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Inspection on 06/08/08 for Copper Beeches Nursing Home

Also see our care home review for Copper Beeches Nursing Home for more information

This is the latest available inspection report for this service, carried out on 6th August 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

A new manager was appointed and is now registered with us. Carpets in corridors and some bedrooms have been replaced, more profiling beds have been acquired and some areas have been redecorated. Care staff are endeavouring to improve their record keeping skills so they provide more detail and accurate information.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Copper Beeches Nursing Home 5 Sylewood Close Cookham Wood Rochester Kent ME1 3LL Lead Inspector Elizabeth Baker Key Unannounced Inspection 6 August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copper Beeches Nursing Home Address 5 Sylewood Close Cookham Wood Rochester Kent ME1 3LL 01634 817858 01634 817855 copperbeeches@schealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare (SE) Ltd. Miss Ellen Delaney Care Home 42 Category(ies) of Dementia (0) registration, with number of places Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE) The maximum number of service users to be accommodated is 42. Date of last inspection 29th November 2006 Brief Description of the Service: Southern Cross Healthcare (SE) Limited operates Copper Beeches. The home is registered to provide services for up to 42 people who have Dementia and have been assessed as having additional nursing care needs. There is a mixture of single and shared rooms and residents’ accommodation is arranged over two floors. A passenger lift provides access to the first floor. There is a small garden and patio area at the rear of the home. The home is situated on the outskirts of Rochester close to local amenities and public transport. The building is a modern detached property, which has parking to the front. Current fees range from £594.25 to £850.00 per week depending on assessed needs, room occupied and funding arrangements. Additional charges are payable for chiropody, hairdressing and toiletries. A church service takes place at the home monthly. Activities currently include quizzes, knitting sessions, armchair exercises, flower arranging, various games, gardening, cooking and barbecues. External entertainment includes singers, memory makers, a summer fun day, karaoke and a mini bus trip. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means people who use this service experience good quality outcomes. Link inspector Elizabeth Baker carried out the key unannounced visit to the service on the 6 August 2008 and a return visit by appointment on the 7 August 2008. In total the visit lasted just over 10½ hours. As well as briefly touring the home, the visit consisted of talking with some residents and staff. Two members of staff and two visitors were interviewed. Verbal feedback of the visit was provided to the registered manager at the end of the visit. In preparation of this visit we (the Commission) provided the home with surveys for them to distribute to the residents, care managers and healthcare professionals. Sadly these were not distributed as requested. We subsequently made telephone contact with four advocates. We also required the home to complete and return an Annual Quality Assurance Assessment (AQAA). This was not returned to us by the required date. A completed copy was provided to us on the 7 August 2008. Some of the information gathered from these sources has been incorporated into this report. At the time of this visit, 36 residents were living at the home. We have not received any direct complaints about the service. There have been two safeguarding adult investigations, one of which is still ongoing. The AQAA records the home has received four complaints, all of which were upheld. There have also been two staff referrals to the Protection of Vulnerable Adults List and two referrals to the Nursing and Midwifery Council. What the service does well: The new registered manager was receptive to advice given and demonstrated an eagerness to put right any matters needing addressing to improve the service. The registered manager spoke openly throughout the inspection process. Staff interviewed are enthusiastic about their roles and enjoy working at the home. The AQAA records details of what the service does well including: • The home has an open visiting policy • It places a high emphasis on residents’ care and welfare and support for relatives Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 6 • • Care plans are audited and monitored so that remedial action can be prompt to maintain standards The manager is very active in the clinical area and works with staff and the multi professional team to continue to improve standards Comments from telephone respondents included “the registered manager is very nice”, “cannot fault the care [relative] receives now”, “when complain this gets things done”, “very good home”, “relative is safe now and are kept very much informed of their condition”, “very friendly staff”, “things have improved but can slip back”, “the new manager is trying very hard to get the right staffing levels and right people”, “staff in their own ways are very caring” and “it is a happy place, people are friendly but there are occasional smells”. And in January 2008 an advocate wrote to us to compliment the staff on an “exceedingly good job” and expressed additional praise for the new manager who the advocate felt “has done an excellent job in bringing all aspects of the home together”. What has improved since the last inspection? What they could do better: The use of inappropriate devices to prop open bedrooms