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Inspection on 29/11/06 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 29th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Residents` general health needs are well met and medication is reviewed to make sure they are on the right medicines. Records viewed during this inspection were well maintained. Residents were seen to be spoken to in a respectful and courteous manner. The home has a warm, friendly atmosphere and residents` visitors are made welcome.

What has improved since the last inspection?

The home`s temporary manager is qualified and experienced at providing EMI services. She had brought about significant changes to how the home operates which have been of benefit to the resident group. Nurses now have access to additional guidance documents for the safe administration of medication to residents. Staff training has improved. The home has addressed a shortfall in the provision of safeguarding adults training noted on the last inspection.

What the care home could do better:

The environment within the home is mostly satisfactory and there is clear evidence of recent redecoration and consideration being given to the refurbishment of some other areas. Some environmental issues however still need to be addressed to ensure that the home is safe and comfortable for residents in all aspects. Lack of adequate storage space and odour control in the home is of particular concern and needs to be addressed. The staff-training matrix needs to be further developed to evidence a clear overview of staff training needs in the home. Recent improvements have been made to the staffing rosters and the deployment of staff in the home. However, the home should continue to monitor that changes made take into account periods of high and low activity and that staffing levels accurately reflect residents level of dependency. Residents would benefit from the reestablishment of formal supervision and appraisal processes for staff. The home needs to ensure that it always communicates effectively with residents` relatives/ representatives regarding their ongoing welfare.

CARE HOMES FOR OLDER PEOPLE Copper Beeches Nursing Home 5 Sylewood Close Cookham Wood Rochester Kent ME1 3LL Lead Inspector Marion Weller Key Unannounced Inspection 29th November 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Copper Beeches Nursing Home DS0000026158.V319300.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 Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 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 copperbeeches@schealthcare.co.uk 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) Southern Cross Healthcare (SE) Limited Sharette May Sparks Care Home 42 Category(ies) of Dementia - over 65 years of age (42) registration, with number of places Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May not admit patients detained under Sections of the Mental Health Act 13th December 2005 Date of last inspection Brief Description of the Service: Copper Beeches is owned by Southern Cross Healthcare (SE) Limited. The home currently has a temporary manager in post. The home is registered to provide services for up to 42 people who have Dementia and have been assessed as having additional nursing care needs. There is a mixture of single and shared rooms and residents accommodation is arranged over two floors. A passenger lift provides access to the first floor 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 ample parking to the front. The home employs registered nurses and care staff working a roster, which provides 24-hour cover. Ancillary staff for catering, maintenance and domestic duties are also employed. Current fees range from £566 to £ 774 according to assessed personal need. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector between 9:30 am and 5:45 pm. During that time the inspector spoke with some residents, relatives, the manager, the home’s administrator and some of the staff on duty. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Due to the nature of the service provided it is difficult to reliably incorporate accurate reflections of residents’ views of the service in the report. Seventeen comment cards were received prior to the inspection and three following the inspection. Responses from relatives and health professionals indicated they were generally satisfied with the standard of care the home provided and the service was seen to have recently improved significantly. Twelve respondents made comments that on occasions there are still insufficient numbers of staff on duty and a further three commented that they are sometimes not informed of issues concerning their relative’s welfare. Two respondents made comments that the home is not completely odour free in some areas. Statements on comment cards included: “I have no complaints my relative is very well looked after” “Staff are caring, friendly and always make themselves available for a chat – there is a good atmosphere in the home” “ Staff really do care and are kind” “I feel that on occasions the carers are understaffed, but they all do their very best for which I am very grateful” “Still not enough staff at busy times” “Staff do not always tell you what is going on, in most cases I have to ask” “I am not happy about the smell in the home” The manager and staff gave their full co-operation throughout the visit. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The environment within the home is mostly satisfactory and there is clear evidence of recent redecoration and consideration being given to the refurbishment of some other areas. Some environmental issues however still need to be addressed to ensure that the home is safe and comfortable for residents in all aspects. Lack of adequate storage space and odour control in the home is of particular concern and needs to be addressed. The staff-training matrix needs to be further developed to evidence a clear overview of staff training needs in the home. Recent improvements have been made to the staffing rosters and the deployment of staff in the home. However, the home should continue to monitor that changes made take into account periods of high and low activity and that staffing levels accurately reflect residents level of dependency. Residents would benefit from the reestablishment of formal supervision and appraisal processes for staff. The home needs to ensure that it always communicates effectively with residents’ relatives/ representatives regarding their ongoing welfare. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1. 2. 3. 4. 5. 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service have the information they need to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples’ diverse needs are identified and planned before they move to the home. EVIDENCE: The home’s service users guide and statement of purpose had been reviewed and the content of both documents was seen to meet the demands of regulation. The manager said a service user guide was provided to each resident or their representative and was also available in communal areas of the home. Representatives spoken to said they had been provided with Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 10 sufficient information about the home to make an informed decision about a resident moving in. Due to the nature of the service provided it was difficult to reliably incorporate accurate reflections of individual residents’ views about their choice of home. Most indicated that they were happy in the home however. The manager or a trained nurse visited prospective residents prior to admission to make a decision as to whether the home could meet their needs. Information was obtained from other parties, including health care professionals to assist in assessments. The information gained is used to compile individual care plans. Records viewed indicated that relatives are involved in this process as much as possible. The manager said prospective residents or their representatives were able to visit the home before deciding to move in. Each resident or their representative was provided with a written contract between the home and themselves. Contracts clearly stated the responsibilities of the organisation and the rights of the resident. Individual fees charged to the individual are included in the document. Relatives spoken with generally knew the charges being made by the home. The provider communicates any planned increases in charges to the resident or their representative in writing. The manger stated that charges to individuals are reassessed annually unless an individuals needs change, when adjustments to fees may be made earlier. Intermediate care was not offered at Copper Beeches. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7. 8. 9. 10. 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and social care needs are clearly set out in care plans ensuring that these needs will be met. Residents are protected by the home’s policies and procedures regarding medication and they can be confident that their privacy and dignity will be considered important and their independence promoted. EVIDENCE: Each resident has a care plan. Three were looked at in detail and were found to be comprehensive, detailed and contained information based on assessment. The format used was a medical model but also included residents’ social care needs and their choices and preferences in daily life. The home relies heavily on information provided by relatives and representatives regarding residents’ Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 12 preferences and likes and dislikes. As such they seek to include relatives in care planning and review wherever possible. Care plans were seen to have been regularly reviewed and changes made to the main plan where necessary. Daily records were being maintained appropriately and reflected care plan demands. Care plans also included residents’ wishes for end of life care. Risk assessments were in place for a variety of aspects of care. Attention was paid to prevention of falls and the moving and handling needs of residents. Discussions with the sisters on each service area and records seen, indicated that residents health needs are monitored and responded to. Some individual’s health care needs are quite complex. Records indicated that other health care professionals offer support or advice when needed. Residents are weighed regularly and this is recorded as part of their ongoing assessment and review procedure. A waterlow score based assessment is undertaken for identying any risk associated with maintaing residents skin integrity A monitored dosage system for dispensing medication is used. Trained nurses administer medication in the home. Temperatures were regularly taken of medication storage areas, including cold storage and records were maintained. The home has a designated lockable medication fridge. Some medication administration sheets were inspected. No gaps in recording administration to residents were found. The home had a current medication policy and since the last inspection, nurses have access to additional guidance documents. Residents prescribed medication is reviewed by their GP quarterly and the home regularly reviews its list of homely remedies with doctors involved with the nursing home. Care plans contained information about how a resident might prefer to be addressed. Staff were observed to be respectful when speaking to residents and good interaction was seen between staff and residents. Personal care is given in a way that clients are known to prefer. Screening is provided in shared bedrooms to promote an individual’s privacy and dignity. Staff said that they try to ensure individuals are given a choice in relation to sharing a bedroom and are both compatible. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 13 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): 12. 13. 14. 