Cooper House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People said they were safe and staff were knowledgeable about their role and responsibilities in reporting concerns. People and their relatives were involved in decisions about their care. Staff recruitment practices were robust. Staff had ongoing support through training and supervision. People's care records provided a clear account of identified risk and care needs, and there was oversight and monitoring of DoLS (Deprivation of Liberty Safeguards). People, their relatives and stakeholders spoke of improvements at Cooper House following the recent appointment of the registered manager. People told us staff were very busy but were responsive to their needs. Staff told us, and records showed staffing numbers were not consistently maintained. Staff spoke of the challenges and difficulties of meeting people's needs due to staffing resources. We found a breach of the legal regulation in relation to the environment and contingency planning. Areas identified by the provider for environmental improvement were not supported by an action plan with timescales, and the system for monitoring and reviewing progress was not robust. This meant known issues had not been addressed in a timely manner. The impact of this was confirmed by some people we spoke with who had experienced difficulties in accessing hot water for showering and washing.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Prior to our site visit we received information of concern about the culture of the service and the lack of responsiveness to concerns, which included how the provider managed staff shortages and the shortfall in the supply of hot water at the service. Staff we spoke with confirmed there were problems with the supply of hot water to some bedrooms and shower facilities. A member of staff said, "Water is an issue, we can use 1 electric shower, so people do get a shower a week. With people who wish to wash, we carry a bowl of water from the kitchen to their bedroom." A member of the management team following our site visit advised an additional electric shower had been fitted to increase showering capacity, and that the shower would stay in place until the boilers were installed. They told us a recently appointed estates manager was working with contractors regarding the installation of new boilers, scheduled for installation in April 2024. Staff told us the recently appointed registered manager was responsive and listened to concerns and took action. Partner agencies confirmed following the recent appointment of the registered manager improvements had been made in a range of areas, including care records. This showed the management team and staff were listening and responding and implementing changes.

The learning culture did not fully reflect openness in recognising and managing safety events and the assessment of risk. For example, the potential risk of staff carrying water had not been assessed, nor had the implications on staff's time and availability to meet and respond to people's needs. An audit of accidents and incidents in January 2024 identified there had been an increase in the number of falls people experienced between late afternoon and early evening. In response, the audit outcome stated an additional member of staff would be on duty during this period of time. However, the staffing rotas for a 3 week period in February and March 2024 showed staffing numbers were not consistently maintained. For example, in the morning there were 6 or 7 staff on duty, and in the afternoon, staffing varied between 5 and 7 staff. The provider relied on a dependency tool to ensure staffing levels were sufficient to meet people's needs. However, the tool looked at people's needs over a 24 hour period and did not consider environmental factors or individual and collective needs. The dependency tool designer advised these factors needed to be considered by managers of services, when determining staffing numbers.

Most relatives found the culture of the service to be open, positive and honest about listening to personal safety concerns. However, people shared how known environmental concerns impacted them. People told us that on occasions warm water was brought to them by staff in a bowl or jug. A person told us, "I have to run the water for 5 to 10 minutes before it eventually warms up." A relative told us, “They are open to discussions, but I have no concerns. I can call them at any time, and they keep me informed of [family members] condition. A second relative told us, “It is safe here, it’s very good. I have got to know all the staff and they look after [family member] very well.”

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at Cooper House, this in part was due to them having developed positive relationships with staff, and those they lived with. A person told us, "I haven't got any concerns, if I did, I wouldn't hesitate to talk about them." Relatives told us they were confident to raise concerns with the management team and staff.

The atmosphere within the service encouraged and supported people to feel relaxed and confident that any concerns would be listened to and acted upon. Staff were kind and caring, and we observed positive interactions between people and staff. Staff were respectful in their interactions with people, using preferred terms of address and consulting with people before they provided support.

The local authority confirmed the registered manager referred safeguarding concerns to the safeguarding team, and that any actions required in response to the outcome of safeguarding investigations were actioned. Staff spoken with demonstrated a good understanding of safeguarding and felt confident in raising concerns and making suggestions if they felt people were at risk. Staff told us the registered manager was responsive, listened to their concerns and took action. Staff understood mental capacity and consent and respected people's right to decline care whilst also protecting them from the risk of neglect.

There were robust safeguarding procedures in place and timely notifications were made to external agencies in the event of actual or potential safeguarding incidents. Incidents, including safeguarding concerns were audited and overseen by senior managers. Staff had undertaken training in safeguarding. The registered manager had identified an increase in incidents and safeguarding's concerns had been mainly due to a service user whose needs had changed as dementia had progressed which had resulted in significant increase in distress. Lessons learnt had resulted in a change to the admissions criteria for people moving into Cooper House.

Relatives were aware of measures taken to reduce risk associated with their family members care. A relative told us, "My [Family member] has a walking frame, and they have placed a pressure mat by the bed." A second relative told us how the registered manager and staff had listened to their account of incidents and accidents which their family member had experienced before moving to Cooper House, and how in response, measures had been put into place to reduce risk when they moved into the service. A relative told us how their family members care plan and records had been updated, and how this was an improvement, as previously notes had not been organised well.

