Inspection on 13/06/08 for Copper Beeches Nursing Home

This is the latest available inspection report for this service, carried out on 13th June 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.

Other inspections for this house

Copper Beeches Nursing Home 19/04/06

Copper Beeches Nursing Home 20/01/06

Similar services:

21 High Street

Vale House

Chestnut Walk

Dunwood Manor Nursing Home

The Old Vicarage

Excelsior

Cherwood House Care Centre

Durban House Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

CARE HOMES FOR OLDER PEOPLE Copper Beeches Nursing Home Rake Liss Hants GU33 7PG Lead Inspector Christine Bowman Key Unannounced Inspection 13th June 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 DS0000065931.V365300.R02.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 DS0000065931.V365300.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copper Beeches Nursing Home Address Rake Liss Hants GU33 7PG 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) 01730 892889 01730 894435 copperbeechesnh@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Lizette Krause Care Home 40 Category(ies) of Dementia (40), Dementia - over 65 years of age registration, with number (40), Mental disorder, excluding learning of places disability or dementia (40), Mental Disorder, excluding learning disability or dementia - over 65 years of age (40) Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be at least 55 years of age. Date of last inspection 13th June 2007 Brief Description of the Service: Copper Beeches is a care home, providing nursing care for forty service users over the age of 55 years. It is registered to accommodate service users who have a mental disorder or dementia. Copper Beeches is situated on a site with two other homes, Silver Birches and Heathmount. Southern Cross, a healthcare provider since 1996, owns the home. The twenty-two single bedrooms, nine shared bedrooms and four communal spaces are accommodated over two floors. There is a shaft lift and a stair lift to provide access to the first floor. The home has large grounds with a secure garden area that is accessible to service users, and a large car park is available for visitors to the three homes. Copper Beeches is located in a rural area near local amenities in Liss. Fees range from £500 to £800 per week and toiletries, hairdressing and chiropody are not included in the fee. Copper Beeches Nursing Home DS0000065931.V365300.R02.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 star. This means the people who use the service experience good quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over seven hours commencing at 10.30 am and ending at 17.30 pm and was undertaken by Ms Christine Bowman, Regulation Inspector. The home’s Registered Manager was on planned leave at the time of the site visit and the deputy manager and other senior staff on duty at the time assisted with the inspection process. The registered manager of one of the adjacent homes, Heathmount, which is owned by the same provider, also offered her support. A tour of the premises was undertaken and staff from most departments were spoken with. Residents were observed as they ate lunch, relaxed in the living areas and their bedrooms and entertained visitors. All the residents had been diagnosed with dementia and had specialist communication needs and therefore interviews were not possible. The key inspection standards for care homes for older people were assessed with regard to the outcomes for the residents living at the home. The service user guide was viewed and residents’ files including assessments, care plans, medication administration records and risk assessments were viewed and staff personnel files, including recruitment, induction and training records were sampled. The home’s quality assurance system, complaints and compliments, policies and procedures and maintenance certificates were also sampled. The service had completed an Annual Quality Assurance Assessment (AQAA) and information recorded in this and on the inspection record since the previous site visit has been taken into consideration in the writing of this report. Visiting relatives and friends completed surveys on behalf of residents during the site visit and a member of staff also completed a survey. Comments from these sources have been included in this report. References to the homes’ own quality assurance assessment have also been made. Thanks are offered to the management and the staff of Copper Beeches for their assistance and hospitality on the day of the site visit and to those who completed surveys for their contribution to this report. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Improvements had been made with regard to health and safety, since the previous site visit. The door to the sluice room where hazardous substances are stored were kept locked to minimise the risk to any residents who may wander in the corridors and walk into the room when it is unattended. Disposable paper towels had been provided in the staff toilet to replace the terry towel provided and to decrease the risk of cross infection. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 7 What they could do better: 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 DS0000065931.V365300.R02.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 DS0000065931.V365300.R02.