Cookridge Court

We found the following examples of good practice.

The home had relevant policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of risks to people who had tested positive for COVID-19.

The provider had implemented a regular programme of COVID-19 testing for people in the home, staff, and visitors. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

The provider had developed person centred risk assessments to address and mitigate the detrimental impact that being in isolation was having on people’s mental health.

The provider kept people using the service and their relatives regularly updated in relation to national guidance and changes to internal policy, such as visiting arrangements.

Staff had received updated training on the use of PPE and their competency in this area was checked, and we observed most staff wearing it correctly during out inspection.

The service had established good working relationships with relevant healthcare professionals and their support continued during the pandemic.

Workforce pressures were not having a detrimental impact on the delivery of the service.

Cookridge Court is a care home which provides personal care to people. At the time of the inspection the home was providing personal care to 59 people.

People's experience of using this service:

Following the last inspection in June 2019 the home have made improvements. People and their relatives told us the quality of care had improved and their needs were being met. There were enough staff in the home, and we found call bells were attended to in a timely manner. Medicines were managed safely. Although, we found some creams were not stored correctly this was immediately resolved.

The home had improved their governance systems and regular audits meant ongoing actions had been taken to improve care. Due to these improvements the home is no longer in breach of regulation. Whilst improvements had been made, we need assurances over a longer period that these improvements become embedded and sustained.

Following the last inspection care records and risk assessment records were now more detailed. However, we found some areas which still required improvement. Fluid charts had not always been completed to monitor people’s fluid intake and completion dates for actions taken on audits had not always been completed.

Individual risks were being managed and actions immediately taken to prevent re occurrences. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again. People were kept safe and protected from abuse and avoidable harm. Staff were knowledgeable about people’s needs and this was reflected in care plans and risk assessments.

The registered manager and staff encouraged person centred care to ensure people were treated as individuals. The staff knew how people preferred to receive their care and support.

Infection control procedures were in place to prevent against infectious diseases. During the Covid-19 pandemic the home segregated a unit to provide support to those with suspected or confirmed cases to prevent against further spread of infection in the home. Staff wore the correct personal protective equipment when supporting people and this was available throughout the home.

People and their relatives said the registered manager was approachable and listened to their concerns. Staff had with regular meetings and supervisions to promote feedback and good communications with the management team. One staff member said, “The relationship between seniors and carers is good. You can easily raise your concerns with seniors, and it gets resolved. We ensure there is good quality of care given to our residents.”

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

Rating at last inspection and update

The last rating for this service was requires improvement (Published 15 November 2019) and there were four breaches of regulation. We issued requirement notices, for regulation 9, person centred care, 12 safe care and treatment, 18 staffing and 17 good governance.

At this inspection the service had improved and were no longer in breach of the above regulations.

Why we inspected

We undertook this focused inspection in line with our current methodology in the COVID-19 pandemic, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, and well-led which contain those requirements.

Ratings from previous comprehensive inspections for those key questions were used in overall rating at this inspection.

The overall rating for the service has not changed.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cookridge Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Cookridge court is a care home which provides personal care to people. At the time of the inspection the home was providing personal care to 65 people.

People’s experience of using this service:

The service delivered at Cookridge Court has been rated Requires Improvement or Inadequate for the past five inspections, which shows a lack of improvement over a sustained amount of time. For the last four inspections the provider has been in breach of Regulation 17.

The provider failed to assess, monitor and improve the quality of the service and maintain accurate and robust care records. We found shortfalls in recordings; for example, repositioning charts, care plans and audits were not always updated or maintained correctly.

People living in the home were not always protected from possible harm. The provider had not followed their fire policy as staff had not carried out evacuations to ensure people could be evacuated safely from the home.

Risk assessments did not always reflect people's needs. We found assessments had not been updated when there was documentation to suggest a risk was present.

Care plans were in place but not always updated to reflect peoples' current needs and related risks. Appropriate action had not always been taken to follow up on deterioration in people’s health.

The providers rota’s were not clear and the dependency tool used to calculate how many staff were required was at times inaccurate. Recruitment checks were completed on new staff to ensure they were suitable to support people who used the service.

Staff were not always up to date with training the provider made mandatory. Staff were provided with regular supervisions and annual appraisals had been completed to support staff development and any new employees completed an induction programme.

The service was not appropriately decorated or designed to meet all people’s needs. There was no signage, tactile simulation or décor which met the needs of people living with dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives told us the staff were kind caring and treated them with respect.

