Inspection on 01/08/08 for Copperbeech Care Home

This inspection was carried out on 1st August 2008.

CSCI found this care home to be providing an Adequate 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

Copperbeech Care Home 03/12/08

Copperbeech Care Home 13/03/08

Copperbeech Care Home 11/05/07

Copperbeech Care Home 13/02/07

Similar services:

Deepdene Care Centre

Ferndale Residential Care Home

David Gresham House

Elizabeth House

Elvy Court Nursing Home

Fontenay Nursing Home

Clairmont Residential Home

Cornford House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Copper Beech Care Home 154 Barnhorn Road Little Common Bexhill-on-Sea East Sussex TN39 4QL Lead Inspector June Davies Unannounced Inspection 1st 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 Beech Care Home DS0000067146.V369483.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 Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copper Beech Care Home Address 154 Barnhorn Road Little Common Bexhill-on-Sea East Sussex TN39 4QL 01424 842770 01242 842770 copperbeachemi@btconnect.com 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) Meeraraj Limited Ms Clare Vilma Sobhanieh Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users should be aged sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is twenty (20). Only service users with a dementia type illness to be accommodated. Date of last inspection 13th March 2008 Brief Description of the Service: Copper Beech Care Home is registered to provide personal care for up to 20 older people with a dementia type illness. It is situated in a residential area on the main road into Little Common, which is on the outskirts of Bexhill-on-Sea. The home provides single accommodation on two floors, and residents are encouraged to personalise their own bedrooms with small pieces of furniture and ornaments. The communal space on the ground floor offers residents comfortable and attractive rooms, with the lounge/dining room large enough to be used for group activities. A shaft lift enables residents to have access to all parts of the building safely, and hoists are available if required for staff to assist residents. There is an attractive garden to the front that residents can use safely when weather permits. Parking for a number of cars is provided to the side and rear of the home. Up to date weekly fees can be obtained by contacting the appointed manager of the home. Copper Beech Care Home DS0000067146.V369483.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 1 Star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took place on the 1st August 2008 over a period of seven and half hours. During this inspection the inspector spoke with the appointed manager, staff and residents. Documentation relating to the key standards inspected were also viewed. The inspector carried out an observational tour of the premises, as well as observing a lunch time meal, and lunch time medication round. Information from the recently received Annual Quality Assurance Review from the home was also taken into account when producing this report. What the service does well: What has improved since the last inspection? Residents’ now have suitable activities to participate in. There are sufficient staff on duty to meet the residents needs and to give residents’ one to one attention. A consortium employed by the registered provider is providing the home with clear guidelines as to the improvements that have been made as well as detailed information on improvements that need to be made. Regulation 26 reports are comprehensive and detailed. The appointed manager is in the process of developing a quality assurance system for the home, while some systems are now in place there is further work to do to ensure that all working practices are quality assured. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 6 The four residents spoken to said that the home had improved over the past year. What they could do better: This is still an adequate service and further improvements as outlined below need to be made to ensure that the residents receive a good quality of care. While the pre-admission template requires detailed information there is evidence that this information is not being gained prior to the resident moving into the home. There is no evidence that the prospective resident has been consulted in regard to this assessment or to the drawing up of their care plan once they come to live in the home. Care plans are not reviewed on a monthly basis, and where a review has taken place, in the three care plans viewed the report was ‘no change’, although for one resident this was certainly not appropriate. Daily records are very much the same for each resident in the home giving the impression that residents are not treated as individuals. None of the personal hygiene tasks for residents are recorded so there is no evidence that residents are bathed regularly, have their teeth/dentures attended to, that male residents are shaved regularly, that tissue viability is checked to prevent pressure areas developing, or that residents have their hair washed regularly. There is no evidence in care plans that residents are weighed on a regular basis to ensure that their nutrition is being maintained. Visits from or to health care professionals, like general practitioners, district nurses, chiropodists, opticians, dentists, community psychiatric nurses etc are not recorded in the residents care plans. The medication trolley needs attention to the lock. One the day of the visit one resident stated that she was in pain, but there was no information available that the general practitioner had been informed. For several residents there were signatures missing from the MAR sheet on a specific day at a specific time, had this been quality assurance monitored by the manager, he would have been in a position to chase this up. Liquid medication and eye drops were not dated on the bottle on the day of opening. Staffing could be better arranged at mealtimes to ensure that those residents who require assistance with feeding receive one to one attention for the whole mealtime from staff, rather than staff jumping up from the tables to deal with other tasks. The complaints policy displayed in the main entrance hall, gave the wrong address of The Commission for Social Care Inspection. During a tour of the building the inspector noted that not all residents had accessible call bells in their bedrooms and there were also some parts of the home that had an offensive odour. The garden of the home is not safe for residents to use freely. