manager in place. 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 manager was not on duty during out inspection. Following our visit, the provider advised us that the manager had resigned from the organisation.

We carried out an unannounced comprehensive inspection of this service on 27 June 2017. We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and rated the service Inadequate. After that inspection we received concerns in relation to night time staffing levels. The provider had submitted an action plan regarding staffing levels at night following our last inspection. However, this had not always been adhered to or maintained as the provider had submitted eight statutory notifications to us since our last visit reporting continuing staff shortages. A notification is information about important events which the service is required to send to the Commission by law.

As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those concerns. You can read the 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.

At this inspection, we also looked at a sample of care records, accident and incident records, and whether staff were aware of out of hours safeguarding reporting processes. We could not improve the ratings for safe, responsive or well led from the ratings they were given at our last inspection because it has only been a short time since our last visit and to do so requires consistent good practice over time. We will check the ratings of these key questions again during our next planned comprehensive inspection to the service.

At this inspection we found there were sufficient numbers of staff on duty in order to meet the needs of people who used the service.

The provider had taken seriously any risks to people and put in place actions to help prevent accidents and incidents from occurring.

Staff were aware of how to protect vulnerable adults and clear instructions were provided regarding the out of hours safeguarding reporting process.

Care records were responsive to people’s changing needs. People’s individual wishes, needs and choices were taken into account.

There was a positive and relaxed atmosphere in the home. Staff told us improvements had been made.

Cold Springs Park Care Home is located in the town of Penrith and is owned by BUPA. The home is registered to accommodate a maximum of 60 older people, some of whom may be living with dementia. The home is divided into two units, Cold Springs unit and Spring Lakes unit. Spring Lakes unit supports people living with dementia. At the time of our inspection there were 52 people living at the home.

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.

At our last inspection of the home in September 2016 we found that the service was not meeting the regulations. People did not receive care and treatment that was person centred or that reflected their needs and preferences. 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. Quality assurance systems in place had not fully identified and addressed the impact on the wellbeing and continued safety of people who used the service. We rated the service as ‘Requires Improvement’. Following this inspection we asked the provider to take action to make improvements. The provider sent us an action plan detailing the improvements they would make in order to comply with the regulations.

During this inspection we found that the provider had made improvements to help make sure people’s legal and human rights were protected. However, people continued to receive care that was not centred around their needs and preferences. Quality assurance systems had not been effectively implemented and monitored to help ensure improvements were made and the wellbeing and safety of people who used the service were protected.

In addition to this we found that the service was not meeting other regulations. People did not receive safe care and treatment and were not always protected against the risks of harm or abuse. People did not always receive the support and monitoring they needed to ensure their nutritional needs were met. There was insufficient equipment to support people in a timely manner with their mobility needs. Complaints had not been responded to appropriately and the registered manager had not always told us about accidents and incidents at the home as required. Staffing levels were not always sufficient to meet the needs of the people who lived at Cold Springs Park.

The people we spoke to during our inspection were complimentary about the staff. People thought that the care was good and that the staff worked very hard. They also said that there were not enough staff on duty to meet their needs and that they often had to wait for support. The staff we spoke to discussed their concerns about staffing levels at the home.

We found that staff had been recruited safely and that appropriate checks on their suitability had been carried out. Staff had been provided with training to help them carry out their roles. However, some gaps remained, particularly around safeguarding adults and fire evacuation procedures. Training dates had been arranged with regards fire evacuation.

We have made a recommendation that the service seeks advice and guidance with regards to the local authority out of hours safeguarding reporting process.

The sample of risk assessments and care records that we reviewed had not been kept up to date as people’s needs changed. We found that medicines had not always been safely administered and managed. We received varied comments from people about the quality and standard of the food provided. We also noted that people at risk from malnutrition were not always effectively monitored and supported.

People told us and we observed that staff approached people with kindness and respect. Privacy and dignity were well maintained and protected. On the first day of our inspection there were few social or leisure activities available for people to enjoy. The activities co-ordinator was at the home on the second day of our visit and was working hard to provide stimulating activities for some of the people who used the service.

Although there was a shortage of mobility equipment we found that equipment had been maintained and kept in a clean condition. The home was generally clean and free from unpleasant odours although there were some areas in need of refurbishment.

We found that there were serious issues around communication between the staff and the managers of the service. Staff told us that they did not feel ‘listened to’ and some of the systems and processes in place were confusing and not utilised effectively. This had resulted in important information not being passed on or dealt with appropriately.

We found that few improvements had been made at the home since our last inspection and found further breaches of the regulations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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