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and stimulation are well managed and as much as possible provide daily variation and interest for residents. Residents are enabled to maintain contact with friends and family who are made welcome in the home. Wherever possible and within the limitations of an individual’s dementia and frailty, residents are given opportunities to make choices, therefore allowing for some level of control over their lives. The meals in this home generally offer both choice and variety and cater for residents’ particular needs. EVIDENCE: Information about residents past interests and hobbies are noted on care plans. Daily living routines and preferences are also recorded if they are Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 14 known. Routines in the home are flexible and varied to suit residents’ preferences where practicable. Activities and opportunities for stimulation within the home are considered an important part of residents’ lives. To this end they offer a full activities programme and employ a dedicated activities organiser for 30 hours per week. A copy of the current activities programme was given to the inspector. This included, amongst other things, music and movement, armchair exercises, board games, ‘pat a pet’, quizzes and reminiscence. The home has recently ordered new equipment for sensory stimulation opportunities to be further developed and expanded. Due to the home’s obvious interest and focus on this aspect of good care, the high dependency of their resident group and the residents’ obvious enjoyment of the activities offered, they should consider adding to the hours an activities organiser is available in the home. This would ensure that more one to one sessions with residents could take place thus capturing all ranges of ability and preference for meaningful stimulation. Relatives/ representatives meetings take place regularly. The most recent was arranged to introduce the home’s new temporary manager and to provide a forum for discussion about the home’s plans for improvement. Plans were said to have been well received by the relatives attending. Some concerns were raised in survey cards prior to the inspection that improvements are sometimes not sustained in the home. As this is still early days, improvements agreed must be monitored by the senior staff for consistency and longevity and issues should be revisited where necessary if feedback is less than positive when sought from relatives. Family and friends felt welcome and knew they could visit the home at any reasonable time. The design of the home provided seating areas within communal areas of the home where residents could entertain their visitors, in addition to the privacy of their own room. Staff said they always try to make time to talk with visitors and share patient information. This was evidenced on the day of the inspection. Some survey respondents said they were sometimes not informed of their relatives’ welfare. It is the inspector’s view that the home should pay close attention to this criticism. It was not evident that this issue is a major failing on the home’s part, but they need to ensure that good two-way communication by appropriate staff is consistently maintained where necessary with residents’ relatives/ representatives. The food provided on the day of the site visit looked and smelt good. The home’s cooks were experienced in cooking for older people and were considered important members of the care team. They evidenced that they were well aware of the recorded dietary and cultural needs of each resident. Some residents were aware of their right to make menu choices and how to organise that with staff. The home’s food menus are changed seasonally twice a year. The manager said food offered by the home is discussed regularly and additional resources had now been made available to the catering staff. The Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 15 home offers a cooked breakfast every morning. The manager said that every effort is made to meet the needs of residents who eat little and often by the provision of smoothies, snack trays and fruit being made available throughout the day. Staff gave assistance to those residents who needed help to eat in a discreet and sensitive manner. The lunch meal observed was relaxed, staff appeared patient and helpful, and allowed residents the time they needed to finish the meal comfortably. Some survey respondents stated that food served on the upstairs living area is not always as hot, neither does it offer the variety of choices given to those residents downstairs. For instance, if Semolina is on the menu, the downstairs dining room will receive this with fruit and jam. This dining area is in close proximity to the main kitchen. Often the fruit and jam will not be sent in the hot trolley to the floor above. These comments could not be substantiated on the site visit but the home needs to be aware of the quality of service issues raised. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 16 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): 16. 18. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. The home takes complaints seriously and they are handled objectively and in keeping with the home’s published procedures. Residents and their representatives can be confident that concerns are listened to, taken seriously and responded to. Staff are aware of safeguarding adults procedures and there are systems in place, which protect residents from abuse. The home continues to train and update its staff to ensure residents’ needs are met at all times in this important area. EVIDENCE: The home has a clear complaints procedure with appropriate timescales for resolution of complaints and concerns. The complaints procedure viewed met all the demands of regulation. The home maintains records of complaints received and also records the outcome of complaints. Since the last inspection the home has received four complaints. Two were substantiated and one partially substantiated. One is ongoing. The home’s complaints procedure is included in the home’s statement of purpose and the service users guide. It is also displayed in the