CARE HOME ADULTS 18-65
Copper Beeches Lodge Care Home 52 Truro Road St Austell Cornwall PL25 5JJ Lead Inspector
Ian Wright Key Unannounced Inspection 6 -8th November 2006 15:45
th Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 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 Lodge Care Home DS0000065158.V307737.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 Adults 18-65. 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 Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Copper Beeches Lodge Care Home Address 52 Truro Road St Austell Cornwall PL25 5JJ 01726 74024 F/P 01726 74024 Telephone number Fax number Email address Persons Web address Name of registered persons(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Steven Jon Tarrant Mrs Maureen Joy Tarrant Mrs Christine Marie Tarrant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Copper Beeches provides residential care for twelve adults with a learning disability. Many of the service users are diagnosed as autistic. Mr Steven and Mrs Maureen Tarrant are the registered persons. Mrs Christine Tarrant is the registered manager. The home is situated in St Austell, near to the town centre. , Accommodation is provided on the ground and first floor with twelve single bedrooms. All bedrooms have an en suite bathroom consisting of a toilet, bath and shower. Service users have access to a lounge, dining area, kitchen, and a quiet lounge. The ground floor of the home is accessible for people with a physical disability. There is sufficient car parking to the front of the property. A copy of the inspection report is available in the office, and it is suggested a copy is requested from management or CSCI if required. The range of fees at the time of the inspection is £800-950 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Key Inspection took place in thirteen hours over three days. All of the Key Standards were inspected. The methodology used for this inspection was: • To case track five service users. This included, where possible, meeting and discussing with the service users their experiences, and inspecting their records. • Discussing with staff their experiences working in the home. • Discussion with other service users and their representatives. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better:
Care and management at Copper Beeches are to a high standard and there are no statutory requirements. This is unusual following any key inspection visit. Two recommendations for good practice have been made. Firstly, during induction training, to include awareness training of people with autism. Management have said they are already planning to implement training regarding autism for established staff. Secondly, written guidelines should be developed for the administration of PRN (as and when necessary) medication such as diazepam. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a suitable statement of purpose and service user guide. This enables service users and their relatives to have suitable information regarding services provided. Service users have a suitable contract of care or statement of terms of conditions of residency. This enables service users to be aware of their rights and responsibilities. The pre admission assessment procedure is good, and enables the registered persons to ascertain they can meet the needs of service users, before admission is arranged. EVIDENCE: Copies of the statement of purpose, service user guide and contract of care / statement of terms of conditions of residency, were inspected. The registered persons said this information was provided to service users and /or their representatives before or on admission. Copies of local authority contracts are also on file where applicable. Copies of pre admission assessments were also inspected and these were comprehensive. A copy of the registered persons’ assessment policy was also inspected and this is satisfactory. Discussion with service users, staff and the registered persons outlined a suitable process of how service users moved in to the home. This included, where appropriate, the opportunity for service users to visit the home/ stay at the home before formal admission was arranged.
Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users have a care plan and these are reviewed. This ensures staff have suitable information to provide care, and care plans are amended when changes in service users’ needs occur. Service users are encouraged to make decisions about their lives with suitable assistance as required. The registered persons approach to handling service users monies is satisfactory, so service users can be assured their financial interests are safeguarded, where the registered persons are involved in this area of their lives. The registered persons have a suitable approach to risk, so service users can be assured they will be supported to take risks as part of an independent lifestyle. EVIDENCE: There is a copy of a care plan in each service user file. Staff said care plans were accessible to them. The care plan format is comprehensive and gives clear guidance to staff regarding service user needs. There is suitable evidence that care plans are reviewed appropriately. Service users and staff said service users are encouraged to make decisions regarding their lives. Suitable risk assessments are in place to assess any risks
Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 10 or actions to promote independence. The registered persons look after most service user monies, for which suitable records are maintained. Suitable risk assessments regarding this intervention are kept. Relatives or legal representatives are responsible for service user benefits, and will provide service users / the home with regular ‘top ups’ of money for day-to-day needs. Suitable records of money received and expenditure are kept. Monies checked matched with records kept. The registered persons act as agent for a minority of service users’ benefits, for which suitable records are kept. The registered persons have a satisfactory policy regarding diversity and equality. There are currently no service users from ethnic minorities, although the registered persons stated they would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can participate in a suitable range of activities, and are able to mix with the wider community. Service users are encouraged to maintain relationships with friends and relatives. Service users rights are respected, and service users are enabled to take a suitable amount of responsibility in their daily lives. Suitable arrangements are in place so service users enjoy a healthy and varied diet. EVIDENCE: Service users said they have a range of activities. These include going bowling, attending day centres etc. Activities such as art, working on computers etc. are also arranged in the home. The registered persons have a minibus to help service users to move around the community. Service users said they visit friends and relatives regularly, and they are encouraged to maintain contact via the telephone or post. Visiting arrangements are flexible, and there is suitable space for service users to receive visitors privately. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 12 Service users said they could get up and go to bed when they wish, although some may need reminding to get up on the days e.g. when they attend the day centre. Service users said staff worked with them in a way, which respected their privacy and dignity. For example staff knock on doors, and mail is not opened without service users’ agreement. Locks are fitted to bedroom doors. Service users and staff said service users have some involvement in household tasks for example doing laundry, some cleaning tasks etc. Service users said they were encouraged to make other choices how they lived their lives. Service users said food provided is to a high standard. There are two choices of meal always provided. For example on the first day of the inspection there was either meat pie or a pasta meal, followed by bread and butter pudding. This was made with fresh produce. Service users all said they enjoyed the food provided, and said it was provided in sufficient quantities. Drinks are available whenever these are requested. Suitable records are maintained regarding food provided. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care is delivered to a good standard, and there are suitable links with medical professionals. Service users medicines are managed appropriately. Service users can therefore be assured there personal and health care needs are suitably met. EVIDENCE: Service users said they received suitable care and support from staff. Any personal care needs are clearly documented in care plans, and staff seemed clear regarding what assistance service users need. Care plans document appropriate links with GP’s, dentists, chiropodists and other professionals. Service users said they regularly saw medical professionals when required. The registered persons and other staff reported no problems with links with medical professionals. Medication is stored securely, and dispensed via a ‘monitored dosage system’. Medication records kept are appropriate. There is a suitable medication returns system. Staff have received suitable training regarding the handling of medication. It is recommended that written guidelines be developed regarding PRN (as and when) medication such as diazepam.
Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered persons have suitable procedures regarding complaints and adult protection. Subsequently service users can be assured there are appropriate procedures to deal with any concerns or bad practice. EVIDENCE: The registered persons have satisfactory procedures regarding complaints and adult protection. Staff and service users showed some awareness of the procedures, and were able to say whom they would approach if they had a complaint or were concerned about abuse. The majority of staff have also attended training regarding the prevention of abuse. Staff and service users all said they had not witnessed any bad or abusive practices. All staff have Criminal Record Bureau check, and a Protection of Vulnerable Adults check (where applicable). Where staff are awaiting the outcome of a CRB/ POVA check the registered manager said their work was supervised and they were not able to carry out any personal care. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Copper Beeches provides a pleasant, homely, clean and well-maintained environment for service users to live and feel at home in. EVIDENCE: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and homely. There is a pleasant garden, which service users can use. All communal rooms are homely and comfortable. There is a lounge, and a dining room. The lounge has a computer area for service users’ use. There is a second lounge for service users’ use, although this is not used very often. The dining room is also used for recreational activities. Bedrooms are to an excellent standard. They are spacious, individualised and comfortable. Many bedrooms have double beds. All bedrooms have en suite facilities including a bath, shower and a toilet. Decorations throughout the home are maintained to a good standard. The registered persons are aware some of the carpets in the communal areas need
Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 16 replacing and are in the process of replacing these. The registered persons said they were aware that some of the windows in part of the home need repair and painting and will attend to this. There are suitable toilet facilities for communal use. Suitable kitchen and laundry facilities are provided. The home was clean and hygienic at the time of inspection. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels appear suitable so service users can be assured they will get appropriate levels of staff support. Recruitment records are good so service users can be assured there are suitable recruitment procedures and checks in place. Staff training provision is good so staff receive appropriate training as required by regulation. This should assure service users that staff have suitable skills and knowledge to cater for their needs. It is recommended staff receive additional training in autism and person centred planning. Equal opportunities issues regarding recruitment and work practices seem satisfactory. EVIDENCE: Rotas show at least three members of staff are on duty in the morning and four members of staff on duty in the afternoon and evening. Two staff sleep in between 2200 and 0800. A cleaner is also employed Monday to Friday. The registered manager also works in the home. Mr Tarrant will also be at the home several times a week. The registered persons have a suitable approach to providing National Vocational Qualifications for care staff. The pre inspection questionnaire stated
Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 18 that 90 of staff have an NVQ 2 or 3. Copies of staff NVQ certificates were contained in staff files. Suitable induction records were available for all staff. Induction includes shadowing more experienced staff; formal instruction from management and viewing videos/ DVD’s regarding various issues such as food hygiene. Staff training required by regulation is to a good standard. Staff training includes most staff having a first aid certificate (at appointed persons level), training in manual handling, fire training, infection control training and food handling. Staff have also attended a health and safety course. The registered persons ensure staff have this training usually within six months. Staff also receive training in epilepsy. This is very good and it is clear the management are committed to ensuring staff receive suitable training. The registered manager said there has been difficulty in obtaining training regarding autistic spectrum disorders. However the registered manager said the NVQ training provider has recently been able to obtain resources to provide training in this area. It is recommended all staff have this training. Training to improve basic awareness of autistic spectrum disorders (e.g. Wing’s triad of impairment, difference between autism and Asperger’s Syndrome etc.) should be covered at the induction stage. Care of people with an autistic spectrum disorder is however to a good standard. It is also recommended staff have training in Person Centred Planning to help assist service users’ development towards independence and increasing sense of autonomy. Recruitment records were inspected. These were to a very good standard and include an application form, two references, supervision records and a record of staff induction. All staff have a Criminal Records Bureau check and Protection of Vulnerable Adults check. Where staff are awaiting their CRB check they are supervised appropriately and the registered manager said they do not participate in any personal care duties. The registered persons’ approach to equal opportunities and anti discrimination is appropriate. Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered persons appear to be suitably experienced, skilled and qualified to manage the home so service users can be assured there are competent people in charge of the home. There is a suitable quality assurance system in place so service users can be assured there is a suitable system to measure and maintain a good quality of service. The management of health and safety issues is good so service users can be assured they live in a safe environment. EVIDENCE: The registered persons appear caring, approachable and competent. The staff the inspector spoke to say the registered persons are good to work for, and provided sufficient guidance and support to help them to do their jobs. Service users were positive about the registered persons approach. The registered persons have a suitable approach to quality assurance. The registered persons have a comprehensive quality assurance system to ensure quality standards and regulatory requirements are maintained. A survey has
Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 20 been completed of stakeholder views and these are positive. A summary report of the findings was produced. There are records that at least 3 resident meetings, 3 staff meetings and 3 senior meetings have occurred in 2006. The registered persons have a suitable health and safety policy. Regular health and safety checks are completed. Other records kept of checks required by regulation are satisfactory. For example there are suitable records of the testing of fire equipment, portable electrical appliances and the electrical hardwire circuit. Accident records are suitably maintained. The gas certificate had expired in October, and the registered persons have been chasing the engineer to service the boiler. Mr Tarrant assured the inspector a copy of the gas certificate would be forwarded to the commission as soon as possible once the work had been completed. Health and safety risk assessments are satisfactory including a suitable system regarding the prevention of Legionella. Copper Beeches Lodge Care Home DS0000065158.V307737.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 Adults 18-65 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Persons(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Persons/s to consider carrying out. No. 1. 1. Refer to Standard YA20 YA35 Good Practice Recommendations It is recommended that written guidelines be developed regarding PRN (as and when) medication such as diazepam. Staff should receive training in Autistic Spectrum Disorders (e.g. basic awareness training during induction). The registered persons should also investigate the possibility of staff receiving training in ‘Person Centred Planning.’ Copper Beeches Lodge Care Home DS0000065158.V307737.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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
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