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 7 Staff personnel files showed that the manager is not always obtaining two written references when employing staff to work in the home and there are not two forms of identification on personnel files. Fire points and hot water delivery are not checked on a regular basis, 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 Beech Care Home DS0000067146.V369483.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 Beech Care Home DS0000067146.V369483.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 3 and 6 People using this service experience POOR quality outcomes in this area. Sufficient information is not gained prior to residents moving into the home to ensure that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector viewed three pre-admission assessments. While there were detailed pre-admission assessments from the funding local authority, the homes pre-admission assessments while requiring detailed information, had not been completed fully and there were many gaps, where information had not been provided. Therefore there was insufficient evidence obtained that the home had the staffing levels or that staff have the knowledge and experience to meet the residents’ needs. The appointed manager stated that these preadmission assessments had been completed prior to him being employed in Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 10 the home. A requirement is being made that pre-admission assessments carried out by the manager and deputy manager contain sufficient information under all headings to ensure that the staff have the skills and knowledge to meet the prospective residents needs, as well as obtaining sufficient information on which to base a care plan. The home does not offer intermediate care. Copper Beech Care Home DS0000067146.V369483.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 and 10 People using this service experience Adequate quality outcomes in this area. The care planning system is not clear and consistent to provide staff with the information they need to meet residents’ needs. Due to poor reporting it is not clear that the health care needs of the residents are being met, or that there is good multi disciplinary working taking place on a regular basis. The administration in the home needs some improvement to ensure that residents are not placed at risk. Staff shows respect of the residents privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 12 Three care plans were viewed, and while the care plan was fairly detailed and there were risk assessments in place in regard to mobility, tissue viability, cot sides and nutrition. The choices sheet on a care plan for a male resident stated that he preferred to wear a nightdress at night, but in actual fact on checking, this was not the case and the resident prefers to wear pyjamas. Care plans viewed showed that the review of care plans does not take place regularly, and in all cases reviews stated no change. There was no evidence that residents and or their relatives sign up to their plan of care. Requirements are being made to ensure that care plans are correct, that they are reviewed regularly, and that the residents and or their relatives/representatives sign up to the plan of care. Daily reports were very much the same for each resident, there was no recording of personal hygiene tasks being carried out, such as denture care, nail care, shaving, bathing, tissue viability, washing and hair washing. There was evidence from observation that staff do attend to residents finger nails. One member of staff stated that one of the activities during the week is to manicure lady residents’ fingernails. One resident in the home has a pressure area, which is attended to regularly by the district nurse. The resident has also been supplied with a pressure relieving air mattress. The manager stated that the resident is turned at regular intervals by staff during the night but there was no evidence either in the night report or via a turning sheet to support that regular turning does take place. While some residents do have a continence problem, there was no evidence in the three care plans viewed that the continence nurse has been consulted. Daily reports in one care plan showed that a resident does have a severe continence problem but the care plan stated that they ‘needed some assistance.’ There was no evidence that residents have access to psychological health care specialists, although the home is registered for dementia care. Completed accident forms showed that three residents fall on a regular basis, but there was no evidence to show that the falls clinic had been consulted or that any actions had been taken to reduce the level of falls for these residents. While each care plan had a nutritional screening risk assessment in place, none of the residents are weighed on a regular basis. The three care plans viewed showed that residents had not been weighed since June 2008. Weighing prior to June had been intermittent and the full date had not been written to indicate what year this had taken place. The manager stated how one resident when waking in the night could be settled by giving him a Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 13 sandwich and hot drink. This had not been written into the care plan and therefore it is not known if night staff were aware of this