Archived: Cold Springs Park Care Home

Updated 17 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 20 September 2016 and was unannounced.

The inspection was carried out by a two adult social care inspectors.

Before the inspection we reviewed the information we held about the service. This included the registered provider's service improvement plan, the action plan for previous requirement notices and information shared by the local authority quality manager and commissioners. We also looked at the information we held from notifications sent to us about incidents affecting the service and people living there.

During the inspection we spoke with the regional support manager for BUPA care services, the registered manager, the deputy manager, unit managers, five staff members, three people who lived at the home and four visitors. We looked at records relating to medications for four people, records of accidents and incidents in the home and care records for seven people who used this service. We looked at a sample of the records relating to staff recruitment and supervision. We reviewed the quality audits carried out by the provider and records relating to the maintenance and safety of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk to us.

Updated 17 January 2017

This comprehensive inspection took place on 20 September 2016 and was unannounced.

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.