People told us the enjoyed the food and were offered choices. We saw people being offered refreshments on the days we inspected. People took part in activities within the home although activities outside of the home were limited.

People told us they were supported to be as independent as possible. Some people received end of life care and relatives provided positive feedback about the care their relatives received.

People living in the home said they felt safe and there were systems in place to reduce the risk of abuse. Medicines were stored, administered and recorded appropriately.

Meetings took place in the home. Staff told us the management team were honest and supportive. Complaints were managed effectively.

We found four breaches of regulation.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 November 2018) and there were three breaches of regulation. We issued requirement notices, for regulation 11 consent, 12 safe care and treatment and for regulation 17 good governance.

At this inspection the service had improved their medicines management and MCA. However, the provider had not improved their governance systems and records which meant they were still in breach of these regulations.

Why we inspected

The inspection was prompted in part due to concerns received about overall care quality and an unexpected death. A decision was made to bring the planned comprehensive inspection of this home forward to allow us to inspect and examine those risks.

This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cookridge court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, safe care and treatment (risk management), staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

Information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an updated action plan to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 13 and 14 September 2018. This inspection was unannounced.

The last inspection of this service took place on 26 January, 1 and 5 February 2018. The service was rated as Inadequate at that time. Following the last inspection, we met with the provider to discuss our inspection findings and we also asked the provider to complete an action plan to show what they would do, and by when, to improve the overall rating of the service to at least 'Good'. At this inspection we found the provider had made some improvements. However, the provider had not taken all appropriate steps to make the required improvements needed and they continued to be in breach of three regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a registered manager in post. 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.

We found medicines were not always managed safely because people did not always receive their ‘as required’ medicines. Guidance for staff in the form of protocols was not always in place to instruct staff on how to administer medicines and some medicines had not been administered at the correct times. Two clinic rooms were not clean and therefore posed a risk of cross contamination.

At the last inspection we found the provider did not comply with the Mental Capacity Act (2005). The process to evaluate the need for Deprivation of Liberty Safeguards (DoLS) was not always documented and mental capacity assessments were at times inaccurate. At this inspection improvements had been made. However, further work was needed to ensure the provider followed the Act. We found best interest decisions had been completed but not all health professionals had been involved. Capacity assessments had not always been recorded and some assessments had been completed that were not necessary.

We found shortfalls in a number of areas relating to record keeping and audits in the service.

Risk assessments were initially completed, reviewed and changed with people’s care needs. However, we found some risk assessments required further detail to provide clear instructions for staff and to maintain people’s safety.

Initial assessments were completed and we found people had been placed on the units most appropriate to their needs. We found some initial assessments which required further details about people’s specific needs and how best to support them.

Following the last inspection improvements had been made to the security of the home, support for staff including supervisions and appraisals, safeguarding incidents had been investigated and incidents and accidents were being managed effectively.

People living in the home told us they felt safe and staff followed the provider’s safeguarding policy for reporting and acting on concerns. We found staff felt confident to raise concerns and whistle blow if needed.

Staff told us there were sufficient staffing levels and the provider rotas confirmed this. People living in the home told us staff had the relevant training to meet their needs. We found new staff were given an induction programme and mandatory training was provided to ensure staff keep their knowledge up to date.

Appropriate checks were carried out to ensure staff working in the service were safe to do so. We found staff received regular supervisions and appraisals to develop their skills and said they felt supported.

Maintenance checks were carried out in the home to ensure it was safe. There was an infection control policy which staff followed and we found the home was clean and tidy other than the clinic rooms.

People living in the home said staff were friendly, caring and respected their wishes. Staff ensured they always offered choice and encouraged people to remain independent when their health allowed.

Most people told us activities were available at Cookridge Court which they enjoyed.

Complaints were managed with actions taken to address the concerns and people felt their concerns would be responded to. There had been a reduction in complaints since the last inspection and an increase in compliments the home had received.

People living in the home, their relatives and staff spoke positively about the current management of the service. The managers had made some improvements to drive further improvement and told us this was ongoing.

The provider gathered feedback from people living in the home and their relatives with annual surveys and staff team engagement surveys.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulations 12 (Safe care and Treatment) and 17 (Good governance) and 11 (Consent). You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 26 January, 1 and 5 February 2018 and at the time of our inspection there were 87 people living in the home. The provider registered with the CQC in August 2014 and has been rated as Requires Improvement or Inadequate for the past four inspections from January 2015 to October 2017.