The management team and staff demonstrated a good understanding of risks relating to people's care. However, periods of distress were not always reviewed, and measures put into place to ensure sufficient staff were able to provide support. The providers reliance on a dependency tool to determine staffing levels meant individual and specific factors such as periods of a person's increased anxiety or distress, were not assessed independently so additional staff support could be planned for. A member of staff spoke of the importance of responding to alarms in a timely manner to reduce the risk of falls for service users assessed as high risk. Staff were able to describe how they were flexible in providing personal care to people that regularly declined but needed support to maintain their hygiene and dignity. They used a range of different approaches, including recognising when the person was responsive and offering personal care regardless of the time of day. Staff discussed people's needs and any concerns in a timely manner with the senior carer and freely approached the deputy or registered manager if they felt they needed additional advice or guidance. This helped to ensure timely action was taken in the event of changes to people's needs.

We observed staff including staff employed in roles other than care spending time interacting with people and providing reassurance and 1-1 support when people became anxious or distressed.

The management team undertook detailed assessments of the risks people faced and consulted people, family members and professionals in identifying measures to mitigate risks. Care plans were of a good quality and reflected people's individual care needs, including support plans for people with known triggers for periods of anxiety or distress. Care records included information which monitored people's capacity to make informed decisions. Systems to monitor Deprivation of Liberty Safeguards (DoLS) conditions were kept under review which supported staff in keeping people safe and reduce known risks. The registered manager undertook an analysis of incidents and accidents and referrals were made for additional support where required, for example, in reach team, falls team, assistive technology, and GP involvement.

The oversight of environmental concerns was not adequate to ensure a comfortable and safe place for people to live. The provider's processes for environmental improvements did not always include timescales for implementation and where timescales were provided these were not always met. For example, there had been a significant delay in making improvements to the hot water supply. We noted flooring in communal toilets and bathrooms was stained, and the garden was not safe for people to access independently. We were informed new flooring had been ordered, and there were plans to improve accessibility in the garden. However, there were no timescales for the work to be carried out. Audits were undertaken to monitor the safety of the environment and equipment. However, these did not always result in timely improvement. External contractors undertook routine safety and compliance checks of the premises and equipment, including electrical installation and fire systems.

Some people spoke of having no concerns about accessing hot water or showers. A relative told us, "My [family member] showers every day."

The provider in 2023 told us improvements would be made to the supply of hot water within the service. However, we found improvements had not been made. The provider was unable to provide a timescale for the works to be carried out at the time of our visit. Following our site visit we were provided with a timescale for the installation of a new system. As an interim measure the provider informed us they had installed an additional electric shower, along with a temporary solution to improve the supply of hot water across the service.

Improvements were needed to some areas of the environment. We noted the main lounge on the ground floor was being decorated, however, the same room had stained tiles on the ceiling.

People and relatives told us whilst staff were busy and rushed they felt there were enough staff. A person told us, "I think there are sufficient staff. There are plenty of staff walking around." A second person said, "Someone is always around when you need them. You can call out for them or press a buzzer and they come quickly if they are not busy." A relative told us, “Since the new manager has taken over, about six months ago, everything has been super. She makes sure that the residents get the care that they need. The staff have been more proactive in responding to people's needs."

An audit of accidents and incidents in January 2024 identified there had been an increase in the number of falls people experienced between late afternoon and early evening. In response, the audit outcome stated an additional member of staff would be on duty during this period of time. However, the staffing rotas reviewed for a 3 week period in February and March showed staffing numbers were not consistently planned for. For example, in the morning there were 6 or 7 members of staff on duty, and in the afternoon, staffing varied between 5 and 7 staff. The provider relied on a dependency tool to determine staffing levels. However, the tool looked at needs over a 24 hour period and did not consider people's collective needs, environmental factors, or short and intermittent needs for example when a person required additional support when anxious or distressed. The dependency tool designer advised these factors needed to be considered by managers as part of their calculations when determining staffing levels. The contingency plan around staffing involved the use of managerial staff to supervise communal areas where required (this was confirmed by staff) and the use of domestic staff to support care staff and staff from 'sister services'. Staff said this rarely happened as sister services also can be short of staff. Therefore these contingency plans may not be sufficiently effective in keeping people safe and meeting their needs. Staff recruitment practices were robust and staff were supported through ongoing training, supervision and assessment of their competence.

Prior to our site visit we received information of concern from staff about how the provider managed staff shortages. Staff told us the provider no longer used agency staff, and that staff from the provider's other services were used to manage staff shortages. Staff told us they sometimes struggle to get staff cover, and it can be difficult to provide the care people need during 'sundowning' (a state of confusion people living with dementia experience which usually occurs in the late afternoon, early evening). A staff member said, "We struggle when staffing goes down to 4, as the senior is often involved in administering the medicines and other duties, and 4 or 5 people need hoisting which requires 2 staff, so we have to ask the deputy or registered manager to supervise people in the lounge." A senior manager confirmed staff from 'sister' services are used to support staff shortfalls, and this approach provides continuity of care as staff have undertaken the same training and are familiar with the provider's systems and processes. Managers were not expected to sit in the lounge to ensure people's safety, and weekly meetings were held to review the dependencies for all people.

We observed positive caring interactions between people and staff during our site visit. Staff were busy and were not seen to sit with people, however care was not rushed and people were given the time they needed. A staff member was present in the lounge which the provider has assessed as a requirement to reduce risk. However, for most of the day of our site visit this was undertaken by the deputy manager, and on occasions the activity co-ordinator, as staff were busy providing care.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.