procedure. None of the care plans showed when residents have contact with health care professionals. One care plan did show two visits from a general practitioner, and that the general practitioner was making a referral to the community psychiatric nurse for a visit, but there was no evidence that this visit had taken place. From the three care plans viewed there was no evidence that residents’ have access to general practitioners, district nurses, community psychiatric nurses, chiropodists, opticians, dentists, continence nurse or any other health care professionals. Requirements are being made that care plans and daily reports are individual to each resident in the home and information on the care plans is relevant to the resident, that personal hygiene tasks are recorded, where specialist care is required a record is kept and that all visits to and from health care professionals are recorded onto the care plan. The medication policy and procedure has been reviewed and contains all the appropriate information in regard to the receipt, recording, administration and storage of medication as well as self-administration, and the administration of controlled drugs and over the counter remedies. It was noted however that this policy and procedure did not state that when a resident dies in the home medication should be retained for seven days after the death of the resident. The inspector observed a lunchtime medication round, and carried out a short audit of medication practices within the home. The administration of medication at lunchtime was carried out in accordance with The Royal Pharmaceutical Society’s guidelines for care homes. It was noted however that there were unsigned and unexplained gaps on Monthly Administration Records for some residents, these gaps were all on the same day at the same time, and indicated that one member of staff might have been responsible for this. It was observed that staff have a problem with the lock on the medication trolley and that this needs attention. Eye drops and liquid medication was not dated on the bottle on the day of opening. One resident in the dining room at lunchtime became very agitated; this was initially started by four staff constantly moving around the table. When the inspector spoke with the resident, she explained that she was uncomfortable and in pain. The manager stated that this resident had recently been taken off an antipsychotic drug, and since then had been saying that she was in pain. The manager said that he would be contacting the resident’s general practitioner to see what pain relief could be given to this resident. Requirements are being made that the lock on the medication trolley must be repaired, and that eye drops/ointments and liquid medication must be dated on the bottle on the day of opening, and that residents are referred immediately to their general practitioner for pain relief. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 14 Staff talk to the residents in a friendly and respectful way using first names. Two residents stated that staff respect their privacy and dignity. The manager confirmed that the practice of district nurses replacing dressings is now carried out in the residents’ own bedrooms and not the dining room. All bedrooms in the home are now single occupancy. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 15 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 and 15 People using this service experience Good quality out comes in this area. Appropriate activities are offered in the home, which residents may choose to join in with. Staff enable residents to access the community on occasions, but this is limited. While meals in the home are good, residents need to be able to make informed choices at mealtimes, and staff should give one to one attention to those residents who need attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection a member of staff was observed in an art and craft activity with the four of the ten residents in the home. Four other residents were in the main lounge, one resident had chosen to sit in the quiet Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 16 lounge and another resident was in her bedroom. Activities for the day are written onto a white board in the main lounge for the residents, and a poster in the main hallway, advises residents what activities are on offer throughout the week. The activities on offer are appropriate for dementia care residents. The manager said that he is always looking for new ideas for activities. Every three months a production company (AIM part of Cambridge Footlights) come into the home to entertain the residents. Staff take residents out in small groups for a walk. Some relatives take their residents out for a ride in the car or for a meal. The manager is in the process of finding out about a mini bus to take the residents out for a tour of the countryside. There is a group of relatives known as ‘Friends of Copperbeech’, who visit the home on a regular basis. The local Church of England visits the home to perform communion for those residents who are interested. Jehovah witnesses visit the home regularly to read to the residents. Relatives and friends are welcome to visit at any time. There were no visitors on the day of this key inspection. The manager told the inspector that residents as far as their level of dementia will allow them are able to make choices in regard to their everyday lives. One resident was able to confirm that she is able to get up and go to bed when she wants to. During a tour of the home the inspector noted that eight of the beds that had been stripped in the morning still remained unmade, should a resident have chosen to go to their bed to lay down they would not have been able to do so. Resident’s rooms were personalised with their own belongings. None of the residents are able to manage their own finances and relatives or representatives do this for them. A new cook has recently been employed at Copperbeech. The