The last inspection of this service took place on 17 and 30 October 2017and the service was rated as Requires Improvement at that time. Following the last inspection, we met with the provider to discuss our inspection findings and we also asked the provider to complete an action plan to show what they would do, and by when, to improve the overall rating of the service to at least ‘Good’. At this inspection we found the provider had not taken appropriate steps to make the required improvements and they continued to be in breach of multiple regulations. We also identified new shortfalls in the service which exposed people to the risk of harm and abuse.

At the time of this inspection there was no registered manager in post. 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.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulations 11(Need for Consent), 12 (Safe care and Treatment), 13 (Safeguarding service users from harm and abuse), 17 (Good governance) and 18 (Staffing). Full information about the CQC's regulatory response to the more serious concerns found during the inspection is added to reports after any representations and appeals have been concluded.

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 within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

The provider had not always acted upon safeguarding matters and concerns related to risk, to protect people living in the home from harm. Incidents and accidents were not always reported which meant processes were not followed in accordance with the provider's policies and actions were not always taken to keep people safe from avoidable harm and alleged abuse.

Risk assessments did not always reflect people's needs. We found assessments had not been updated when there was documentation to suggest a risk was present or when serious incidents had occurred.

The provider failed to assess, monitor and improve the quality of the service and maintain accurate and robust care records. We found shortfalls in recordings; for example, Medication Administration Records (MARs), repositioning charts, care plans and audits were not always signed, updated or maintained correctly.

Audits had been completed. However, we could not be confident that these reflected all that had happened in the home due to the shortfalls in recording. Actions had not always been completed and there was a lack of information to determine trends and themes within separate parts of the home.

Most people living in the home told us they felt safe, although one person told us they felt unsafe due to an incident which had not been reported to protect the individual from harm.

We found the provider was not working within the principles of the Mental Capacity Act 2005. Care records did not include information to reflect that assessments had taken place where people lacked capacity, and the provider had not sought the views of relatives that were acting legally on people’s behalf.

Initial assessments were not robust. There was no criteria to determine whether people would be best supported in the specialised dementia unit, or the residential unit of the home. We found people with progressed dementia living within the residential units due to a lack of beds in the dementia unit.

Care plans were in place but not always updated to reflect peoples’ current needs and related risks. People and their relatives were invited to formal reviews of their care on a six monthly basis.

We could not be certain that staffing levels were safe as the provider failed to evidence that there were sufficient staff on duty at all times.

Staff were provided with regular supervisions, however, these were generalised and not specific to the staff member. Some annual appraisals had been completed to support staff development and any new employees completed an induction programme.

Appropriate checks were carried out to ensure staff working in the home were appropriately skilled and of suitable character to do so. People and their relatives felt staff had sufficient training to do their job, however, staff told us they had not received training to support people with challenging behaviour.

Most people and their relatives told us the staff were caring and spoke positively about their relationships. However, we concluded that the provider was not caring as they failed to provide a safe and caring environment where the support people received was safe and of the minimum standard required to meet the requirements of relevant regulations.

People and their relatives spoke highly of the activities provided at the home. We saw regular activities, weekly timetables of planned events and monthly newsletters.

People told us the food served had improved recently. Fluid and food charts were used for people that required further support to maintain their nutritional needs, although, we found these records were not always completed properly.

People told us staff treated them with dignity and respect. We saw people being supported to be as independent as possible. End of life care was provided which was individualised to the person's needs and regularly reviewed.

Meetings took place in the home and annual surveys were used to gather people’s views on the home. We saw regular meetings took place with people, to ask for their views.

Although most people we spoke to said they received their medicines, we found not all medicines had been recorded, stored correctly and administered at the correct times.

We found infection control issues throughout the home which meant people were at risk of being exposed to harmful products, hazards and possible infection.

The provider did not always comply with the Mental Capacity Act (2005) as the process to evaluate the need for Deprivation of Liberty Safeguards (DoLS) was not always documented and mental capacity assessments were at times in accurate.

We found shortfalls in a number of areas relating to record keeping and audits in the service.

Quality assurance reports identified themes and trends for incident, accidents, safeguards, pressure sores and medicines however, these were not always effective as audits did not reflect all of the actions required.

People told us they felt safe living at Cookridge Court and followed the provider’s policy for reporting and acting on concerns.

Risk assessments were initially completed, reviewed and changed with peoples care needs. Staff were aware of individuals risks and how to support people.

Maintenance checks were carried out in the home to ensure it was safe.

Staffing levels were adequate although the provider’s dependency tool was ineffective as it did not reflect the amount of staff required. Most people living in the home and their relatives felt there was enough staff however; a few people felt this could be increased.

