Inspection on 13/03/08 for Copperbeech Care Home

This inspection was carried out on 13th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Copperbeech Care Home 03/12/08

Copperbeech Care Home 01/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Copper Beech Care Home 154 Barnhorn Road Little Common Bexhill-on-Sea East Sussex TN39 4QL Lead Inspector Kathy Flynn Unannounced Inspection 10:30 13 and 14 March 2008 th th 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.V359253.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Copper Beech Care Home DS0000067146.V359253.R01.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 Vacant Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Copper Beech Care Home DS0000067146.V359253.R01.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 11th May 2007 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. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. This unannounced inspection that was carried out on the 13th and 14th March and took place over eight hours. The inspection included a tour of the home, a review of pre-admission assessments, care plans, accident records, staff records and training, medication records, activities, policies and procedures and menus. There were 14 residents at the home during the inspection and all of them were spoken with. The manager and the staff on duty discussed the care and support they provide at the home. The Annual Quality Assurance Assessment (AQAA) returned to the Commission in July 2007 was used as part of the preparation for this inspection. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term ‘service user’ to describe those living in care home settings. However for the purposes of this report those living at Copper Beech will be referred to as ‘residents’. What the service does well: What has improved since the last inspection? The additional improvements planned for the home have been delayed due to planning restrictions. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 6 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 Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 7 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.V359253.R01.S.doc Version 5.2 Page 8 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): Standard 3. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre admission assessments are completed for all prospective residents to ensure the home can meet their needs. EVIDENCE: The manager confirmed that preadmission assessments are completed for all prospective residents before they are offered a room at the home. The current manager has been in post for three weeks and is reviewing all the policies and procedures, and advised that he will be making changes if appropriate. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 9 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system does not meet the needs of residents at the home, staff have been trained to administer medication to protect residents. EVIDENCE: Five care plans were examined in detail. Only one contained some completed records, which included risk assessments for pressure relief, continence and falls assessment. The care plan for one resident was empty, and there was only basic information gathered during admission for another resident. A risk assessment for falls had not been completed for a resident who staff said was at risk. This resident had fallen recently and been injured, this was not recorded on the falls record sheet, and a plan of action had not been developed to enable staff to support this resident and ensure that the risk of falls was minimised. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 10 In two of the care plans it was noted that someone had recorded inappropriate statements about the residents social and cultural needs being limited due to their level of dementia. The manager and other staff spoken with agreed that this is not acceptable. The care plans do not identify the individual needs of residents, therefore staff are unable to provide the care and support they need. Some of the staff spoken with said that they do not write the care plans, they only complete the daily record, which indicates how the residents have spent their time and the support the staff have provided. The manager said that he is planning to introduce new forms to ensure that they record the needs of residents, and accepts that this will take some time to complete. Some records showed that residents are weighed on a regular basis, but the variations in measurements highlight a problem with the system used, in terms of faulty scales or staff inability to use them effectively. Where weight loss was recorded there was no evidence that any action had been taken or that nutritional assessments were completed in line with any changes. The manager advised that the scales may need calibrating and this will be addressed. Residents are registered with GP’s and the home has good links with the District Nurse (DN) and the Diabetic nurse. The DN has provided training for staff to enable them to give insulin for residents with diabetes and visit on a regular basis if required to apply dressings. Referrals to allied health professionals, including the continence nurse, community psychiatric nurse and chiropodist, can be arranged if required. Training has been provided by a local pharmacist for staff and those spoken with have completed the training and are aware of their responsibilities. The Medicine Administration Record (MAR) charts were viewed and found to be signed to reflect the medicines that had been given to residents. However some of the records were incomplete, the number of analgesic tablets given to a resident were not recorded and some residents were not prescribed appropriate pain relief. The manager confirmed that there are no controlled drugs in the home. Communication between residents and staff was friendly and first names were used, some of the residents said ‘the girls are good’. Some of the staff have been working at the home for some time and know the residents very well, they understand their basic needs and are able to support Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 11 them. However some of the conversations between staff and residents were inappropriate, and further training in communication and treating residents with respect is to be provided. This is to ensure that they are treated with respect and their dignity is protected at all times. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 12 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): Standard 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no activity programme at the home for residents to participate in, the food is satisfactory but residents are not offered choices for the main meal. EVIDENCE: There were no activities for residents during the two days of the inspection, although a programme has been developed and is advertised on the notice board just inside the entrance. Most of the residents were sitting in the lounges with the televisions on, although when asked they said they were not watching, and the sound was too low for them to hear. The staff advised that they were unable to provide activities or spend a lot of time with the residents because a number of staff have left recently. The manager said that staffing numbers was an issue and they were advertising for staff and a number of application forms were being sent out. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 13 Visitors are welcome to the home at any time, although there were no visitors at the time of the inspection to discuss the support provided at the home for residents. The manager said that an open day is planned for the end of March, invitations are to be sent out to relatives of residents at the home, and health professionals who have placed residents there or who provide support. The provider will be there to discuss the plans to develop the home, including the extension and the use of the additional rooms for nursing. The staff said that residents are able to make choices but observations during the inspection noted that staff were directing residents rather than offering alternatives. This may be due to the reduced number of staff at the home and the manager said this will improve as they employ more staff. Residents were offered a hot lunch on both days of the inspection, but they were not offered a choice and a number of residents did not eat most of the meals. It was noted that residents were not asked if they had eaten enough and were not offered anything else, although it was clear that they had not enjoyed the meals. During discussions a member of staff suggested that if the residents did not eat the meals then they are not hungry, the view that the residents might not eat the meals because they did not like them had not been considered. During afternoon tea there was also no choice, cups of tea were handed out and residents were not asked what they would like, or offered a choice. They had run out of biscuits and cakes so staff gave residents a few crisps, they were not asked what they wanted. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 14 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 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have appropriate complaints policies and procedures in place and the home, training in adult protection has been provided for staff to protect residents. EVIDENCE: The manager said there have been no complaints about the services offered at Copper Beech since he became manager, and the staff confirmed that as far as they know there have been no complaints. The staff spoken with had an understanding of adult protection although they had not all attended the training. The manager was unable to produce current policies and procedures concerning complaints and adult protection, he advised that he is reviewing these. He also confirmed that he is reviewing staff training, so that he can arrange further training as required to ensure that all staff are up to date with regard to safeguarding adults. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Copper Beech offers residents a comfortable and homely place to live. Training in infection control is provided for staff to protect residents, however some staff were not following the homes policies regarding the use of gloves. EVIDENCE: There is sufficient communal space in the home, a lounge/dining room, a smaller lounge, and a separate dining room are available for residents to use. The layout of the lounge/dining room enables residents to choose whether they want to sit in front of the TV or not, and the dining tables are available for use throughout the day. The room is large enough to be used for activities although these were not provided at the time of the inspection. Small tables Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 16 have been provided for the residents to use in the lounge, one resident was noted to be sitting on one of these although they are not strong enough to support a persons weight. The use of these table should be reviewed and alternatives provided if necessary. Residents are able to personalise their rooms with their own possessions, and many have done so. There are plans to extend the property to provide some nursing beds, and improvements to other parts of the home, including the kitchen, will be carried out as part of this programme. There are attractive gardens around the home and the manager said that some work is being done on these to ensure that residents can use them safely when the weather permits. There is an ongoing maintenance program for the home and the maintenance person is available to carry out necessary repairs when they are identified. Training in infection control has been provided, two of those spoken with have attended this and one had not. Staff were observed to be using gloves incorrectly on the second day and this was identified as a problem at the last inspection. The manager advised that this training will be reviewed and repeated as required. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 17 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 and30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are followed in the home to protect residents, however there were not enough staff working at the home, which may put residents at risk. EVIDENCE: Staff provided residents with basic support at the time of the inspection. However they were unable to offer them activities or personal time, in addition to assistance with washing, dressing and at meal times, because there were not enough of them working in the home. The staff advised that they do the best they can and are able to ensure the residents are comfortable. It was noted that some of the staff clearly know the residents very well, are able to anticipate any problems and are aware of their needs. Although they agreed that they were unable to offer all the residents the same level of support. Clearly they allocated their time depending on the needs of the residents at the time, and one resident was particularly distressed and needed more support. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 18 The manager confirmed that he is to address the staffing issues as a matter of urgency. New staff at the home will be required to complete the induction programme, the induction training could not be assessed at this time, and will then be encouraged to work towards National Vocational Qualifications (NVQ). Two members of staff have completed, or are about to complete, NVQ courses and other staff are being encouraged to enrol onto courses in care, housekeeping and cooking. Staff spoken with said they have not attended training that would enable them to provide appropriate support for people with dementia. With the lack of relevant training, and the recent turnover in staff at the home, there are concerns that staff may not be aware of their roles or have the necessary skills to care for the residents. The home has appropriate recruitment procedures and the manager confirmed that these are followed, including completed application forms, two references, Criminal Register Bureau (CRB)\and Protection of Vulnerable Adult (POVA) checks are completed. The manager stated that new members of staff who are working at the home with Protection of Vulnerable Adults (POVA) check only, do so under supervision at all times until the CRB check is completed. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 19 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 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager at the home was recently appointed and has identified a number of areas that require improvement. The health and safety or residents may be at risk because staff do not follow appropriate health and safety policies. EVIDENCE: The manager has been in post for just over three weeks, he has experience of providing support and care for people with dementia, and confirmed that he is applying to study the Registered Managers Award. The expectation is that he Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 20 will also apply to register as the manager of Copper Beech with the Commission. Quality assurance and monitoring systems are not in place, policies and procedures require updating, and an adequate training programme and staff supervision systems are not available to support staff. The home does not take responsibility for residents finances. Some money is kept in the home for small payments if required and the manager has access to this. The health and safety of residents is not protected at all times. Staff were noted to use inappropriate moving and handling techniques; staff were not using gloves as required but were noted to be wearing them continually; hoists were stored in one of the residents room, which may put the resident at risk. The Commission is not being informed of incidents at the home that affect residents, including falls and visits to Accident and Emergency at the local hospital. The manager is aware that a considerable amount of work is needed to ensure that the home offers support and services safely, and meets the needs of residents. Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 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 1 28 3 29 3 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(1)(2) Requirement The care planning system is to include current information regarding the assessed needs of residents to enable staff to offer appropriate care and support. Outstanding from 06.08.07 Appropriate screening to be used to ensure residents have a nutritious and appetising diet, and action is taken if any there is weight loss and gain. Staff to ensure that residents are given medication appropriate to their specific needs. Staff to ensure that the privacy and dignity of residents is protected at all times. Staff to provide social and cultural activities based on the preferences of the residents. Staff are to provide support and care for residents in such a way that they are encouraged to make choices about all aspects of their day to day lives. Outstanding from 15.06.07 Suitable levels of staff, with the DS0000067146.V359253.R01.S.doc Timescale for action 23/06/08 2 OP8 OP15 12(1)(a) 16(2)(i) 28/04/08 3. 4. 5. 6. OP9 OP10 OP12 OP14 12(1)(a) 12(4)(a) 16(2)(m) 12(2) 07/04/08 07/04/08 23/06/08 07/04/08 7. OP27 18(1)(a) 07/04/08 Page 23 Copper Beech Care Home Version 5.2 8. OP33 24 9. 10. OP38 OP38 OP26 13(4)(c) 13(3) necessary skills, to be employed at the home to provide appropriate levels of care for the residents. An effective quality assurance and monitoring system to be developed and introduce to assess the efficacy of services provided for residents. Staff to follow relevant health and safety practices to protect residents. Training in infection control to be reviewed to ensure staff protect residents by following the homes policies. Outstanding from 15.06.07. 23/06/08 07/04/08 28/04/08 11. OP38 13(5) Training in moving and handling 28/04/08 to be reviewed to ensure staff protect residents by following the homes policies. Outstanding from 15.06.07. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Copper Beech Care Home DS0000067146.V359253.R01.S.doc Version 5.2 Page 24 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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