CARE HOMES FOR OLDER PEOPLE
Copper Beeches Woodlands Way London Road Andover Hants SP10 2QU Lead Inspector
Annie Billings Unannounced Inspection 8th November 2005 12:30 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 DS0000037292.V261911.R01.S.doc Version 5.0 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 DS0000037292.V261911.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Copper Beeches Address Woodlands Way London Road Andover Hants SP10 2QU 01264 353703 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) brenda.hurst@hant.gov.uk Hampshire County Council Mrs Brenda Hurst Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Copper Beeches is a local authority residential home, registered for forty two service users in the categories of old age, not falling within any other category, and dementia care for service users over the age of sixty five. The home is situated in a quiet residential area of Andover, within easy reach of local amenities. Accommodation is arranged on two floors, with passenger lift access. Ten of these beds are arranged as a separate unit to offer five beds as an interim facility for those waiting for long-term care, and five beds offering intermediate care. The registered manager, Mrs Brenda Hurst, also has management responsibility for a day centre, which is located alongside the residential facilities. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4.5 hours and was the second inspection of the year April 2005 to March 2006. Many of the core standards were inspected during the previous visit on the 10th May 2005; therefore referral to both reports will give a full overview of the service. A partial tour of the premises took place and observation of daily routines within the home. Records were sampled and discussions were held with eight residents, three visitors and five staff members. Comment cards were also received from two relatives, four service users, two care managers and two district nurses. Additional information was supplied within a pre-inspection questionnaire. What the service does well: What has improved since the last inspection?
Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 6 Since the last inspection a new assisted bath has been installed, a number of areas have been redecorated and additional facilities provided in the kitchen, with new procedures in place to ensure that ceiling fly screens are cleaned on a regular basis. A programme of training for all care staff in dementia care has commenced. New management systems have been introduced to improve auditing and monitoring of the premises, health and safety and safe working practice. 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. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 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 Beeches DS0000037292.V261911.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected EVIDENCE: Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The procedures and practices for dealing with medication are robust. EVIDENCE: The home operates a monitored dosage system for the administration of medication, supplied by a local pharmacist, who regularly audits practices within the home. The most recent audit report was sampled and identified no issues. The majority of records sampled were well maintained, with all medication checked and booked into the premises, and returns signed off by the pharmacist. The assistant unit manager advised that only senior staff administer medication, following appropriate training, assessment and supervision and was able to demonstrate an excellent understanding of the homes policy and procedures. One resident confirmed, “All my tablets are given to me regularly”. It was noted however that there was one occasion when three medicines had not been administered to one resident, and no reason given; and a tablet was later discovered on the dining room floor. The assistant unit manager agreed to investigate these matters and feed back to the Inspector.
Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 10 Changes in medication were also noted on the medication administration records. The home has been unable to gain GP signatures to confirm these changes, although instructions have been well documented, and a Change of Medication sheet has been developed. The home is encouraged to obtain written instructions from the GP whenever possible. Two residents are supported to self medicate or partially self medicate, with appropriate storage and risk assessments in place. Although standard 11 was fully inspected at the last visit, comments made by one resident suggested a lack of privacy during discussion with the manager, due to interruptions, and that staff do not always treat them with respect when discussing sensitive issues. This was discussed with the manager, who intends to discuss this at the next staff meeting. This will be monitored at the next inspection. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected. EVIDENCE: Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Policies and procedures are in place to protect residents from abuse. EVIDENCE: Members of staff and management spoken with had a good awareness of abuse issues, and were able to describe the reporting procedures. Training records confirm that all staff receive training in the protection of vulnerable adults. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 Although some progress has been made in upgrading one bathroom and WC’s, further improvements are necessary to ensure that the home is well maintained and provides sufficient facilities to meet peoples’ needs. EVIDENCE: Since the last inspection a new assisted bath has been fitted in one bathroom, and a number of WC’s have been decorated and new flooring fitted. Ceiling fly screens in the kitchen have been cleaned, and procedures put in place to ensure this task is completed regularly. A new grill has been provided in the kitchen, and additional work surfaces made available. Recent refurbishment of communal areas has been welcomed by residents, who said it was “lovely”. The main lounge is particularly welcoming with attractive décor and furnishings, and is divided into several small clusters of comfortable seating, including a private conservatory lounge. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 14 The shower room, due for completion in September has yet to be completed, and remains out of commission and the bath in room 64 remains badly scratched. A recent flood in room 8 has resulted in the carpet becoming waterlogged. Despite evidence of recent cleaning, the unpleasant odour is detectable throughout the floor, although this area is not currently occupied. Several other areas of carpeting are badly stained, particularly the corridors on both floors, despite regular cleaning, and outside the kitchen in the dining room, which reflects badly on the recent improvements in other areas. The loop system, fitted in one lounge to assist residents fitted with a hearing aid, was disconnected for decoration, and is now out of use. This must be replaced to ensure that facilities previously available to residents are replaced. The call system within the home is insufficient to ensure the health and safety of residents. Only four pagers are available to staff, when there can be as many as six on shift. This has been highlighted as a health and safety risk within the last three regulation 26 reports forwarded to the commission, with no action taken to date. This must be addressed, as this potentially puts residents at risk. The manager advised that following consultation with a designer and architect, plans are in place for the central courtyard area to be developed in the Spring 2006, with areas of raised beds, sensory planting, seating and a water feature. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 Recruitment and training procedures in the home are robust in the protection of residents. EVIDENCE: Nine of fifteen staff have qualified to National Vocational Qualification Level 2 in care or above. A further two staff have qualified in cleaning and support services. Certificates were seen on display in the reception area. A resident advised that a badge is awarded to staff members on successful completion of the course. Three staff files were sampled and found to be well organised and complete. These provided evidence that the home undertakes all appropriate checks on applicants prior to offering employment. Evidence was also available within files to demonstrate that new members of staff receive a thorough programme of induction training, which is assessed and signed off by a senior member of staff. Residents, relatives and visiting professionals all made very positive comments about the staff team, saying, ”staff are polite, cheerful and caring”, “nothing is too much trouble”, and “we have good carers”. A programme of training in dementia care for all care staff has commenced, but is not due for completion until early in 2006. The requirement will remain
Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 16 until this is completed. Plans are in place for ancillary staff to receive this training during 2006. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 38 The home is well managed, records are well maintained and effective procedures are in place to safeguard resident’s financial interests, health, safety and welfare. EVIDENCE: The registered manager has been in post since 2003, following many years in senior management positions, and has recently been awarded a National Vocational Qualification level 4 as well as attending a variety of training courses and refresher updates. Mrs Hurst demonstrates her commitment to maintaining high standards of care and has a good understanding of her responsibilities. Staff confirmed they felt well supported by management, with clear direction and guidance, and one commented, “It feels like a family group”. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 18 The manager advised that residents’ finances are either supported by families, or advocates. Personal allowances held for safekeeping were checked, and records were accurate and well maintained. Maintenance certificates for services and equipment are all current, and regular tests and visual checks of fire safety equipment were found to be up to date. An issue relating to one resident smoking in the home was identified, and the risk assessment sampled. Despite action taken to minimise any potential risk, a significant risk remains, and the manager was advised to consult with the fire safety officer to resolve the issue, and advise the commission of the outcome. New systems have been implemented recently across all local authority home to ensure safe working practice. A residential care and nursing care practice manual has recently been introduced, that provides staff and manager with good practice guidelines. The manager also advised of a county wide audit of incidents/ near misses and environmental failures, to identify areas of improvement needed, and monthly health and safety audits are to be undertaken on the premises, to improve monitoring systems in the home. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X 2 2 X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 20 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 OP19 Regulation 23 Requirement Badly stained carpets must be deep cleaned or replaced. Timescale of 31.7.05 not met The loop system and call system must be upgraded. Appropriate numbers of bathrooms must be available in proportion to the numbers of service users. Timescale of 30.9.05 not met The registered manager must ensure that all staff members working at the home receive training in dementia care. This requirement has been partially met in respect of some of the care staff team but must be completed. Timescale for action 31/01/06 2. 3. OP19 OP21 23 23 31/01/06 31/01/06 4. OP30 18 31/01/06 Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 21 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 OP21 Good Practice Recommendations Consideration should be given to updating several washbasins, and reorganising WC stalls. Copper Beeches DS0000037292.V261911.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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