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Inspection on 22/08/05 for Copper Beeches Nursing Home

Also see our care home review for Copper Beeches Nursing Home for more information

This inspection was carried out on 22nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The activity co-ordinator in this home works well with the client group and ensures that all service users have regular stimulation to suit their life styles and wishes. The inspectors were impressed with the wide range of activities that are provided and the dedication which she brings to her role.

What has improved since the last inspection?

The manager has ensured that staff supervision has now started in the home, it is hoped that this will continue on a regular basis. The manager also confirmed that all new staff now takes part in a formal induction programme.

What the care home could do better:

The care plan and assessment documentation is gradually changing, so there are in effect two systems in place. No time scales were available for the completion of this work. The service users and or their family are not involved in the formation of the plan. The home needs to ensure that service users are offered a choice at meal times. There was a strong smell of urine in several areas in the home and with sticky handrails the home did not appear as clean as it could be. Staff training should be made available to ensure the staff havethe skills to provide the required care. The nurses have the training required to stay current. However, some care and nursing staff have not completed the required training, or are in need of refresher courses, i.e. moving and handling, infection control.

CARE HOMES FOR OLDER PEOPLE Copper Beeches Nursing Home 5 Sylewood Close Cookham Wood Rochester Kent, ME1 3LL Lead Inspector Sally Hall Unannounced 22 August 2005 10:00 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Copper Beeches Nursing Home Address 5 Sylewood Close Cookham Wood Rochester Kent ME1 3LL 01634 817858 01634 817855 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare (SE) Limited Care Home with Nursing 42 Category(ies) of Dementia Over 65 - 31 registration, with number Mental Disorder Over 65 - 12 of places Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May not admit patients detained under Sections of the Mental Health Act Date of last inspection 25 January 2005 Brief Description of the Service: Copper Beeches is managed on a day-to-day basis by Southern Cross Healthcare (SE) Limited. The home is currently registered for people who have Dementia and have been assessed as having additional nursing care needs. The home is situated on the outskirts of Rochester close to local amenities and public transport. The building is a modern detached property which has amply parking Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection at Cooper Beeches took place on 22nd August 2005 at 10am. The Inspectors agreed and explained the inspection process with the Registered Manager. Documentation and records were read, including care plans. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. The manager showed the inspectors around the home, but a full inspection of all the areas were not undertaken. The focus of the inspection was to assess Cooper Beeches in accordance to the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. What the service does well: What has improved since the last inspection? What they could do better: The care plan and assessment documentation is gradually changing, so there are in effect two systems in place. No time scales were available for the completion of this work. The service users and or their family are not involved in the formation of the plan. The home needs to ensure that service users are offered a choice at meal times. There was a strong smell of urine in several areas in the home and with sticky handrails the home did not appear as clean as it could be. Staff training should be made available to ensure the staff have Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 6 the skills to provide the required care. The nurses have the training required to stay current. However, some care and nursing staff have not completed the required training, or are in need of refresher courses, i.e. moving and handling, infection control. 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 Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 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 standard(s) 3,4, Whilst service users can be confident that their needs will be assessed in order to evaluate whether the home can meet their needs they cannot always be confident that the home will be able to meet them. EVIDENCE: Some of the service users files were sampled and the assessments viewed, it was evident that information provided by the service users, their relatives and specialist health/social care professionals have enabled the Home to identify the needs of service users and develop individual care plans. The inspectors did note however that these assessments had been in place since the service users had been admitted and the service users had not been reassessed every six months, to ensure that the home could continue to meet the service users need. The care plans seen generally reflected the assessment of need but could have been more specific in the action required by staff to meet the service users’ needs. The staff training record showed that not all staff have had all of the required training. Specialist training such as working with dementia or how to deal with challenging behaviour had not been made available to any staff. As Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 9 this home provides care for older people with dementia it is important the staff have a good understanding of how diagnosis can affect the service users’ communication and social awareness. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7,8,9,11 Service users’ care plans outline the support to be provided to meet their care and nursing needs. However, there is no involvement of the service user or family when plans are being drawn up and some plans need more detailed action. The care plan and assessment documentation is gradually changing, so there are in effect two systems in place. No time scales were available for the completion of this work The service users’ health care needs are monitored but follow on action is not always provided or recorded. The home has a robust system in place for the administration, storage and recording of medication. However staff need to check that the service users’ personal information has been documented in full. Service users wishes relating to their funeral arrangements are not always recorded on the service users’ files. EVIDENCE: Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 11 The individual plans of care were inconsistent in the detail of the staff action required to meet the individual needs of the service users. The daily notes seen generally cross referenced with the plans of care, but again needed more detail and follow on information. The daily notes did not show the times that events occurred and care was provided. The key worker is not reviewing the plans of care monthly, however outcomes were being recorded when they were reviewed. The service users are not being reassessed at least six monthly and having new plans of care written with the involvement of the service user and/or family. The service users care manager if they have one should also be invited to these meetings. Key points were seen to be identified with regard to the service users health care needs. However the action identified for staff to follow was not always being acted upon. For example a service user whose weight was a specific problem had been identified as requiring weekly weight checks but this had never actually been done. The home ensures that service users have access to other health professions such as chiropodists, opticians and dentists for example. Hospital visits are facilitated and escorts provided if families are not able to attend. The files showed good risk assessments particularly regarding falls. Action is well detailed for the prevention and healing of pressure areas, the manager confirmed that a number of new service users do come into the home with pressure areas. The treatment room was seen to be generally clean and tidy. Medication is stored appropriately and signed in when it comes into the building. The home uses the blister pack system that is provided by a local chemist. The home also records all medication being returned to the pharmacy. The Medication Record Sheets did not have all the personal information about the service users missing and this was discussed with the nurse. The home also does not bring forward the stock from the previous month, so it makes it difficult to an audit. The home has a drug fridge and the temperature is being monitored. The service users files sampled did not record the wishes of the service users in the event of death. This question is one of many on a form the family asked to complete when their relative are admitted. The manager explained this was to be one of the tasks of the key workers that have recently been reintroduced to the home. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Service users benefit from a selection of activities which vary in choice and skill level so meeting the diverse needs of all. Whilst service users benefit from the provision of home cooked meals using fresh ingredients they do not benefit from being offered a choice of meals. EVIDENCE: The home has an Activities Co-ordinator who has been in post for 3 years. There are a variety of activities in place for service users including games of varying skill levels, arts and crafts, group and individual sessions, games and activities which include using different senses and areas of skill. She aims wherever possible to ensure that the many activities can be used to prompt reminiscence and promote well-being with the individual. Other activities also include cake and biscuit decorating and sewing, jigsaws etc. The Activities Coordinator accesses specialist organisations that cater for special recreational activities. An entertainer or singer also visits the home, and the service users also go out on trips to the seaside. It was not evidenced that outings occur on a regular basis during this inspection. The home actively promotes ‘open’ visiting hours and encourages family and friends to participate wherever possible. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 13 A selection of menus were viewed that showed a choice of meals were available, although it appears that this was not always the case, and records of meals eaten were not being kept. The manager stated that she would introduce a system of meals that had been eaten and also to ensure that a choice was available. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) these standards were not evidenced fully during this inspection. EVIDENCE: Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The quality of service users daily living is reduced because parts of the home are unclean and not free of offensive odours. EVIDENCE: Although this standard was not fully assessed during this inspection, both inspectors found that during a walk around the building that areas smelt highly of stale urine. This was discussed with the manager. One of the areas had been identified as needing new flooring. The inspectors also noted that the staff toilet on the ground floor needed to be cleaned and redecorated to make all the surfaces viable and reduce the risk of cross infection. The inspector also found that some surfaces such as hand-rails were dirty and felt sticky. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 Whilst staffing levels appear to be adequate to meet service users needs, their care is compromised because of the number of long days and nights staff are required to work without a break thereby increasing the risk of staff stress and fatigue. Service users are protected by the home’s robust recruitment policy. Service users cannot be confident that staff receive adequate training to enable them to improve their quality of care. EVIDENCE: The number of staff on the rota each day indicated that there is enough to meet the care needs of the service users. The home has at least two nurses on duty at all times. These work one on each floor with care staff offering support. The inspector was very concerned by the number of long days some staff are working on a regular basis as well as the number of nights also worked week on week. These continuous long hours could lead to staff feeling stressed and going off sick. The home has a total of 25 care staff and 5 of these staff now have an NVQ level 2 in care. The manager confirmed there are another 5 actually doing the award with a further 4 booked to start in September. This will give the home when they are all completed the 50 of staff with an NVQ in care that is required. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 17 The home has a recruitment procedure and all the information required in staff files was available for the last four staff that have been employed by the home. The manager was reminded however that staff cannot work unsupervised in the home until a satisfactory CRB check has been received. The home has arranged for all new staff to have the formal induction that meets the workforce targets. The training matrix seen however showed that much of the required training and specialist training has not been happening. For example according to the matrix many staff have not undertaken training in infection control, first aid, health and safety, or adult protection. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Service users are protected by the home’s robust employment policies and procedures and can be confident that staff will receive regular supervision as a means of improving the overall quality of their care. EVIDENCE: The inspector noted that the home had comprehensive employment policies and procedures. Induction training for new staff was evidenced. However regular staff supervision has only just started. The first supervision was seen recorded on file and covered the topics detailed. The manager has been given new forms to be used during supervision with staff. The manager confirmed that she supervises all the trained staff and they supervise the care staff. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 2 COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x 3 x x Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 20 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 Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 18 (1)(A) Requirement Staff individually and collectively have the skills and experience to deliver the services and care which the home offers to provide. 18.— (1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; The registered person shall ensure that the care home is conducted so as— (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of Timescale for action 30th November 05 2. OP8 12,13 30th September 05 Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 21 service users. The registered person shall make arrangements for service users— (a) to be registered with a general practitioner of their choice; and (b) to receive where necessary treatment, advice and other services from any health care professional. 3. OP9 13(2) 13.—(2) The registered person shall makearrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home.Regulation 17(1)(a)Schedule 3(k) a record of all medicines kept in the care home for the service user, and the date on which they were administered to the service user; The service user’s wishes concerning terminal care and arrangements after death are discussed and carried out. 12.—(2) The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. (3) The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed 30th September 05 4. OP11 12(2)(3) 30th November 05 5. OP15 16(2)(h),( i) schedule 4.13 30th September 05 Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 22 6. OP26 7. OP30 8. OP7 and recorded requirements, and that meals are taken in a congenial setting and at flexible times 13, 16, 23 The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 18(1) 18.— (1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users—(a) ensure that at all times suitably qualified,competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users;(c) ensure that the persons employed by theregistered person to work at the care homereceive—(i) training appropriate to the work they are toperform; and(ii) suitable assistance, including time off, forthe purpose of obtaining further qualificationsappropriate to such work. 15,13 A service user plan of care generated from a comprehensive assessment(see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 31st Ocotber 05 31st December 05 30th September 05 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 Good Practice Recommendations H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 23 Copper Beeches Nursing Home 1. Standard OP27 the hours staff work needs to be monitored to ensure that staff dont become over tired which could lead to stress, sickness and at worse abuse/neglect of the service users in their care. Multiple long days or more than 4 nights in one go with out several days rest between is not appropriate. Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent, ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Copper Beeches Nursing Home H56-H06 S26158 Copper Beeches V233255 220805 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!