Cookridge Court is a 'care home'. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Cookridge Court is a residential home providing accommodation for persons who require personal care, some of whom are living with dementia. Cookridge Court has four units which included residential and dementia specialist accommodation. The units were called ‘Court suite’, ‘Grange’, ‘Iverson’ and ‘Lawnswood.’ 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.