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 include residential and dementia specialist accommodation. The units are called 'Court suite', 'Grange', 'Iverson' and 'Lawnswood.'

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

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

Following the last inspection we imposed conditions on the provider’s registration of the service. At this inspection we found the service had met these conditions however, when we last inspected the service we found breaches and at this inspection that there had not been improvements therefore the breaches have remained.

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.

The inspection took place on 31 January and 3 February 2017 and was unannounced. We carried out the last inspection in December 2015, where we found the provider was not meeting all the regulations we inspected. We found at that inspection the care plans we looked at were not updated on a regular basis, some sections were not completed appropriately or were inaccurate. We concluded the provider had not taken appropriate steps to ensure staff received appropriate supervision and an appraisal in line with their own policy. We told the provider they needed to take action; we received an action plan telling us what they were going to do to ensure they were meeting the regulations. At this inspection we found the home was still in breach of these regulations. We also found additional areas of concern.

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 rece

We observed staff treating people with respect, being polite and courteous. People who used the service and their families had contributed their opinions and preferences in relation to how care was delivered. One person told us, “Staff listen to me and I can do what I want when I want.”

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.

This inspection took place over two days, on 13 and 15 December 2015. Both days were unannounced.

At the last inspection in May 2015 we found the provider had breached several regulations associated with the Health and Social Care Act 2008. We found people’s care plans did not contain person specific mental capacity assessments, applications for the Deprivation of Liberty Safeguards had not been carried out appropriately, care plans were not updated on a regular basis, some sections were not completed or were inaccurate. There were not enough staff to provide support to people who used the service, the provider had not taken steps to ensure staff received ongoing or periodic supervision and an appraisal to make sure competence was maintained. The management of medicines did not protect people from the risk of unsafe care or treatment, risks were not fully assessed for the health and safety of people who used the service and the environmental risks had not been updated. The provider had not taken appropriate steps to ensure people were protected from abuse and improper treatment, complaints were not acknowledged, recognised or handled in accordance with the provider’s complaints procedure and the provider had failed to monitor the quality of the service to identify issues. We told the provider they needed to take action; we received an action plan. At this inspection we found the home was still in breach of two of these regulations.

Cookridge Court and Grange is registered to provide accommodation for up to 96 people who require personal care, included people who are 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.

At the time of this inspection the home did not have a registered manager, although there was a manager who had been in post since May 2015 and had applied for registration. 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 it difficult to establish if staffing levels were maintained effectively on each floor on each shift. Staff did not receive individualised supervision and appraisal. Staff training did not always equip staff with the knowledge and skills to support people safely. We found care plans did not always contain sufficient and relevant information.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People received their medicines at the times they needed them and in a safe way.

Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. People’s mealtime experience was good and they received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

The care plans we looked at contained appropriate mental capacity assessments. At the time of our inspection Deprivation of Liberty Safeguard applications had been carried out appropriately. There was opportunity for people to be involved in a range of activities within the home or the local community.

People had opportunity to comment on the quality of service and influence service delivery. Effective systems were in place which ensured people received safe quality care. Complaints were welcomed and were investigated and responded to appropriately.

Although there had been some improvements since the last inspection, there was still a breach of regulation 9 and regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.