Cooper House Care Home

Cooper House is a residential care home providing personal and nursing care for up to 80 people. The service provides support to older people some of whom are living with dementia. The home is purpose built with accommodation provided in separate units over three floors, each with their own facilities. At the time of our inspection there were 42 people using the service.

People’s experience of using this service and what we found

Medicines were not always managed safely which placed people at risk of harm. The provider was working with external specialists to monitor subsidence issues with the building. However, we were not assured the risks had been fully mitigated.

We found improvements had been made since the last inspection which had resulted in better outcomes for people using the service. People received person-centred care. Staff knew people well and understood how to support people who were distressed or anxious. Staff were kind, caring and compassionate. They treated people with respect and maintained their dignity.

Staff understood how to manage any risks to people and knew the processes to follow to manage any allegations of abuse. Care records provided detailed information about people’s needs and preferences.

There were enough staff to meet people’s needs. Recruitment processes ensured staff were suitable to work in the care service. Staff were trained and had received recent supervision. Communication systems had improved; a range of daily meetings ensured managers and staff were kept updated about any changes.

Leadership and management had improved. The manager had good oversight and knowledge of the service and monitored and supported the staff team making sure the quality of care was maintained. Quality assurance systems were effective in identifying and addressing issues, although medicine audits needed to improve. Accident and incidents were analysed and lessons learned were shared with staff. The provider had an ongoing improvement plan to ensure improvements were sustained.

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 inadequate (published 28 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in relation to these breaches.

This service has been in Special Measures since 28 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service on 27 May to 11 June 2021. Breaches of legal requirements were found. We served warning notices in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and requirement notices in relation to Regulations 10, 13 and 18.The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection 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, Caring and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified two breaches in relation to medicines and the premises at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cooper House is a residential care home providing personal and nursing care for up to 80 people aged 65 and over, some of whom are living with dementia. The home is purpose built with accommodation provided in separate units over three floors, each with their own facilities. At the time of our inspection there were 67 people using the service.

People’s experience of using this service and what we found

People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people’s health and care needs as well as environmental risks. Safeguarding procedures were not followed consistently.

Parts of the premises were not clean or well maintained. Some people’s rooms were personalised and comfortably furnished; others were stark and bare with damaged furniture and no personal effects. Infection control procedures were not always followed by staff as personal protective equipment (PPE) was not worn correctly and social distancing was not maintained.

There were not always enough suitably qualified, competent, skilled and experienced staff deployed to meet people's needs and keep them safe. Staff were rushed and people were not provided with the care, support and comfort they needed. Staff received training and support to carry out their roles, however we found some staff did not have the skills or competencies to meet the needs of people living with dementia.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always treated with respect by staff or had their privacy and dignity maintained. Although some staff were kind, caring and compassionate and treated people well, other staff were task focussed and did not respond appropriately to people’s needs.

There was a lack of consistent and effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level. Effective systems were not in place to address shortfalls identified at the inspection and drive improvement.

People were supported to keep in touch with family and friends through video, phone calls and indoor visits. Activities were taking place. People had access to healthcare services and received their medicines when they needed them. People were provided with plentiful supplies, and a choice of, food and drinks.

The provider was responsive to the inspection findings, took action during and after the inspection and shared plans to improve their systems and processes.

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

Rating at last inspection

The last rating for this service was good (published 20 October 2018).

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about falls and risk management. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We inspected and found there were concerns with risk management, so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from good to inadequate This is based on the findings at this inspection.

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 Cooper House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, safe care and treatment, staffing, dignity and respect and good governance at this inspection.

Full 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

The home was clean and well ventilated.

The home closed to all non essential visitors when the national lockdown was imposed. Before the national lockdown the home had been able to offer indoor visiting in a designated indoor space. Safety measures in place to reduce the risk of transmission during these visits included offering COVID-19 testing to relatives using Lateral Flow Tests.

People living in the home and staff had regular COVID-19 tests through the government testing scheme. In addition staff had twice weekly testing using Lateral Flow Tests.

Everyone living at the home had received their first dose of the COVID-19 vaccination. The roll out of vaccinations to staff was still in progress at the time of our inspection.

There was a good supply of Personal Protective Equipment (PPE) including aprons, gloves, masks and hand sanitiser. Staff had received training on the correct use of PPE and checks were done to make sure they continued to follow best practice guidelines.

Cooper House is a ‘care home.’ People in care homes receive accommodation and nursing or 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 80 older people and older people living with dementia in one purpose built building. Accommodation is provided over three floors.

