This inspection took place on 29 & 30 August 2018 and was unannounced.

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.

This inspection took place on 5, 10 and 11 July 2017 and was unannounced.

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 relative

We inspected Cooper House Care Home on 22 and 29 November 2016 and the visits were unannounced.

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 che

We inspected Cooper House Care Home on 13 October 2015 and the visit was unannounced.

Our last inspection took place on 16 and 17 March 2015. At that time, we found breaches of legal requirements in seven areas; fit and proper persons employed, staffing, safe care and treatment, dignity and respect, person centred care, receiving and acting upon complaints and good governance. We asked the provider to make improvements and they told us they would be fully compliant with the regulations by 31 July 2015.

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. Cooper House provides accommodation in 80 single en-suite bedrooms with toilet and shower facilities arranged over three floors. On the day of our visit there were 74 people living there and two people were in hospital.

The service did not have a registered manager. 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. A manager was in post who was intending to register with CQC.

Recruitment procedures ensured staff were suitable and safe to work with people. Staffing levels were sufficient to meet people’s needs and to keep the home clean. Training for staff had improved and staff understood their roles and responsibilities. We found leadership across the three floors varied and found some staff were working better as a team than others.

People told us they felt safe in the home. Staff had a good understanding of what constituted abuse and the reporting mechanisms. We saw any allegations were dealt with appropriately and referred to safeguarding.

Some areas of the home had been redecorated and the communal spaces had been re-designed to make them more homely; as well as memorabilia to interest people such as rummage and memory boxes. We also found the home was clean and tidy. There were a number of checks in place to make sure the premises and equipment were kept in good order.

Staff understood the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

We found care plans were in place, however, these were not always up to date and did not demonstrate how people had been involved in planning their care and support. Risk assessments had not always been updated or plans put in place to show what action had been taken to mitigate any risk to people.

People told us staff were kind and caring and that they were treated with dignity and respect. There were some activities of offer for people to join in with and relatives told us they were made to feel welcome when they visited.

People’s health care needs were being met and doctors or community matrons were called if they were unwell. We found the medication system was well managed and people were receiving all of their medicines as prescribed by their doctor.

The chef had a good knowledge of people’s dietary preferences and spoke with them directly about the meals on offer. People told us the meals were good offering both choice and variety.

A complaints procedure was in place and we saw the manager had taken action to resolve the complaints they had received.

A new manager has been in post since May 2015 and they have made significant improvements. People knew the manager and told us they were approachable and supportive.

We found some of the quality assurance systems were working well, but found inconsistencies between the service being delivered on each floor. For example, team working and mealtimes. Further improvements need to be made and others consolidated so people receive a consistent, quality service.

We found three breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.

The inspection team consisted of two inspectors, a specialist advisor and an expert by experience.

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.

We spoke with five people who lived at the home, two relatives and staff. These are some of the things they told us;

“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.

We spoke with five people who lived at the home, two relatives, two visiting health professionals, a volunteer and staff. These are some of the things they told us;

“They are always short of staff. They tell you to press your buzzer if you need help and they used to come straight away, but not now.”

“I usually have to wait quite a long time after I press my buzzer.”

“The Sunday dinner is usually alright, but I couldn’t cut up the Yorkshire pudding this week, I had to fight with it.”

“I had a terrible night, there was someone shouting and carrying on all night. When I first came here I was told that I would be with people like me, who I could talk to, but it’s not like that now. I’ve nothing to keep my brain going at all. I wish I was in my own home again.”

“I can’t fault it I think they are good.”

“Staff are very good and caring, they care for my relative and look after me too.”

“Staff deliver basic care and follow instructions. The staff are caring but there are not enough of them.”

“They are really poor at answering the telephone you can ring and ring for ages, but the phone is in the nurses room and if no staff are around it just doesn’t get answered.”

At the start of the planned review representatives of people using the service told us they were concerned that people were not always receiving safe and appropriate care. They told us they were concerned that the senior management of the company were not taking action quickly enough to sort out the problems in the home.

The people we spoke to when we visited the home told us they were satisfied that their relatives are receiving appropriate care. They told us they are kept informed about their relatives care and any changes. One person told us they had "no qualms" about leaving their relative at Cooper House, they said they felt safe in the knowledge that they would be contacted if there was any change in their relatives condition. Another person said they would give the home a score of 8 out of 10, (10 being the best). They said their relative had improved and gained weight since moving into Cooper House.

People said they have seen some improvements since the new manager started. However, some said they were cautious because they had been given assurances in the past that improvements would be made and these had not been sustained.

Some people told us they had lost confidence in the home's complaints procedures. They said they were listened to but action was not always taken to put things right and they were having to complain about the same things repeatedly. Other people told us they seldom had anything to complain about but on the occasions that they had the matter had been dealt with.

People told us the staff are kind and treat them well. They said they the home has a good group of core staff but worried there are not enough of them. They told us they were worried by all the staff changes and the high use of agency staff. People told us some staff did not always seem to understand and be able to meet people's care needs.

People told us the home is clean and does not have unpleasant odours.

People told us there is a problem with the home's telephone system. They said they often have difficulty getting through to the home, particularly in the evening and at weekends.

People told us they were concerned that the home had not taken action to clear the paths and fire exits during the recent severe weather.

We inspected Cooper House Care Home on 16 and 17 March 2015 and the visits were unannounced.

Our last inspection took place on 19 August 2014. At that time, we found breaches of legal requirements in two areas, cleanliness and infection control and assessing and monitoring the quality of the service. We asked the provider to make improvements and they told us they would be fully compliant with the regulations by 30 October 2014.

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. Cooper House provides accommodation in 80 single en-suite bedrooms with shower facilities arranged over three floors.

The service has 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.

The service was not well-led as the registered manager was not responding to complaints and some staff were frightened to speak with us because they thought they would get into trouble or lose their jobs. Although there were lots of audits in place these were not effective as they did not identify the areas we have found that are in breach of the regulations.

On the second day of our inspection the operations director took immediate action to strengthen the management of the home.

Staff were not being recruited safely and there were not enough staff on duty to provide the care and support people needed. We saw some staff were very good and talked with people and were confident in their role. However, some staff lacked the skills and experience to care for people in a respectful and dignified way.

We found staff were doing most of their training on the computer and were not getting supervision to help with their personal and professional development. This meant there were no formal checks on individual staff member’s practice.

The medication system was not being managed safely and there was a risk of people not receiving their medication.

The home was clean and tidy and most of the bedrooms we saw had been personalised to suit the taste of the occupant.

Meals at the home were good, offering choice and variety. However, staff were not always offering people choices at mealtimes.

There was a good activities programme in place and we saw people enjoying the activities that were on offer. People also told us there were trips out which they really enjoyed.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to 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.