cook was able to show the inspector rotating menus, and explained that she was in the process of changing some of the menus to ensure that residents have a balanced and nutritious diet and to make the best of fresh local produce. Residents are given a choice of meal, but consideration needs to be given to pictorial menu cards so that residents can make informed choices about what they would like to eat. There are three meals a day offered to residents, breakfast is usually a choice of cereal but on two days of the week Monday and Fridays residents can have a cooked breakfast, lunch is a cooked meal and sweet and residents are given choice, teatime meal is a cooked dish as well as sandwiches, and cakes. Residents are offered a choice of drinks with their main meals, and drinks are also offered at other times. On the day of this inspection the inspector observed staff offering residents a mid morning drink with a choice of fruit and or biscuits. The lunchtime menu on the day of this key inspection was beef burgher, chips and peas or fish fingers chips and peas and pudding was either mixed fruit or cheesecake. Three residents told the inspector that portions on their plates were often too large and they were not Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 17 able to eat it all. The inspector also noted that the large cutlery container was left on the dining room table while residents were eating. Three residents needed assistance with eating, and there were sufficient staff on duty to give individual attention to all three residents, but the inspector noted that staff did not sit constantly with these residents, who then became agitated, one resident in particular became very agitated. The inspector noted that this resident was not sitting comfortably, and a cushion behind her back might have given her more comfort. The cook confirmed that the home caters for diabetic diet, and that other diets can be catered for as and when needed. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 18 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 and 18 People using this service experience Adequate quality outcomes in this area. There is some evidence that complaints are listened to and acted upon Only one member of staff has received recent adult protection training, this leaves residents at risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and procedure while displayed needs to be updated and give the correct address for CSCI. One complaint has been made to the home since the last inspection, this was appropriately investigated and the complainant informed of the outcomes. A requirement is being made that the complaint policy and procedure is updated to reflect the correct address for The Commission for Social Care Inspection. The protection from abuse, bullying and harassment policy and procedure has recently been updated as has the whistle blowing policy and procedure. The home does not have the Sussex Multi-Agency Policy and Procedures for Safeguarding Vulnerable Adults. There have been no adult protection issues in the home since the last key inspection. Only one care staff member out of nine has received recent Safeguarding Vulnerable Adults training, further training has been booked for December 2008. Staff recruitment practices Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 19 ensure that staff receive the appropriate Protection of Vulnerable Adults Register and Criminal Records Bureau checks prior to being deployed to work in the home. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 20 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 and 26 People using this service experience Adequate quality outcomes in this area. The standard of the environment in the home is good providing residents with an attractive and homely place to live, but attention needs to be paid to call bells being appropriately in place for residents use. While the general appearance of the home is clean and well tended, there are some offensive odours that must be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 21 Copperbeech provides a comfortable well furnished and decorated home for the residents to live in. It was noted during a tour of the building that some bedrooms do not have call bells or call bells are not close to the bed. At the present time the gardens of the home while being well tended are not safe for the residents to use, there are small drops in level from concrete paths to lawned areas, which could place residents at risk of falling. Fences are not in place, and therefore residents would be able to access the neighbouring garden or the busy A259 main trunk road. A requirement is being made that all residents have access to a call bell from their bedrooms. At the time of the inspection the industrial washing machine had broken, and a small domestic washing machine was being used. The manager stated that a new washing machine was on order, but he was not sure if this machine would offer a sluicing and disinfecting facility, in accordance with the National Minimum Standards. While the home was generally in a clean condition in some parts of the home there were offensive odours. It was evident from looking in communal toilets and bathrooms that staff are supplied with disposable gloves and plastic aprons. The clinical waste bin had the appropriate yellow sack for clinical waste. Only two staff have received recent infection control training, and further infection control training is booked for September 2008. A requirement is being made that all parts of the home are kept free from offensive odours. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 22 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 and 30 People using this service experience Adequate outcomes in this area. Sufficient staff are employed in the home to meet the needs of the residents. Recruitment practices must be improved upon to ensure that residents receive care from appropriately vetted staff. Staff mandatory training needs to improve to ensure that staff have the skills and knowledge to safely meet the residents needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From rotas and the number of care staff on duty at the time of this unannounced key inspection, there are sufficient care staff on shifts to meet the needs of the residents at all times of the day. These staffing levels need to be kept under review as more residents move into the home. At the present time there are only 10 residents living in Copperbeech, which is registered by The Commission for 20 residents. A new cook has recently been employed; there is a gardener, a new handyman, and a housekeeper. These ancillary staffing levels also need to be kept under review. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 23 Nine care staff are employed by the home and at the present time three of these staff have obtained their NVQ qualification, with a further three staff in the process of completing their NVQ qualification. The inspector looked at three personnel files and found that while new staff are Protection of Vulnerable Adults Register checked and Criminal Records Bureau checked only one of these employees had two references, two files only had one reference. None of the files had two forms of identification, which should have included a recent photograph. A requirement is being made that prior to new staff being employed by the home two references must be obtained, and that new staff must have at least two forms of identification on their staff personnel files. The provider has recently employed a consortium to provide training for staff in the home. The inspector viewed all staff training certificates and found out of the nine care staff employed only seven had receive moving and handling training, six had received fire training, three had received first aid training, one had received protection of vulnerable adults training, two had received infection control training, five had received medication training, and none had received dementia care training although three staff have covered dementia knowledge through their NVQ. There was evidence that the training consortium have arranged for further mandatory training this year to cover Moving and Handling, Infection Control, Health and Safety, Food Hygiene, Record Keeping, Safeguarding Vulnerable Adults, and First Aid. There was evidence in the three staff personnel files that staff receive initial induction training as well as completing a ‘Skills for Care’ related induction. A requirement is being made that all staff receive their mandatory training as soon as possible and that new staff receive this training within the first six months of their employment. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 24 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, 36 and 38. People using this service experience adequate quality outcomes in this area. The manager has a good understanding of what needs to improve in the home, and now needs to put planning in place as to how these improvements will be made. The quality assurance system needs to be further developed to ensure that residents receive the best quality of care. Some aspects of health and safety need to be addressed to ensure that residents and staff live and work in a safe environment. This judgement has been made using available evidence including a visit to this service. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 25 EVIDENCE: The appointed manager has many years experience of working with dementia care residents, he is a qualified RMN and is in the process of completing his Registered Managers Award. He has an open and flexible approach to management and is available to both residents and staff during his working day. The appointed manager is not at the present time Registered with The Commission. A system is being developed for quality assurance checks within the home. Questionnaires for residents/relatives and staff have been sent out, but the manager still needs to develop a questionnaire for visiting professionals to the home. On the day of this key inspection a staff meeting had been arranged. The manager still needs to develop the monitoring of systems used in the home – care planning, care plan reviews, medication, menu planning, cooking and presentation of food, medication, cleaning processes etc. The inspector was able to view the Health and Safety check carried out for the home, which covered both the internal and external areas of the home. An independent company has carried out a recent fire safety check and the report at the present time is with the registered provider. The consortium employed by the registered provider carries out monthly Regulation 26 visits and the inspector on viewing these found them to be comprehensive, and they clearly showed where improvements have been made and need to be made, to ensure that the home provides the best quality of care for its residents. The home does not manage any of the personal allowances for its residents’, all personal allowances are managed by the residents own relatives/ representatives. Where urgent expenditure is required on behalf of a resident, the purchase is made via the home’s petty cash system and the family is then invoiced. The appointed manager has just started staff supervision and a supervision matrix was seen to verify that future supervisions will take place. As mentioned previously under staffing none of the staff have received all of their mandatory training, but this has been or is being arranged via a consortium that provides training, and training dates of booked mandatory training are available. The home has recently reviewed policies in respect of health and safety procedures in the home. All cleaning materials are kept under lock and key within the home. No Legionella testing has yet taken place and through discussion with the manager he confirmed that he is about to arrange for testing to take place. All hot water outlets are controlled via