The service provides personal care and nursing care to people living with dementia, older people and adults. At the time of our inspection there were 75 people using the service

When we inspected the service in August/September 2016 it was rated as ‘Inadequate.’ When we returned in July 2016 the current registered manager had taken over and improvements had been made. The service was rated as ‘Requires improvement’ because we needed to be assured improvements could be sustained and developed over time. On this inspection we found improvements had been sustained and developed further. in addition, we found the service had improved to outstanding in the caring domain

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.

The service was exceptionally caring. Everyone we spoke with was very complimentary about the service and said they would recommend the home. There was a strongly embedded culture within the service of treating people with dignity, respect, compassion and love.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and management team. Staff were receiving formal supervision where they could discuss their ongoing development needs.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. There was an excellent choice of meals and people said the food was very good. There were plenty of drinks and snacks available for people in between meals.

Excellent activities were on offer to keep people occupied both on a group and individual basis. Trips out were arranged every week and there were good links with the local community. Visitors were made to feel extremely welcome and could have a meal at the home if they wished.

The home was spacious, well decorated, clean and tidy. All the bedrooms were single occupancy with en-suite toilets and showers.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Everyone spoke highly of the registered manager who said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

At the last inspection on 22 and 29 November 2016 we rated the service as ‘Inadequate’ and placed the service in ‘Special Measures.’ We identified seven regulatory breaches which related to staffing, safe care and treatment, safeguarding, dignity and respect, person-centred care, need for consent and good governance. Following the inspection we took enforcement action. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was undertaken to check improvements had been made and to review the ratings.

Cooper House is a purpose built care home situated in a residential area of Bradford. The home offers care to older people requiring general and specialist dementia nursing care and residential dementia care. Cooper House provides accommodation in 80 single en-suite bedrooms with shower facilities arranged over three floors. There are lounge/dining rooms on each floor, a garden area and car parking to the front of the building.

At the time of the inspection there were 68 people using the service.

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.

The manager was providing strong leadership and direction and had brought about significant improvements in all areas of the service. We found staff up-beat, enthusiastic and confident, which had a positive effect on the people they cared for.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their various roles. Staff told us they felt supported by the registered manager and deputy manager and were receiving formal supervision where they could discuss their on-going development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion. They also told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

Staff knew about people’s dietary needs and preferences. People told us there was a choice of meals and said the food was very good. We also saw there were plenty of drinks and snacks available for people in between meals.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People who used the service and relatives told us they were happy with the care and support being provided. We saw people looked well-groomed and well cared for.

People’s healthcare needs were being met and medicines were, in the main, being managed safely.

Activities were on offer to keep people occupied both on a group and individual basis.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We saw some redecoration and refurbishment had taken place since our last inspection to improve the communal areas of the home. We found the home clean, tidy and odour free.

We saw systems had been introduced to monitor the quality of the service. We saw these had identified areas for improvement and action had been taken to address any shortfalls. People using the service and relatives were being consulted about the way the service was being managed and their views were being acted upon. We saw that the audit systems were helping to drive improvements in the service. Whilst it was clear the service was on a journey of improvement, it was too early for the provider to be able to demonstrate that the quality processes were fully embedded and that these improvements could be sustained over time.

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 is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Cooper House is a purpose built care home situated in a residential area of Bradford. The home offers care to older people requiring general and specialist dementia nursing care and residential dementia care. Cooper House provides accommodation in 80 single en-suite bedrooms with shower facilities arranged over three floors. There are lounges and dining rooms on each floor, a garden area and car parking to the front of the building.

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.

Prior to this inspection we had received a number of concerns relating to management of risks, people’s personal care and nutritional needs not being met, lack of staff and management of the service.

When we inspected the service in March 2015 we identified seven breaches of regulations and the overall quality rating for the service was inadequate. When we returned in October 2015 we found some improvements had been made but the service remained in breach of three regulations and the overall quality rating was requires improvement. On this inspection we found some of the improvements we saw on the last inspection had not been sustained and there had been a further decline in the service.

Staff were being recruited safely, however, there were not enough care staff on duty to keep people safe or to meet their needs in a timely way. There were not enough housekeeping staff to ensure the home was kept clean at all times or enough laundry staff to ensure people’s clothing was returned to the right people.

A number of people using the service had been assessed as being at high risk of falls. We saw there had been several un-witnessed falls on the second floor and not enough had been done to mitigate the risk of people falling. The design and layout of the building made it difficult for staff to supervise communal areas as well as the corridors. We saw people walking around going in and out of other people’s bedrooms with no staff available to redirect them.