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): Standards 1,3,6 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Sufficient information is available to prospective clients to help them to make a decision about the suitability of the home to meet their needs and expectations. Prospective residents individual needs are assessed prior to the offer of a placement to ensure the home is able to meet them. The home does not provide intermediate care, so Standard 6 does not apply. EVIDENCE: The service user guide, which was available in the home, contained comprehensive information about all aspects of life at the home. The document was set out clearly with an index of contents and headings in bold block capitals to enable access for those whose vision was poor, and it was also available on audio-cassette. The manager wrote in the service user guide that, Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 10 ‘before a new resident is admitted, consideration is given to ensuring the best interests of the current residents along with the needs of the new residents, and decisions are made accordingly.’ A senior member of staff confirmed that the manager or the deputy manager, both of whom were Registered General Nurses, visited the prospective client and conducted the initial assessments. Visits to the home were usually made by relatives/representatives on behalf of prospective residents to avoid unnecessary confusion and causing them to be upset. However, the manager wrote in the AQAA, ‘If the potential service user is able, they are invited to come for an afternoon to participate in activities and/or a cup of tea to let them get a “feel” of the home’. Three residents’ relatives completed surveys on their behalf on the day of the site visit. Two confirmed they received sufficient information regarding the home before they moved it so they could decide if it was the right place for them, and the third wrote that they were already resident at Silver Birches, which is a care home on the same site and owned by the same organisation. They were transferred to the nursing home when the previous home could no longer fulfil their needs. The manager wrote in the AQAA that, ‘during their initial pre-admission assessment all potential service users, relatives or advocates are advised on the services which we provide in the home, and are encouraged to speak out and to ask questions in order to help us determine if we are able to meet all their needs, should they choose to come to our home’. Completed preadmission assessments of residents who had been admitted since the previous site visit, showed that physical, sensory, dependency, mobility, nuitrition and personal care needs had been looked at in detail and risk assessed. A dementia assessment was also included to look at the mental health needs of prospective residents. The assessment form did not specifically require information with respect to equality and diversity, except for the propective client’s religion, but notes and comments were included to confirm that the manager had taken this into consideration and she wtote in the AQAA, ‘during all potential service users pre-admission assessments we take into account their disabilities and establish if they have any specific cultural, religious, dietary needs, and do our best to ensure that our service is tailored to meet their individual needs. This involves such areas as to their daily routine and activities, choice of décor, furniture and personal items for their room in order to make it familiar, comfortable and welcoming.They are also asked about menu, likes and dislikes, and how and when they like to take their medication’. An allocated key-worker and a named nurse, who will listen to the new residents and help them to communicate when required, give support to help them to settle into their new home. Copper Beeches Nursing Home DS0000065931.V365300.R02.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): Standards 7,8,9,10 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are planned and carried out appropriately, medication is handled safely, and residents’ right to be treated with respect and have their privacy upheld is promoted. EVIDENCE: Residents’ care plans sampled showed that each care need was set out with an individual risk assessment and instructions to carers on actions to take to meet those needs. The manager commented in the AQAA, ‘we encourage the resident’s involvement in the risk assessment process, as their views are important in helping us to identify if the things that they want to do, are achievable, or may cause harm to them or other service users, before an agreed plan is implemented’. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 12 A resident, who was visited in their bedroom, had a history of falls and bedrails were used to prevent them from falling out of bed. The home used bed wedges, which were pillows/cushions, shaped to be placed between the resident and the bedrails to avoid direct contact and any resulting discomfort or hazard. Records showed that a risk assessment had been carried out and that the resident’s food and liquid intake had been recorded. The care plan included turning the resident regularly every two hours to ensure pressure sores did not develop from putting too much weight for a prolonged period of time on any one part of their body. Regular continence checks had also been made to make sure the resident was comfortable. Monthly recordings of the resident’s weight had revealed a decrease over several months and that a referral had been made by the General Practitioner to a dietitian, whose recommendations had been followed. Other residents, whose care plans were viewed, showed other priorities such as behaviour plans, according to their assessed needs. All the residents in the home had a diagnosis of dementia