doors compromises the home’s overall fire safety standards for all residents, staff and visitors. To maximise residents’ protection, the home must demonstrate that its vetting process of new staff fully complies with current regulations. This refers to investigating employment gaps in application forms. The number and deployment of staff must be reviewed to ensure that all residents are provided with appropriate assistance with their meals, as per their assessed individual needs. Indeed a telephone respondent indicated that when visiting at mealtimes there can be a lack of supervision in the dining rooms, resulting in some residents not eating their meals. More attention must be given to ensuring the self esteem of all residents is maintained with particular regard to hairdressing needs. So residents are living in a comfortable environment the blown window panes, stained carpets and worn bed linen must be replaced. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 7 One telephone respondent said communication between staff could be improved as not all information is passed on as should be, resulting in some care inconsistencies. And another respondent indicated there can be difficulties in trying to leave messages about care concerns because regular nurses are not always available. The AQAA states the home could do better by: • Improving residents’ experience of meal times • Continuing to improve care planning with regards to person centred care • Improving staff’s understanding with regards to individual choice, dignity and respect of the service user. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a visit to this service. New residents move into the home knowing their assessed needs can be met. EVIDENCE: Where practicably possible the registered manager visits prospective residents in their current place of occupation to determine whether the home is suitable to meet their individual needs. Information is also sought from other agencies involved in prospective residents’ care including local authorities and or primary care trusts, where a sponsor is involved in the placement. Information gathered during the pre admission process is then used to help inform a plan of care, which all residents are provided with following their admission into the home. Not all prospective residents are able to visit the home prior to admission. Where this is the case, their relatives or advocates do so on their behalf. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 10 The home has recently revised its Statement of Purpose and Service User Guide. For equality and diversity purposes, the Service User Guide states it is also available on an audio cassette. Both documents advise the reader on how to make a complaint. However neither document outlines the addresses and telephone numbers in order to make a complaint, for ease of access purposes. The section also refers to the inspection and regulatory authority. However our contact details are stated under the Quality Assurance section of the document. For ease of reference having addresses and telephone numbers of both the provider and us in the complaints section, might prevent any delay in accessing contact details. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a visit to this service. The health and personal care needs of residents are met with evidence of multi-disciplinary working taking place on a regular basis. EVIDENCE: For case tracking purposes the care records of four residents were inspected. Records contained pre admission assessments, care plans and a range of supporting clinical and safety risk assessments, including wound and body maps, tissue viability, falls, nutrition, moving and handling, weights, continence and dependency. Each care plan had a review form which indicated monthly reviews are undertaken. However where a change in the residents’ condition or preference was identified elsewhere in the care records, this did not always generate a review or update of the respective care plan component. This included skin integrity and personal hygiene. Indeed a change in the resident’s skin integrity had not generated a review of the corresponding Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 12 assessment either. Daily progress notes are kept and had been initialled timed and dated. The notes generally gave a mix of residents’ quality of day and health condition. However some entries were difficult to decipher because of the handwriting and an abbreviation had been used. Written care records should be easily readable and not contain any abbreviations. Registered nurses must ensure they maintain all care records in according with the professional body’s guidance on good record keeping. Medication administration record (MAR) charts were inspected. Generally these had been completed as is required by current good practice. However where a variable does analgesia had been prescribed on an administer when required basis (PRN) neither the MAR chart or corresponding care plan contained precise administration details. There was no accompanying pain assessment chart either to monitor the effectiveness of the treatment. The home has a clinical room in which medicines and nursing sundries and aids are securely and hygienically kept. As is good practice daily records are maintained of the drug fridge and room temperatures. However a review of the room temperature records identified there are occasions when the temperature exceeds the recommended levels. Medicines must be kept at temperatures stipulated by their manufacturers to maximise the efficacy of the treatment plans. Residents were seen appropriately dressed for the time and day. The first inspection visit coincided with the hairdresser’s visit. A number of residents were seen having