thermostatic control valves. Every window in the home has a window opening restrictor fitted. The external doors to the premises are fitted with number locks. The inspector viewed the fire log book and this showed that fire point checks have not been carried out regularly for the last two months there has Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 26 only been one check a month, when these checks should be carried out weekly. No evidence was seen that hot water thermostatic control valves are checked on a regular basis. A requirement is being made that fire call points are checked weekly and that hot water outlets are checked regularly to ensure that hot water is being delivered at 43ºC. All accidents are recorded within a Health and Safety Executive accident book, but staff need to ensure these accident forms are completed fully and that they are kept in accordance with the Data Protection Act 1998. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 27 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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 28 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 OP3 Regulation 14 Schedule 3(1)(a) Requirement Timescale for action 02/10/08 2. OP7 15 Schedule 3 The registered person shall not provide accommodation to a resident at the care home unless, so far as it shall have been practicable to do so – the needs of the resident have been assessed by a suitable qualified or suitably train person; There has been appropriate consultation regarding the assessment with the resident or a representative of the resident. The registered person has confirmed in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the resident’s needs in respect of his health and welfare. The registered person shall, after 02/10/08 consultation with the resident or a representative, prepare a written plan as to how the resident’s needs in respect of his health and welfare are to be met. The registered person shall make the resident’s plan available to the resident, keep the resident’s plan under review, and consult DS0000067146.V369483.R02.S.doc Version 5.2 Copper Beech Care Home Page 29 3. OP7 15 4. OP8 17 Schedule 3 5. OP8 12 13 6. OP9 13 with the resident or a representative of his, revision of the care plan, and notify the resident of any such revision. The registered person must ensure that daily records are detailed in accordance with the individual needs of the resident, all care given is not helpful or adequate. Daily records when well written, help ensure a consistent approach and good quality of care for service users. Staff must record personal hygiene tasks undertaken to ensure that all aspects of personal hygiene are met. The registered person shall maintain in respect of each resident a record which includes the information, documents and other records specified in Schedule 3 relating to the resident, especially specialist health care and nutrition. The registered person must ensure that residents’ have access to all health care specialist when appropriate and that visits to and from these specialists are recorded in the residents care plan. The registered manager must ensure that the medication trolley is kept in a good state of repair. That any residents’ who experience pain are referred to their general practitioner to ensure that appropriate pain relief is prescribed. 02/10/08 02/10/08 02/10/08 02/10/08 7. OP16 22 Schedule That eye drops/ointments and liquid medication are dated on the bottle on the day of opening The registered person must 02/10/08 ensure that the complaints policy DS0000067146.V369483.R02.S.doc Version 5.2 Page 30 Copper Beech Care Home 4 8. OP22 23 9. OP26 16 10. OP29 19 Schedule 2 11. OP30 12 18 12 13 12. OP38 is kept under review and that correct information is given in regard to contact addresses. The registered person must ensure that all residents have access to a call bell system in their bedrooms. The registered person shall ensure that all parts of the home are kept free from offensive odours. The registered person shall ensure that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. The registered person must ensure that all staff receive mandatory training in the first six months of their employment. The registered person must ensure that fire points and hot water delivery are checked on a weekly basis and any faults are rectified immediately 02/10/08 02/10/08 02/10/08 02/10/08 02/10/08 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 OP15 Good Practice Recommendations It is good practice to ensure that residents’ have an understanding of the food they wish to order, and in the case of dementia care residents it is appropriate to have a pictorial menu, that resident can view and make choice from. Staff should be allocated to residents who need assistance with feeding to ensure that staff are with the resident continuously throughout the mealtime, to ensure that the resident has sufficient to eat and reduce any agitation. Copper Beech Care Home DS0000067146.V369483.R02.S.doc Version 5.2 Page 31 Crockery containers should not be left on dining tables whilst residents are eating. Consultation should take place with the cook in regard to the amount of food given to each resident at each mealtime, to ensure that residents’ are not over faced with food, and feel that they can comfortably eat what is placed in front of them. The registered person should obtain Sussex Multi-Agency Policy and Procedures for Safeguarding Vulnerable Adults. The registered manager must ensure that he continues to develop the Quality Assurance System in the home to ensure that residents receive the highest level of care. The registered manager must ensure that staff complete accident forms correctly and that these accident forms are kept in accordance with the Data Protection Act 1998. 2. 3. 4. OP18 OP33 OP38 Copper Beech Care Home DS0000067146.V369483.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. 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