and life story work had been carried out for some residents, with assistance from their families. Life story books contained photographs of important events in the resident’s life and members of their family to encourage discussion and aid memory. Most of the staff had received training in dementia awareness and in challenging behaviour to support the residents and a senior staff member stated that, ‘residents’ families and friends are invited to attend the ‘Yesterday, Today and Tomorrow’ training to understand their relatives’ diagnosis and behaviour better. There is no charge for this service and we also offered guidance, with a handout, on how to respond/react when faced with some of the more challenging behaviour of our residents’. One of the three relatives who completed surveys on behalf of residents, confirmed they always received the support and care they needed and two that they usually did. All responses recorded that the staff listened and acted on what they said and one stated that they always received the medical support they needed and two that they usually did. The nurses in the home specialised in areas such as infection control, diabetes, the promotion of continence and tissue viability. Services were available from a visiting chiropodist, an optician, a dentist, a physiotherapist, an aromatherapist and a reflexologist. The service user guide was clear about which of these services incurred an additional cost and about the referral process for free services through a General Practitioner. Medication was administered by trained nurses only, and the staff training matrix confirmed they had all received a recent up-date with regard to the safe handling of medication. Since the previous site visit a senior nurse confirmed that a metal cabinet, appropriately bolted to a wall, was now in place for the safe storage of controlled drugs. Records confirmed that regular audits were carried out of medication held and that an audit trail of medication received Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 13 into the home, administered and disposed of, was kept to confirm safe handling and to ensure the residents’ rights were protected. No residents had been assessed as able to take care of their own medication at the time of the site visit. Observations of the interactions between the staff and the residents throughout the site visit, showed respect and promoted the privacy and dignity of the residents. The staff knocked on the residents’ bedroom doors, screens were provided in shared bedrooms to allow some privacy for medical examinations and the carrying out of personal care tasks, and a mobile telephone was available for receiving private calls. Copper Beeches Nursing Home DS0000065931.V365300.R02.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): Standards 12,13,14,15 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Some good work has been undertaken to improve the information available with regard to lifestyle experiences, expectations and preferences of some residents, but the response is generalised. More input is required to promote and stimulate interest in individuals and to provide a more person-centred approach to satisfying their individual social, cultural, religious and recreational needs. Contact with relatives and representatives is encouraged, but access to the community and the ability of clients to exercise choice and control over their lives is limited. Residents receive a balanced diet in pleasing surroundings. EVIDENCE: The AQAA recorded that, ‘on admission, the activity co-ordinator visits the new resident and their family in order to find out as much information as possible about their past and present life. From this they are able to formulate some idea of what this resident may like, and what they are able to do on a day-toCopper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 15 day basis’. Relatives and friends of residents had been consulted in the compilation of the social life history section of the care plan. Life story books sampled contained contributions mostly of photographs, but also of other items of relevance to the resident and newpaper cuttings from important times of their lives, all of which could be helpful in remembering their past. The activities co-ordinator was on annual leave at the time of the site visit and could not be interviewed. A senior member of staff stated that the records of participation in activities were in a locked cupboard. Very little organised activity was seen on the day of the site visit. Several residents were watching an old film in the activities room, other residents were relaxing in the other two sitting rooms but there was no evidence of stimulation and, of the three other residents, seen in their bedrooms, one was asleep, one was being supported to eat lunch and the other was receiving a visitor. Some residents wandered in the corridors throughout the day and sought out the senior staff on duty. A staff member stated that birthdays were celebrated in the home and a resident had a birthday party organized with their family recently in the smaller sitting room. The AQAA recorded that, ‘Regular Snoozelen (sensory) sessions are held. Hand and head massage is often part of this relaxing time and is also used for the bed bound and terminally ill’. A visiting hairdresser and a dedicated hairdressing room provided a weekly service and the manager stated, ‘The ladies especially look forward to her visits where they can have a chat over tea in the salon’. PAT dogs also visited on a weekly basis and the manager wrote in the AQAA that, ‘our administrator also brings her rescued sheep dog into the home, he is definitely very much loved by the residents.’ Regular monthly communion services were held at the home for those who wished to attend. The AQAA recorded that, ‘the activity co-ordinator has a comprehensive list of activities for each day, ensuring that she involves residents from the whole home, and encourages carers to bring residents to the activity room and participate with them’. Colourful mobiles were hanging in the dining room and a staff member stated that they had been made by the residents in a craft session. Other activites offered at the home included parachute games, ball games and making sandwiches. The home provided transport in the form of a minibus, which was specially adapted to accommodate wheelchairs and a member of staff stated that recent trips out had included a museum trip, shopping, seaside trips to Southsea and country trips to the Elstead area with a picnic. The trips were dependant on having sufficient staff for a 1:2 ratio to ensure the safety of the residents. Photographs of residents visiting the Hampshire Living History Musem were displayed in the corridor near the library. A bar-b-cue was planned for August and the AQAA recorded that, ‘during the year we hold special events such as a pantomime, bell ringers, carol singers, dancers and a summer open day fete. Plans were in place to introduce themed events from around the world. ‘Members of staff initially, will be invited to share their culture, be it in food, Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 16 music or pictures, for residents and relatives to enjoy and participate in, and promote discussion and understanding’ the manager wrote in the AQAA. Special arrangements had been put in place to enable residents who smoke to continue to do so with appropriate risk assessments in place and agreed support required in order to minimise risk and ensure compliance with the law. Several relatives visited residents throughout the day and were warmly welcomed. Receiving visitors in private for residents in shared bedrooms was not satisfactory. Screens were available to enable some privacy but conversations could not be confidential when both residents were present. The meals were prepared at one of the adjacent homes and brought to Copper Beeches by heated trolley. The dining room was nicely set out with small tables covered with table cloths and the lighting was domestic. French windows led outside to the garden, which the residents could look out upon whilst taking lunch. Menus displayed showed choice and the main course of haddock, peas and new potatoes was well presented. Carers were sitting beside residents when giving support, which appeared to be sensitive and caring, however, one carer was encouraging a resident to finish their drink quickly and a senior staff member intervened. Crockery and cutlery specially adapted to enable residents to eat independently were provided and a number of residents were sucessfully managing to eat without assistance. The manager wrote in the AQAA, ‘we have introduced the NUTMEG system (menu planning software) and have revised the menus to ensure a highly nutritional balance’. Feedback received from relatives on behalf of residents was that, one usually liked the meals, one sometimes did and one thought the nutrition was poor. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 17 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): Standards 16,18 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training ensure the staff are informed of how to deal with complaints and safeguarding issues, and the residents are confident that their complaints will be listened to and that they will be protected from abuse. EVIDENCE: The home’s complaints procedure, which was included in the service user guide, set out clearly ‘how to make a complaint’ to inform residents, their relatives and representatives. The three relatives, who completed surveys on behalf of residents, confirmed they always knew who to speak to if they were not happy and knew how to make a complaint. A staff member, who completed a survey, also knew what to do if a resident, their relative or representative had concerns about the home. The procedure promised residents that their complaints would be taken very seriously and investigated thoroughly. The AQAA recorded that. ‘the manager has an open door policy, which is emphasised regularly to all family and friends’. A suggestion box was located at the front door with a pen and paper available beside it. Nine complaints had been received since the last site visit and the AQQA recorded that they had all been resolved within twenty eight days and no Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 18 complaints had been upheld. The home kept a record of complaints investigations and associated letters. Since the last site visit the Commission for Social Care Inspection had received a copy of a letter from the relative of a deceased resident stating their lack of satisfaction with a complaint investigation reported back to them by letter. They alleged that a misdiagnosis by the medical staff at the nursing home had caused unnecessary trauma to their relative, who was unable to speak for themselves. The relative felt that access to a General Practitioner had been denied when there was an obvious need for a medical opinion. Since the site visit a relative of a prospective client had visited the home and telephoned the Commission for Social Care Inspection to make a complaint about the home. They stated that, ‘at the time they arrived at the home, there was an overwhelming unpleasant odour and that this got worse as they were taken upstairs to view a bedroom. As they walked past a resident’s bedroom they were concerned to see that the door was wide open and that the resident’s privacy and dignity was not being respected. The resident was agitated and when this was pointed out to the nurse showing the visitors around, she allegedly dismissed the issue and said, ‘there’s nothing we can do about this lady.’ The complaint has been sent to the provider to investigate. The home held a copy of the local authority Safeguarding Adults policy and procedure and a flow chart on the notice board in the nurse’s station and the staff room, along with whistleblowing policy, demonstrated that staff would be well supported if they reported bad practice. The staff training matrix confirmed that all the staff from all departments had received up-dated training in the Protection of Vulnerable Adults. Training in challenging behaviour for the staff taught them how to respond appropriately to physical and verbal aggression, using minimal restraint if necessary in order to protect themselves and/or others. Training in bed rail safety had been accessed by all the nursing and care staff and the manager wrote in the AQAA that, ‘the use of bed rails or any other considered means of restraint is thoroughly risk assessed, discussed, and documented before it is implemented, bearing in mind the dignity, independence and human right of the individual. Any form of restraint is only used after discussion with the GP, service user representatives and the care manager as appropriate’. Recruitment checks had been carried out on pospective new staff prior to the offer of a post, however, all the recruitment information of staff transferred from other homes within the organisation should also be available in the home for inspection. There had been no Protection of Vulnerable Adults Investigations since theprevious site visit. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 19 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): Standards 19,26 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a comfortable, safe and pleasant environment, with some adaptations specific to their needs. The home is usually clean and hygienic, but not consistently free from unpleasant odours. EVIDENCE: Copper Beeches is a large Victorian house which had been extended and adapted to provide suitable accommodation for a nursing home. The shared accommodation consisted of two comfortable lounges, set within the older part of the building and retaining original features such as high ceilings with moulding, fire places and large windows. The larger of the two lounges contained comfortable seating, a large television, video and hi-fi equipment, Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 20 and an organ. It was lit by an elegant chandalier and wall lights. Some of the residents were relaxing in this room, and one resident, who had just had a birthday was surounded by a large number of greeting cards. Occasional tables were provided and there was a hat stand where residents conveniently kept their sun hats for protection when venturing out into the well-maintained, pleasant and secure garden. An outdoor seating area with sunshades was provided in the garden and large pots overflowing with plants and hanging baskets enhanced the environment for the enjoyment of the residents, providing an extra space for entertaining visitors in the summer months. The AQAA recorded that, ‘on a sunny day most residents will be eating their meals in the gardens. A staff member stated that one of the residents, who had been a farmer, had enjoyed helping with the planting. The smaller lounge, which had been recently re-furbished, was used as a quiet room. Pictures on the walls, potted plants and books, domestic lighting and comfortable seating made this room homely for the residents. A member of staff stated that this room could be used for family parties, without inconveniencing the other residents because other sitting areas were provided. Windows had been fitted with restrictors and radiators covered to safeguard the resdents from hazards. A third communal area was known as the Snoozelen/Activity room. An old film was playing on the television and some residents were enjoying this. There was a large collection of videos, newspapers, games, bingo, jigsaw puzzles, a table tennis table and painting equipment in this room for the residents’ occupation and entertainment. Sensory lights and mobiles also promoted the residents’ interest. A cupboard leading from this room was locked and a staff member stated this was because the activities co-ordinator was taking planned leave. They confirmed that more equipment was stored in the locked cupboard. This room was in need of re-decoration and refurbishment and the florescent lighting, which was not suitable for a domestic environment, required repair and cleaning. On the ground floor, the corridors had been transformed into ‘streets’, giving the residents addresses, such as ‘Market Street’, which was immediately recognisable by a market stall containing artificial flowers and fruit, and Tulip Street, which had a large mural of flowers. Corridors were decorated with a variety of tactile boards to support residents whose confusion and loss of memory caused them to forget where they were. Picture sensory boards and rummage boxes also offerred residents an opportunity to stimulate speech and expression. One board showed phographs of residents celebrating and dancing with the staff. Doors were colour-coded and labelled for easy recognition. A recently refurbished bathroom had been decorated in a seaside theme, complete with crabs in a net and flying seagulls. The seaside mural, painted in shades of blue and yellow, was designed to have a calming effect on residents and to enhance their enjoyment whilst bathing. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 21 The home was on two levels and the upper floor was accessible by lift, chair lift and by stairs. Safety gates fitted with keypads afforded protection to the residents ensuring they did not wander on the staircases unsupervised. Ramps were provided for easy access by wheelchair users on the ground floor. Some of the nine en-suite single bedrooms, thirteen single bedrooms, six ensuite shared bedrooms and three shared bedrooms were viewed. Two residents, who were visited in a shared bedroom were bedfast. The environment was pleasant, light and bright with windows overlooking the wellkept garden. One resident was finishing lunch, supported by a staff member. There were photographs, plants and fresh flowers displayed in the bedroom, giving it a homely feel, and a screen was availble for ensuring privacy for personal care and medical examinations. Some of the bedrooms viewed were not so well-maintained and some of the bedding was old and worn. Some of the old-style beds had been replaced by profiling beds (beds which support residents to move to the sittting position and can be adjusted for the comfort of the residents and aid the carers with their support) and the development plan promised more and a rolling programme of redecoration and refurbishment. The AQAA recorded that, ‘all the bedrooms have television aerial sockets and telephone points and most of the bedrooms have doubled glazed windows and thermostatically controlled radiators for individual’s preferences’. The home provides accommodation for a resident group of up to forty older people with a diagnosis of dementia. The accommodation is provided over two floors and some adaptations have been made to support the residents’ need for familiarity. It has, however, been generally established that smaller units provide for the needs of residents with dementia better than large homes with large numbers of residents sharing communal accommodation. Consideration should be given to the breakdown of the home into smaller units with with their own staff to maintain familiarity and consistency. A full time maintenance person was employed to deal with isssues as they arose and to undertake the rolling programme of redecoration, and a team of domestic staff were employed to keep the home clean. The laundry was based in one of the other homes on the same site and was not viewed on this occasion. The staff training matrix confirmed that 67 of the staff team had received up-dated training on infection control, staff were observed wearing suitable clothing such as aprons and gloves to protect themselves and the residents and to prevent the spread of infection. There were no noticeably unpleasant odours in the home on the day of the site visit and two relatives, who completed surveys on behalf of residents, thought the home was always clean and fresh. One thought it was sometime was but that, ‘there was a very bad smell of urine most of the time.’ A visitor, who was looking for a placement for a relative, also contacted the Commission for Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 22 Social Care Inspection to complain about the unpleasant odours in the home when they visited. Supplies of liquid soap and paper towels were available throughout the home, including the staff toilets to promote infection control. The staff-training matrix showed that 67 of the staff had received training in infection control over the previous twelve months. The AQAA recorded some other improvements, which had been made over the previous twelve months, including an increase in domestic staff hours and new cleaning schedules, the purchase of two new vacuum cleaners and the redecoration of the hairdressing room. Plans for improvements over the next twelve months included making the secure garden more stimulating for the dementia client group, new carpet in corridors on the first floor and more decoration of the home for the dementia strategy, including making more sensory picture boards for the corridors. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 23 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): Standards 27,28,29,30 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. A well-trained staff team meet the needs of the residents and ensure they are in safe hands at all times. Residents are protected by safe recruitment practices, however this information is not always available at the home for inspection. EVIDENCE: The staff rota, which was on the wall in the managers’ office showed that two qualified nurses were on duty during the day and one at night and that they were supported by seven care staff. Records showed that staff turnover in the past twelve months had been high and that eight full-time and six part-time care/nursing staff, which is more than a third of the total number, had left the home’s employment over the previous twelve months. All the residents had been diagnosed with dementia, had specialist communication needs, required support with the all their basic care needs, including help, supervision or prompts to eat their meals. Thirty-two residents had physical disabilities and required two or more staff to help with their care during the day and eight residents were bed fast. With such high levels of dependency, the layout of the Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 24 home on two levels and that only eighteen hours were designated for support other than personal care, it is difficult to see how the staff would be able to offer the kind of individual attention necessary to enable all the residents to enjoy life to their fullest potential as promised in the service user guide under ‘Our Philosophy of Care.’ A staff member, who completed a survey, thought there were usually enough staff to meet the individual needs of the people who use the service. The manager recorded in the AQAA, ‘we continue to staff above the minimum staffing levels and the manager and deputy use the roster to reflect the differing needs of residents as required’, and ‘the home has developed protective meal times, which has enabled more help during the busy times at breakfast, lunch and supper. In addition to the qualified nurses and care staff working at the home, an activities co-ordinator, domestic and laundry staff, a head cook and kitchen staff and a maintenance person were employed. The manager wrote in the service user guide that, ‘although each member of staff has a role within the home, the emphasis is very much on teamwork. All our staff are encouraged to continue with Life Long Learning and to undertake such training as to ensure they are competent to meet the needs of our service users. The AQAA confirmed that 50 of the care staff had achieved or were working towards a National Vocational Qualification at level 2 or above. A requirement had been made at the previous site visit that records relating to the recruitment of staff including confirmation of CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) checks and of current registration with professional organisations such as the Nursing and Midwifery Council should be available for inspection. This information had been held at the organisation’s Human Resources Department and was forwarded to the CSCI immediately after the last site visit. The recruitment documentation of two new care staff, who had transferred from another service owned by the organisation, was not available in the home to be inspected at this site visit. Confirmation of the necessary recruitment checks was forwarded to the CSCI regional office within twenty-four hours of the site visit, however, as stated in the previous report, staff personnel files, including recruitment documentation should be available for inspection if the staff have taken up employment at the home. The personnel files of two other staff recruited since the previous site visit were sampled, confirming that important checks such as references, POVA and CRB checks had been returned prior to the offer of a post. Certificates to confirm induction and foundation training were seen in staff training and development files. A senior member of staff stated that there was a large training room for the staff on the top floor and that training videos were used on induction. There was no evidence that the Skills for Care Common Induction Standards, which offer new carers a good introduction to the caring role highlighting the importance of promoting the residents’ privacy and dignity and other important values fundamental to the development of professionalism, had been accessed. However, the manager confirmed in the Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 25 AQAA that, ‘staff induction and development meets the National Minimum Standards for the service.’ A copy of a staff Handbook, given to all staff upon employment, was viewed. It contained terms and conditions of employment, policies pertaining to employment and included important information with respect to health and safety, whistle blowing and a statement of the organisations commitment to equal opportunities and the principles of equality and diversity. The staff-training matrix showed commitment to keeping mandatory training up-to-date and highlighted updates required. Staff in all departments had completed fire safety, fire drills, food hygiene, health and safety, moving and handling and the protection of vulnerable adults training. Pressure care, customer care, challenging behaviour, dementia awareness, ‘Yesterday, Today and Tomorrow’ (the home’s own intensive four-day course on dementia), infection control, nutrition, the control of substances hazardous to health and bed rail safety training had been accessed by significant numbers of staff. Registered nurses had received training in the safe handling of medication and care planning and five members of staff were first aid qualified. The manager wrote in the AQAA that some of the nurses had specific areas of responsibility with respect to infection control, the promotion of continence, diabetes and other areas of specialised clinical expertise. Plans were in place to provide end of life, care of the dying and palliative care training and to identify staff to attend train the trainer and mentoring courses to ensure good support for the staff. Comments received by the home in their most recent quality assurance survey included, ‘I always see such kindness, infinite patience and gentle treatment. It seems to me that all the staff are cheerful, polite, and well-trained. I thank you for this,’ and ‘you have created such a wonderful caring environment, where nothing is too much trouble.’ Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 26 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): Standards 31,33,35,38 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Good leadership and systems are in place to ensure the home is run safely and in the best interests of the residents and plans in place promise improved outcomes for residents with dementia in line with best practice. EVIDENCE: The manager was on planned statutory leave at the time of the site visit and had informed the CSCI of the arrangements in place for the management of the home in her absence. She had excellent qualifications for managing the home including a nursing degree, the Registered Managers Award, a certificate Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 27 in supervising health and safety at work, was a trained trainer and had many years of experience in running a nursing home. The AQAA recorded that the manager had won an award for being manager of the Year for 2007/2008 in the southern division of Southern Cross. The manager stated in the AQAA that she belongs to, and attends meetings of, the local provider’s forum and the local branch of the nursing home association. Both of these help her to keep abreast of local and regional changes in legislation and proposed developments. The AQQA, completed by the manager, gave detailed information about the development of the service. Systems were in place to ensure the views of the residents, their relatives and representatives and the staff contributed to the running of the home. Quality assurance questionnaires had been completed over the previous year to gather the views relatives and representatives on behalf of residents and regular meeting were held to enable their views to be heard. Some comments included in the quality assurance report included, ‘I am pleased with the way you care for my relative, under difficult circumstances,’ and ‘the management, nurses and carers are first class staff, always friendly and happy.’ A monthly newsletter was written and distributed to all service users and relatives and was available in reception. Regular audits had been carried out by the manager and deputy manager. A dementia strategy action plan, which had been completed by a dementia consultant in May 2008, was viewed. The main outcomes of the plan was to achieve a person-centred environment based on current evidence for people suffering with dementia and to become a centre of excellence by May 2009. A senior member of staff stated that Head Office kept individual statements of residents’ accounts and that only small amounts of cash were kept in the home on behalf of residents. Records were kept of receipts and all transactions were double signed to confirm safe handling. Improvements had been made with regard to health and safety, since the previous site visit. The door to the sluice room where hazardous substances are stored was kept locked to minimise the risk to any residents who may wander in the corridors and walk into the room when it is unattended. Disposable paper towels had been provided in the staff toilet to replace the terry towel provided and to decrease the risk of cross infection. However, the disposal bins throughout the home had not been replaced with the type that can be opened by a foot lever, to minimise the risk of cross infection. As recorded under the staffing section of the report, mandatory staff training with respect to all aspects of health and safety was good and important information was supplied to the staff in the staff handbook. The AQAA confirmed that policies with respect to health and safety were in place and that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body in a timely way to protect the residents and the staff. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 28 A sample of certificates seen on the day of the site visit confirmed this. Accidents had been recorded appropriately and the results collated monthly with actions to reduce risks. A staff member, who completed a survey, commented on what they thought the service did well. They thought the residents were well looked after, that their needs were well met and that the home was good at keeping in touch with relatives. They also thought the regular meetings both for staff and for relatives and residents were good. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 29 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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. 1. Standard OP26 Regulation 16(2)(k) Requirement The premises must be consistently free from offensive odours to maintain a pleasant home environment for the residents, their visitors and the staff. Records relating to the recruitment of staff including confirmation of CRB and POVA checks must be available for inspection. Timescale for action 13/07/08 2. OP29 17(3)(b) 13/07/08 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. Refer to Standard OP26 Good Practice Recommendations Disposal bins throughout the home should be of a type that can be opened by a foot lever, to minimise the risk of cross infection. A more person-centred approach to providing activities based on individual resident’s assessed needs should be DS0000065931.V365300.R02.S.doc Version 5.2 Page 31 2. OP12 Copper Beeches Nursing Home 3. OP14 implemented to satisfying their social, cultural, religious and recreational needs. Residents’ ability to exercise personal autonomy and choice should be assessed under the Mental Capacity Act to ensure their best interests are protected. Copper Beeches Nursing Home DS0000065931.V365300.R02.S.doc Version 5.2 Page 32 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 DS0000065931.V365300.R02.S.doc Version 5.2 Page 33 - 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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