home. The Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 17 manager was informed that some survey respondents appeared unsure about the home’s complaints procedure. She stated her intention of including a reminder of the process and providing additional copies of the published document at future residents/relatives meetings. The inspector was unable to ascertain residents’ knowledge of the complaints procedure due to their mental infirmities and frailty but relatives spoken to on the day of the inspection were aware of how to complain and who to speak to if they were concerned. Relatives spoken with felt confident that there concerns would be listened to. The home’s complaints records were inspected. Suitable procedures had been followed and situations resolved to the complainants satisfaction. Individuals had all received written responses to concerns and complaints raised. Advocacy services are available to residents and can be readily accessed by the home. Staff stated that most resdsients use the advocacy of relatives or friends if they have concerns The home’s Adult Protection policy was reviewed and revised in January 2006. Staff spoken to was aware of safeguarding procedures and how to raise an adult protection alert and who they needed to contact. Staff training in safeguarding adults continues. Residents’ rights are promoted. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 18 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): 19. 20. 21. 22. 23. 24. 25. 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment within the home is mostly satisfactory and there is clear evidence of recent redecoration and future planning for replacement and refurbishment of some areas. Other issues however still need to be addressed to ensure that the home is safe and comfortable for residents in all aspects. Lack of adequate storage space and odour control in the home is of particular concern and needs to be addressed. EVIDENCE: The environment offered by the home is basically sound but does require refurbishment in some areas. Some recent redecoration has taken place. The tempory manager said she is probably 70 of the way through environmental Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 19 items that require immediate attention and the home has plans in place to resolve the remainder. New carpet is on order for corridors, reception, one lounge, the conservatory and five bedrooms. The lights in the kitchen mentioned on a previous Environmental Health Officers report cannot be provided with suitable replacement covers. The model is no longer made. New lights are now on order and a contractor has been identified to fit them. The previously aged kitchen floor has been replaced. There are two new external sheds on order to help with the home’s storage problems. Some items of equipment were noted to be stored in residents’ bathrooms, i.e. hoists, sit in scales etc. A laundry cupboard that housed towels and flannels had been placed at the top of the stairs, which led to the entrance of the first floor residents living area. The cupboard was not attached to the wall. The manager said she had moved the cupboard to its current position to give more space on the unit. However, it needs to find a permanent and more suitable home. The home does have a significant problem with storage space and it is entirely understandable that potentially unsuitable solutions will be sought to problems. The home’s storage and space limitations must be assessed and addressed. It is the inspectors view that the home would benefit from an Occupational Therapy Assessment to inform any future refurbishment plans designed to improve the provision and to overcome storage problems and space limitations. Some specialist chairs are needed to meet individual residents needs. Staff were padding out ordinary domestic type chairs to keep individuals comfortable and secure. There are chairs available that would be better suited to some residents needs and their purchase or provision must be made. The home’s sluices have limited space and are aged but were seen to be clean and well maintained. Some bathrooms also looked a little aged but were clean and fresh. There is a distinct and very strong odour of urine that is confined to one area of the home. This was discussed with the manager and the nurse in charge of that section. The situation was explained to the inspector. It was decided that the manager would take further action to hopefully ameliorate or resolve this issue. An unpleasant odour of urine was also mentioned in some survey returns received from relatives prior to the inspection. The home employs sufficient cleaning and maintenance staff. The manager has recently revised the home’s rosters and additional domestic hours have been made available to the home. A downstairs visitors toilet had a domestic cotton hand towel hanging on the wall, although there was liquid soap and paper towels in evidence as well. The Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 20 staff said it was there for decorative purposes. It was agreed that although attractive its presence could compromise the nursing home’s infection control procedures and should be removed. Relatives and residents spoken with liked the home and said that the manager had been trying her best to update and redecorate since her arrival. Several people said that the difference was quite astonishing. It was noted that the downstairs dining room is much more attractive and pleasant for residents to enjoy their meal in now. Residents’ bedrooms were highly personalised and people are encouraged to bring small items of furniture, pictures, ornaments etc when they move in. All the rooms inspected reflected residents individual tastes and interests. Attention is paid to aide memoirs for residents in their rooms and in communal areas to ensure they are as comfortable and aware of the home’s environment and the facilities offered to them within it as possible. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 21 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): 27. 