their hair done by the hairdresser at this time. However some other residents were seen with dishevelled hair giving them an unkempt appearance. Files contained personal hygiene charts for staff to complete as and when assistance and or support are provided. In one case the chart had been completed to show that for July and up to the time of this visit a particular resident had had their hair washed/set on three occasions only – all in July. This was despite a request that the resident has their hair washed at least twice a week due to its condition. The records did not indicate whether there had been a specific cause that the request had not been met. Personal care is an important aspect of residents’ wellbeing and must be met. Because of residents’ frailties many residents are incontinent and rely on aids to preserve their dignity. Residents are provided with individual incontinence protection aids, with the exception of net knickers. Using net knickers on a communal basis is institutional practice and should be discouraged. Most of the residents living at the home will do so for the rest of their lives. Information on residents’ spiritual preferences is sought at the time of their admission. Care plans have a death and dying component. However where a religion is identified on admission this is not always transferred to the care plan component, which could result in a resident not getting their end of life spiritual needs. Apart from one, records included resuscitation instructions. Having full spiritual, cultural and end of life details can help minimise any Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 13 unnecessary omissions, errors and or anxieties at a sensitive time. The training matrix provided in support of this visit does not demonstrate staff having received palliative care or end of life training. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a visit to this service. Meals and activities offer both choice and variety. Residents are supported in attaining their lifestyle preferences. EVIDENCE: The home offers a range of structured activities for residents to take part in if that is their wish. There is a four weekly rota and include activities such as baking, chair exercises and musical movement, arts and crafts, ball games, quizzes, sewing, chit and chat, reminiscence, reading and bingo. Indeed a resident said how much they enjoyed the bingo. External entertainers also visit the home and provide singing, music and Karaoke. A summer fun day has been arranged for the 16 August 2008. And a number of residents are able to go to the seaside as the home is able to use a minibus on an occasional basis. One to one sessions are provided for residents who prefer or because of their condition remain in their bedrooms. Many residents have their own TVs and or radios and many were on during the visit. However some residents did Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 15 not seem to be engaged with the TV programmes being broadcast as they appeared to be asleep. For one resident a modern radio station was playing whereas the residents’ preference is classical. A classical programme was heard in this room at the end of the visit. Bedrooms seen had been individualised with personal effects. A visitor said they can visit their relative when they like and are offered refreshments. A Church of England service takes place at the home on a monthly basis. Other faiths and beliefs would be catered for on request. And birthdays are celebrated with a cake and greetings card. Each floor has its own dining room for residents to use if that is their wish. The registered manager said the majority of residents require assistance and or support with their meals. Because of this meals are served in two sittings. However during the visit to the first floor on the 6 August a number of breakfasts were seen left in bedrooms getting cold, whilst waiting for staff assistance. Indeed in one case two bowls of cereal and one drink were left precariously on the foot board of one bed. Another drink had been left on a digital box on top of a TV. In another room the resident’s breakfast had been left in front of them, getting cold. The resident was asleep in their armchair. When meals are finished with on this floor they are taken to the kitchenette. Records are supposed to be kept of meals consumed. However where an uneaten breakfast was seen left in this kitchenette, neither the circumstances nor name of the resident could be established. Although meals were not sampled on this visit, an appetising lunch was seen. A telephone respondent indicated their relative enjoys their meals but would like more bread and butter as they continually feel hungry. Residents are weighed and the weights are recorded. Specialist advice from dieticians is sought if there is an assessed need. Because some of the residents have difficulty sitting on the chair scales, the home has purchased a weighing device which is fixed onto a hoist. This is good practice. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a visit to this service. Residents and their advocates can be satisfied their concerns are complaints are listened to and acted upon. EVIDENCE: A complaints procedure is displayed in the reception room. Reference to complaints is included in the Statement of Purpose and Service User Guide. However as stated previously the address and telephone number are not included in these documents, preventing ease of access. The home maintains a log of both formal and non-formal complaints. This is good practice as it is a means of monitoring trends for quality assurance purposes. The visitors spoken to and advocates subsequently contacted said they knew what to do if they had a concern. Staff interviewed described appropriately the action they would take if they suspected abuse had taken place. The training matrix supplied in support of this inspection indicates that 49 of staff have received abuse and POVA training. There have been two safeguarding investigations in the last 12 months, one of which is ongoing. The investigation is being carried out under the county’s multi agency procedures. Although we have not received any formal complaints about the service, a complainant made us aware of their correspondence with the provider. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a visit to this service. Improvements to the environment will enhance residents’ quality of life. EVIDENCE: An environmental inspection of the home’s kitchen and some associated records was undertaken last year. Legal contraventions were noted. The registered manager said all the required work was carried out. The kitchen was not inspected as part of this visit. The home has small rear gardens and a patio area for residents to use in good weather. However weeds were growing through the pavement slabs and the flower beds and lawn was overgrown, providing an uninviting and neglected look. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 18 With the passage of time and continuous wear and tear the decorative state of parts of the home are looking tired. Numerous doors, walls and doorframes are contact damaged by wheelchair or other mobility aids giving the home an institutional feel. Since the last visit the registered manager said some carpets have been replaced, including corridors and in a number of bedrooms. And that the carpet replacement programme continues. This is good news as a number of bedroom carpets seen on this visit were stained and worn. Since the last visit window restrictors have been replaced. Sadly the frames have not been made good following the removal of the original fitments. Numerous window panes in residents’ bedrooms were seen to have “blown” giving a dirty window appearance, as well as reducing residents’ views. The home’s driveway requires attention as there are many potholes. This makes walking hazardous and ambulance transfers uncomfortable. The provider leases the property. Freeholders are responsible for major building and maintenance work. An annual building survey has just taken place and has also identified that the home requires some work, including the driveway and windows. The home tries to accommodate all residents’ lifestyle wishes and preferences, and this includes propping open bedroom doors. A Zimmer frame, large teddy bear and foot stools were seen in use to achieve these wishes. Whilst not wishing to deny residents their choice, for the protection of all residents living at the home, as well as staff working there, it is the provider’s responsibility ensure that only approved devices are in place. The home had been contacted by the county’s Fire Safety Officer informing them of an imminent fire safety audit of the home. We required the registered manager to seek the Fire Safety Officer’s specialist advice during his visit. As expected of homes providing nursing care, the home has designated sluice rooms, one on each floor. Both rooms are suitably equipped. The ground floor sluice room was musty. The fan was noted to be dirty. The home has a range of pressure relieving and preventative equipment and is continuing to increase its current stock. Handrails are fitted in corridors to assist mobile residents walking safely around the home. For lifting and transferring residents, the home has a number of hoists and intends to increase the number. Clean linen was seen in bedrooms and the laundry. However sheets were thin and threadbare. This situation may compromise residents’ skin integrity. During this visit it was identified that due to lack of linen rooms, clean linen is sometimes stored in residents’ drawers. In one case a residents’ duvet was seen stored in the bottom of their wardrobe. And packs of incontinent pads had to be removed from a chair in this room before it could be used as intended. This situation reduces residents’ facilities and should be stopped. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a visit to this service. Some residents are at risk because staffing levels do not reflect their individual assessed needs. EVIDENCE: As well as care staff, staff are employed for cooking, activities, cleaning, laundry, maintenance and administration. The home is staffed 24-hours a day and a roster is maintained. On the morning of the 6 August visit there was one registered nurse and four healthcare assistants on the first floor and one registered nurse and two healthcare assistants on the ground floor. Staff on the ground floor were seen carrying out their duties in an unhurried manner. However staff on the first floor were unable to provide the level of support and assistance required despite rushing around. As mentioned previously, some residents were left waiting for assistance with their meals because staff were assisting other residents on this floor. This is poor practice and staffing arrangements must be reviewed to ensure sufficient staff are available to support and assist residents when required, including meal times. Indeed the registered manager said that nearly all residents require some assistance with their meals because they are inattentive and or have swallowing difficulties and that close supervision is required. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 20 Disappointingly the AQAA records that only 33 of unregistered care staff are trained to NVQ level 2 or above in care. While acknowledging that another six members of staff are now working towards this qualification, there is an expectation that 50 of staff would now be qualified. New staff are required to complete an induction programme, which generally follows the Skills for Care training programme. A healthcare assistant spoke of her desire to complete her NVQ II training before a period of absence. The healthcare assistant has aspirations of progressing further in care and spoke enthusiastically about her role. The training matrix supplied in support of this visit indicated that some staff have received training in subjects including abuse and POVA, infection control, pressure care, care planning, dementia awareness and safer use of bed rails. Some registered nurses have received clinical training on subjects including venapuncture and wound care. As the home is registered for residents with dementia, the registered manager has received specific Yesterday, Today and Tomorrow training. There was an expectation that the registered manager would cascade this training to all staff. However the training matrix indicates that this has not been achieved yet. The training matrix does not record any member of staff having received Mental Capacity Act awareness training. As this new Act may have implications for the residents living at Copper Beeches, this training must be arranged. Minutes provided to us following a recent safeguarding meeting facilitated by the local authority indicated the provider would be employing a clinical nurse lead. The registered manager said the post had been advertised but to date the position has not been filled. The home is also in the process of recruiting another registered nurse. A number of new healthcare assistants have recently been employed. Three staff files were inspected. As part of the home’s vetting practices, references are sought and obtained, POVAFirst is accessed and Criminal Record Bureau checks undertaken. The application form requires applicants to state full employment histories. This is good practice as regulation now requires this. However one application form had an unexplained employment gap. And another form indicated the applicant had worked at a school but no dates of this employment were stated. During 2006 we published guidance to assist providers and managers in the development of their recruitment procedures and practices. The publications in question are called Safe and Sound? Checking the suitability of new care staff in regulated social care services and Better safe than sorry – Improving the system that safeguards adults living in care homes. Both publications are available from our website – www.csci.org.uk. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a visit to this service. The new registered manager has a good understanding of what needs to improve the service further. EVIDENCE: Since the last visit a new registered manager is in post. The registered manager is a registered general and mental health nurse. She has achieved a Diploma in Health Service Management and has enrolled on the NVQ level 4 Registered Managers Award course. The registered manager was open and frank throughout both inspection visits and said she has enough resources and company support to assist her managing the home. A staff member said “I can talk to the manager easily – she’s always available”. Staff receive regular supervision and records are kept of matters discussed. Staff interviewed said they receive supervision and attend staff meetings. One Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 22 member of staff said she is able to access the home’s policies and procedures at any time, when she is unsure of anything. The AQAA records that with the exception of three, policies and procedures were last up dated in December 2006. So that staff have ready access to current regulation and good practice, policies and procedures should be reviewed at least annually. The home has “surgery” days for relatives and or advocates, to meet with the registered manager. Details of the days are displayed in the reception room. Relatives and staff meetings regularly take place. The provider undertakes an annual satisfaction survey to obtain the views of advocates, relatives and professionals connected with residents’ care. The provider’s representatives visit the home at least monthly, as required by regulation. Copies of the resultant reports are available for inspection. The home maintains personal monies for most of the residents. A separate interest bearing account has been opened. The bank calculates and distributes any interest accrued to each resident. A small amount of cash is safely held so residents’ can have ready access to some of their monies if they wish. Advocates are provided with regular statements of account so balances can remain in credit. Where services have been provided or items purchased on residents’ individual behalf, the home obtains receipts. The provider audits the system as part of its quality assurance programme. The returned AQAA and a subsequent telephone call to the home indicates that equipment has been serviced and tested since the last visit as required by the manufacturer or other regulatory body. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 2 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 3 Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP15 OP19 OP37 Good Practice Recommendations All residents must be provided with the appropriate assistance with their meals, as per their assessed needs. When residents require their bedroom doors to be left open or ajar, only approved devices must be used to do this. Residents’ care records must be maintained in accordance with the registered nurses’ professional body. Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Copper Beeches Nursing Home DS0000026158.V369476.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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