Appropriate checks were carried out to ensure staff working in the service were safe to do so and staff received initial induction programmes, training, regular supervisions and annual appraisals.

People were given a choice of food options however, there were mixed views on the quality of the food.

People living in the home had positive relationships with staff who said they were friendly, caring and respected their wishes. Staff ensured they always offered choice at all times and encourage people to remain independent when their health allowed.

Most information was safely stored in locked cupboards although some personal information had been left in a kitchen and handovers took place in communal areas which did not follow the provider’s policy.

Initial assessments were completed and care plans included people’s preferences and specific needs. These were reviewed and updated when people’s needs changed.

Activities took place within the home although we received mixed reviews on the quality of these.

We observed ‘Call bells’ being answered in a timely manner however, some people said they had to wait for assistance at times.

Most complaints were managed with actions taken to address the concerns and most people felt their concerns would be responded to. Some people living in the home felt their concerns had not been addressed and this was discussed with the regional manager.

People living in the home and staff spoke positively about the current management of the service.

We were informed that the home did not currently have a registered manager as the previous manager left recently and the regional manager was acting as manager until they had recruited into the post.

Regular meetings were held within the home and some of these were with care staff, kitchen staff, and the administration team.

The provider gathered feedback from people living in the home and their relatives with annual surveys and staff team engagement surveys.

Cookridge Court is situated in the Cookridge area of Leeds close to bus routes and local shops. The home is registered to provide accommodation for up to 96 people who require personal care, of which half may need care due to living with dementia. The accommodation is situated over three floors that are serviced by passenger lifts. All bedrooms are single rooms with en-suite facilities. There are several communal and dining areas and the home has an enclosed garden area.

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 told us they felt safe. Staff understand how to safeguard people from abuse. People and staff we spoke with expressed mixed views regarding staffing levels. We saw from the rotas staffing levels were based on the provider’s assessment of people’s needs but saw examples of where people’s care could have been compromised. The recruitment process was robust and staff completed an induction when they started work.

Individual risks were not always updated regularly, and sometimes contained contradictory information. People were mostly protected against the risks associated with the administration, use and management of medicines. We found people had access to healthcare services to make sure their health care needs were met. Overall, people lived in a clean, comfortable and well maintained environment.

Staff had completed a range of training; however, some staff training had expired. We saw from the 2016 supervision schedule staff had received supervision but not on a bi-monthly basis as stated in the provider’s policy and five staff member’s appraisal was overdue for 2016.

Most care plans we looked at contained a range of capacity assessments, although consent was not well documented. Staff told us they knew what ‘Deprivation of Liberty Safeguards’ (DoLS) meant, however, they were not immediately clear about the implications of having a DoLS in place, or which people this affected.

We observed the lunch time meal on all the floors and saw the food looked and smelled appetising. However, we saw an inconsistent approach to the monitoring of people identified at being at risk of poor nutrition or hydration and weight monitoring records were not always completed as required. We have made a recommendation regarding the monitoring of people’s food and fluid intake.

Throughout our visit, people were treated with kindness and compassion. Staff had a good rapport with people, whilst treating them with dignity and respect. However, we did see examples that demonstrated staff were not always caring. There was opportunity for people to be involved in a range of activities within the home or the local community.

We found care plans did not contain sufficient and relevant information, which meant people may not receive the appropriate care and support. People were not protected against the risks of receiving care that was inappropriate or unsafe. Care staff did not always have access to people’s care plans.

Staff provided positive feedback about the new manager and felt they had already made improvements to the service. People who used the service, relatives and staff members were asked to comment on the quality of care and support through surveys and meetings. Complaints were investigated and responded to appropriately.

We found some of the quality assurance systems were working well, but others needed to be improved to ensure people received a consistent quality service. Notifications had been sent to the CQC by the service as required by legislation. However, we noted two incidents recorded in people’s care plans had not been reported to CQC. Following our inspection we received both of these notifications.

We found shortfalls in the care and service provided to people. We found breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People had detailed care plans relating to all aspects of their care needs. They contained a good level of information setting out exactly how each person should be supported that ensured their needs were met. We spoke with seven people who used the service and they told us they were happy with the care and treatment they received. One person told us, “They are very nice and friendly people; it is like a hotel, everything is alright.”

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The design and layout of the premises was suitable for carrying out the regulated activity.

We found that people were supported by sufficient numbers of qualified, skilled and experienced staff which met people’s needs. People who used the service we spoke with told us there were always enough staff to help them when they needed support.

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. This provided a good overview of the quality of the service’s provided.