28. 29. 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by a staff team who are well directed and supported in their work. The home continues to train its staff to ensure residents’ needs are met at all times. The home’s training matrix needs to be further developed to evidence a clear overview of staff training needs. Recent improvements have been made to the staffing rosters and the deployment of staff in the home. However, the home needs to continue to monitor that changes made take into account periods of high and low activity and residents level of dependency. Service users are protected from potential abuse by the home’s robust staff recruitment procedures. EVIDENCE: There appeared to be sufficient care staff on duty on the day of inspection. Residents’ needs were being met and none of them were being hurried over Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 22 meals or the provision of personal care. Some survey respondents commented on the lack of care staffing on occasions in the home. Some staff spoken with also commented that they would welcome additional help at busy times. The manager confirmed that staff had previously raised this issue with her. The manager said the home is now using its full establishment staffing allocation, which exceeds that issued by The Dept of Health staffing formula guidance. The manager has recently revised staffing rosters and staff deployment in the home. She believes the additional resources will ease the situation. The manager said the issue of staffing levels had also recently been raised and discussed at a residents/ relatives meeting and the revised rosters had been explained to people attending. There are now appreciably more domestic and nursing hours deployed on the rosters viewed. The staffing situation however in this home needs to be continually monitored to ensure the changes made have taken into account periods of high and low activity and the current resident groups dependency level, which is observably high. The situation must be resolved to the resident groups benefit. Recruitment is sound and follows the provider’s robust procedures. Staff files evidenced CRB/ POVA checks for all staff before staff they commence work. New staff undertake a probationary period and are required to complete a formal induction. Following this they commence basic training, which covers all mandatory subjects. The home continues to train its staff and has training records. The home’s training matrix needs be improved to give a clearer overview of staff training accomplished, updates due and training planned for individuals. This was discussed with the manager and the home’s administrator. The manager stated her intention to revise the current document. NVQ competency training for care staff continues in the home. It was further established that the number of qualified care staff currently exceeds the 50 requirement level. All trained nurses have current listed NMC pin numbers and receive their update training locally. Relatives spoken with liked the staff and found them very helpful and supportive. Comments made during the inspection included “They are very caring and kind” and “Very happy with the staff and the care my relative receives from them.” Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 23 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): 31 32 33 34 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Residents’ benefit from the home being managed by someone who is competent, experienced and resident focussed. Residents’ financial interests were protected and their welfare promoted through regular maintenance and equipment safety checks. Policies and procedures were in place, which supported the best interests of residents. Residents would benefit from the reestablishment of formal supervision and appraisal for staff. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 24 EVIDENCE: A temporary manager is in post in the home. Mrs Kohdja is a project manager from Southern Cross with significant experience in service provision and in particular, the care of residents with EMI Nursing needs. Mrs Kohdja is a trained nurse. In the short time she has been in post she has made significant changes and brought about real improvement. Mrs Kohdja was commendably honest and open on the day of the inspection. She is aware of regulation and the standards the home must consistently achieve to provide good quality care. Staff uniformly said they find her approach firm, fair and objective. Staff spoken with support the recent changes made in the home even if some have been somewhat challenging for them. Mrs Kohdja said staff supervision had not previously taken place as often as she would prefer in the home but this was to be reintroduced by January 2007. Staff files evidenced a recent lack of formal supervision and appraisal taking place in the home. The home’s policies and procedures have been recently updated. Maintenance and equipment checks were in order and Mrs Kohdja was trying to secure as many resources as possible to make the home a more comfortable environment for the resident group. Much has been achieved already. Recent redecoration has taken place in some areas. She said she is probably 70 of the way through items that require her immediate attention and the home has internal plans in place to resolve some of the remainder. New carpet is on order for corridors, reception, one lounge, the conservatory and 5 bedrooms. The lights in the kitchen mentioned on a previous EHO report cannot be provided with suitable replacement covers, as the model is no longer made. New lights are now on order and a contractor has been identified to fit them. The previously aged kitchen floor has been replaced. There are 2 new external sheds on order to help with the home’s storage problems. Mrs Kohdja is keen to increase staff training and access to training has improved. The home has also addressed the lack of Adult Protection training, which was deficient on the last inspection. NVQ competency training for care staff