Although there were safeguarding policies and procedures in place and staff were able to tell us how they would make a referral they were not identifying omissions to people’s care and their safety as safeguarding issues. Following our visit we made six safeguarding referrals to the local authority adult protection team for their consideration.

We found the service was not meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

People’s healthcare needs were being met and medicines were being managed safely.

People told us there was a choice of meals and the food was good. We saw people’s weights were monitored closely and high calorie smoothies were provided to people who were nutritionally at risk.

In their direct dealings with people we saw most staff were kind and caring. However, we found practices in the home which showed a lack of respect and compassion for the people who lived there. People were not receiving person centred care which met their needs or preferences.

Staff told us training opportunities at the service were good and we saw from the records the majority of staff were up to date with their training. However, we saw there were times when staff did not have the necessary skills to support people.

There was a complaints procedure in place and formal complaints had been investigated and responded to. However, the registered manager was unaware of the problems with the laundry system which we raised with them.

We saw a range of checks were undertaken on the premises and equipment to help keep people safe. These included checks on the fire, electrical and gas systems.

We found there was a lack of effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. We found shortfalls in the care and service provided to people. We identified seven breaches in regulations – regulation 18 (staffing), regulation 12 (safe care and treatment), regulation 13 (safeguarding), regulation 10 (dignity and respect), regulation 9 (person-centred care), regulation 11 (Need for consent), and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. 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

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.

Before this inspection we had received information of concern about staffing levels and care practices at the home. We looked at these issues during this visit and did not find any evidence to support this.

We reviewed all the information we held about the home before this inspection. This included information from the provider, and speaking with the local authority contracts and safeguarding teams.

On the day of our inspection we spoke with 12 people who lived at Cooper House, six relatives who were visiting the home, ten members of staff, the registered manager and the operations director. We looked around some areas of the building including people's bedrooms, bathrooms and communal areas. We also spent time looking at records, which included eight people's care records and records relating to the management of the home.

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Is the service safe?

Some aspects of the service were not safe. We found areas of the home were not clean. This meant people were not living in a clean and hygienic environment.

Medicines were managed safely and people received their medication at the right times.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005. This is legislation that has been designed to protect people who can't make decisions for themselves or lack the mental capacity to do so.

We found the location was meeting the requirements of the Deprivation of Liberty Safeguards.

Is the service effective?

The service was effective. People's nutritional needs were met. The menus we saw offered variety and choice and provided a well-balanced diet for people who lived at the home. We saw staff actively encouraged people to choose their meals.

Records showed people had regular access to healthcare professionals, such as GP's, community matrons, dieticians, specialist nurses, podiatrists and opticians.

Is the service caring?

The service was caring. Staff knew about the lives, interests and preferences of the people in their care. We saw staff treated people with patience, care and compassion.

People's care plans were easy to follow and staff were able to tell us in detail about what care and support the people who lived in the home required.

Is the service responsive?

The service was not always responsive. There were not enough appropriate activities on offer for people on an individual or small group basis. We also saw people who lived at the home were upset when they couldn't find staff to offer them support and direction.

People's health, care and support needs were assessed and individual choices and preferences were discussed with people who lived at the home and/or a relative. We saw people's care plans had been reviewed on a monthly basis.

Is the service well-led?

The service was not well led. We found although there were procedures in place to monitor the quality of the service these were not always effective.

There had been a number of accidents and incidents recorded many of which had not been witnessed by staff. No analysis of these had been completed to see if there were any common trends or to identify any actions that may reduce risks to people who lived in the home.

A relative told us they were involved in discussions and decisions about their relatives care needs and were kept informed about any changes. They said "my relative loves it here,I am involved with my relatives' care plan. The staff are really good with my relative and is in good hands here, well cared for and loves the food." People who lived in the home and their relatives said the food was very good and the home was clean, nice and comfortable.

'The staff have been doing dementia training and we have noticed a big difference since your (CQC's) last visit. The changes are very positive. Instead of having two lounge/diners they have made one into a dining room and the other is the lounge. This is better for people as they have to get up and move around more. It is also easier to keep these rooms clean as at some point during the day they are empty so the cleaner can get in.'

'We have notice a more systematic approach to the cleaning and they are keeping on top of it.'

'My relative is happy here and really likes the food but would like more activities.'

'Someone used to come and do armchair Zumba, which was really good, but we haven't seen them recently.'

'The staff are nice if you ask for something they will get it for you.'

We spent time on the first floor where people are living with dementia. We saw that there were staff available in the lounge and dining room to offer support. The atmosphere was relaxed and we saw some warm interactions between staff and people living at the home.