continues. Mrs Kohdja has revised the home’s staffing rosters and made sure the home is using its full staffing allocation. Some staff have been deployed to work in alternative areas of the home. Some relatives had been anxious about the changes and this issue was reflected in survey returns sent to CSCI prior to the inspection. Mrs Kohdja has already held one relatives/representative meeting to date where she discussed her plans for improvement. She said more meetings would be arranged until issues are resolved to people’s satisfaction wherever that is practicable. Mrs Kohdja has worked within EMI provision for a Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 25 long time and evidenced a sincere commitment to the provision of quality care for this very vulnerable client group. The manager said quality assurance questionnaires are sent out to a proportion of individuals or their representatives who receive the home’s services per month. There are also questionnaires forms available in reception for people to fill in, as they feel necessary. Southern Cross collates the information annually to inform their future planning. To date this has not been shared with the CSCI. Regular monthly provider visits are made to the home and the results sent to the CSCI. Client and staff information is held securely in the home. Lockable facilities were evidenced and sensitive and privileged information is handled appropriately. Residents’ financial interests are protected by sound financial procedures with regard to their personal monies kept within the home. The home’s administrator is very organised and maintains good records. The home has a substantial safe for storing residents’ valuables/ allowance monies in their care. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 27 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP22 Regulation Requirement Timescale for action 09/02/07 23. (2) The Registered Person shall, (n) having regard to the number and 16 (2) (c ) needs of service users, ensure that suitable adaptations are made, and such support, equipment and facilities as may be required are provided for service users who are old, infirm or physically disabled. In that: Appropriate specialist chairs designed to meet the individual needs of services users are purchased where necessary. 2 OP22 23 (2) (l) A plan to address this should be provided to the Commission by the timescale given. The Registered Person shall, 09/03/07 having regard to the number and needs of service users, ensure that suitable provision is made for storage for the purposes of the care home. In that: • Residents’ bathrooms must be free of the home’s stored items of equipment. Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 28 Such as hoists and sit in scales. • Suitable provision is provided for the home’s storage purposes. 3. OP26 16 (2) (k) The cupboard at the top of the first floor stairs must be fixed to the wall. Suitable provision must be made for the permanent storage of the home’s linen/ towels for this service area and the cupboard removed. The Registered Person shall keep the home free from offensive odours. • 09/02/07 4. OP28 OP30 18 (1) (a) In that: Offensive odours in one bedroom and a communal corridor area in the home must be eliminated. 30/01/07 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; In that: The improvements to staff rosters must continue to be closely monitored and a system operated for calculating staff numbers/ competencies required, in accordance with the guidance recommended by the Dept of Health. A comprehensive assessment, the Methodology used and the Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 29 outcome is to be forwarded to the Commission within the timescale given. There must be additional staff on duty at peak times of activity. 5. OP31 OP31OP31 9. —(1) A person shall not manage a care home unless he is fit to do so. (2) A person is not fit to manage a care home unless— (b) having regard to the size of the care home, the statement of purpose, and the number and needs of the service users— (i) he has the qualifications, skills and experience necessary for managing the care home; In that: The registered manager to be successful in completion of the NVQ Level 4 Registered Managers Award within the period of one year. This timescale expires on 28.6.2007. We are serving this notice under the provision of Sections 17, 18 and 19 of the Care Standards Act 2000. (Previous timescale of 06/03/06 not met.) 28/06/07 Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 30 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 2 Refer to Standard OP19 OP22 Good Practice Recommendations A programme of renewal of the fabric and redecoration of the premises is produced and provided to the Commission with relevant timescales. It is very strongly recommended that the home demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified Occupational Therapist, with specialist knowledge of the client groups catered for which provides evidence that the recommended disability equipment has been secured or provided and the environmental adaptations made to meet the needs of service users are in place. Evidence that this is being produced and the timescale involved is provided to the commission. It is strongly recommended that the home complies with infection control procedures and removes cotton hand towels in the visitor’s toilet. It is strongly recommended that the home’s training matrix is further developed to give a clear overview of staff training needs. It is strongly recommended that the manager fulfil her intention to ensure that staff receive formal supervision at least 6 times per year. It is recommended that good two-way communication is maintained and evidenced between the home and residents relatives to ensure their ongoing welfare. 3 4 5 6 OP26 OP30 OP36 OP38 Copper Beeches Nursing Home DS0000026158.V319300.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local 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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