Inspection on 18/09/07 for Copper Hill Nursing Home

This inspection was carried out on 18th September 2007.

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.

Other inspections for this house

Copper Hill Nursing Home 25/10/06

Copper Hill Nursing Home 30/11/05

Copper Hill Nursing Home 03/08/05

Copper Hill Nursing Home 01/03/05

Copper Hill Nursing Home 22/07/04

Copper Hill Nursing Home 28/01/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Copper Hill Nursing Home Church Street Leeds Yorkshire LS10 2AY Lead Inspector Sean Cassidy Key Unannounced Inspection 18th September 2007 08:30a 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 Hill Nursing Home DS0000001333.V351431.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 Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copper Hill Nursing Home Address Church Street Leeds Yorkshire LS10 2AY 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) 0113 2771042 0113 2719324 www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Verity Taylor Care Home 180 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (150), Physical disability (8) Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE(E); Mental Disorder, excluding learning disability or dementia - Code MD(E) and Physical Disability - Code PD The maximum number of service users who can be accommodated is: 180 25th October 2006 2. Date of last inspection Brief Description of the Service: Copper Hill is owned by BUPA Care Homes and is located in the Hunslet area of Leeds. It is designed to care for residents with Dementia, Mental Disorder, Physical Disability and also Terminally Ill and Older People. The Home is comprised of six bungalows providing care for a total of 180 residents. There are attractive garden areas with outdoor seating near to each bungalow and ample car parking space giving easy access to all parts of the home. Each bungalow contains its own lounge facilities and kitchenette. The majority of bedrooms are fully furnished, with en-suite facilities. Service users are encouraged to bring personal effects such as ornaments, pictures and small items of furniture. Facilities nearby include supermarkets, a church, post office, banks and a variety of shops. There is a good bus service into the city centre of Leeds. The fees for a room at this home range from £403- £628 per week. Copies of the previous inspection reports can be found at the reception area of the home. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence in this report has included: • • A review of the information held on the home’s file since the last inspection. Information obtained from service users, relatives and staff. An unannounced visit to the home was conducted by two inspectors and lasted two days. The majority of this time was spent speaking to residents, management, staff and relatives. The visit included a tour of the premises. A number of documents were examined which included care files, training files, recruitment files and health and safety details. The information required from the provider in the form of the Annual Quality Assurance Assessment was provided prior to the inspection and information from this is also included in the report. One inspector in the specialist dementia unit carried out a Short Observational Framework Inspection. This provided evidence to measure the direct experience of people with dementia living in a care home, particularly focussing on the standards concerned with dignity. What the service does well: All residents now receive a robust assessment prior to moving into the home. They are also consistently offered the opportunity to visit and look around as well. Te home provides residents with a good standard of care planning and risk assessment, which now involves a person centred care approach. Evidence was seen to show there was a consistent attempt to involve people with their care documentation. The care planning systems are reviewed on a regular basis. The home operates a good recruitment procedure that helps protect people that live in the home. A good standard of training is provided to assist staff with carrying out their roles. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 6 People are assured that they are provided with a safe environment within the home. What has improved since the last inspection? The care home has improved in the following areas: • The Statement of Purpose contains all the necessary information needed to ensure people are enabled to make an informed choice whether to move into the home or not. Improvement has been made with regards to the environment and the provision of memorabilia within the specialist unit. All new residents are now appropriately assessed prior to moving in. Residents are now provided with a care planning system that identifies the care needs and provides staff with clear person centred details as to how these care needs should be met. All residents are appropriately risk assessed in areas such as: nutrition; falls; continence; moving and handling and pressure area care. The equipment used to measure the weights of people is now checked to ensure it is in good working order. Complaints are now investigated following the home’s internal policy. Staff now receive training in safeguarding vulnerable adults. They also have an improved awareness of this issue. Staff now receive an improved training programme that meets the mandatory requirements and also the personal care need requirements of individuals. All the required information is now obtained for prospective employees before they start work. • • • • • • • • • What they could do better: All people living in the care home must be provided with a copy of the terms and Conditions of their stay. Major improvement is needed with regards to ensuring the privacy and dignity of the people that use the service is promoted and upheld at all times. Particular attention must be paid to the personal care of residents as there was Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 7 significant evidence seen to show that this was not provided to a good standard. Improvement must be provided with the provision of activities and the opportunities to provide other forms of stimulation to the people who live in the home. All people living in the home must be provided with a good standard of environment. There were specific issues highlighted in the report that indicate the cleanliness of the environment, furnishings and personal items needs improvement. Some people told the inspectors that the staffing levels were not appropriate to ensure all personal care could be provided. This must be reviewed to ensure the levels of staff are correct. More staff working at the home must be trained to NVQ level 2 or above. Any personal information belonging to people who live in the home, or the staff that work there, must be properly protected in line with the Data Protection Act. 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 Hill Nursing Home DS0000001333.V351431.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 Hill Nursing Home DS0000001333.V351431.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. and 5 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Each person is appropriately assessed and provided with sufficient information before moving into the home. EVIDENCE: The Statement of Purpose and Service User Guide have been reviewed by the organisation and now contain the necessary information needed to ensure the reader is fully informed of what service is offered by the home. Conversations held with at least three people provided evidence to show they were provided with enough information to help them make their choice of moving into the home. These documents were seen in people’s rooms and were also at the entrance of each unit. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 10 People spoken to said they had the opportunity to come and look around the service before moving in and some took this opportunity. Five people spoken to said that someone from the home came to assess them in hospital to make sure they could meet their care needs. One unit manager explained they normally receive a referral from a care manager and would then request a care plan. On receipt of the plan they would send a suitably qualified person to carry out an assessment of needs. This can last up to one and half hours and they may make a second visit if the behaviour is known to be challenging or change at different times of the day. The assessment is person centred and takes a holistic approach. If the assessment shows the environment is appropriate they can come to visit. Some have stayed for a few days. The relatives sometimes visit the home if there are difficulties with the person wishing to use the service visiting. A review of each person is held at the end of a six-week ‘settling in’ period. This determines whether the home can fully meet their care needs. The care files inspected as part of the case tracking process showed evidence that each person had been assessed as part of the homes’ admission process. These documents were signed and dated and contained a thorough picture of each individual. Copies of the homes’ Terms and Conditions are given to people who privately fund their place, but these documents are not provided to those that are funded through the local authority. This must be reviewed to ensure all people using the service are fully informed about their stay in the home. Intermediate care is not provided in the home. Copper Hill Nursing Home DS0000001333.V351431.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 and 10 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Peoples’ care documentation and risk assessments highlight the care needs and how they are to be met. Peoples’ privacy and dignity needs are not provided to a good standard. EVIDENCE: The care documentation of six people living in the care home was inspected. The care they received from their admission to the point of the inspection was thoroughly examined. There was clear evidence that improvement in this area has been made since the last inspection. Care files showed evidence that a full assessment was carried out at admission for each person and where care needs were identified a care plan was developed to meet this need. Evidence was also found to show Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 12 the home now actively attempts to involve the person receiving the care, or their relative, with the development of the care plans and risk assessments. Care plans were in place for all issues identified, they were very detailed and gave personal preferences of people. The documents provided staff with information about any possible risks to the person, their identified needs and the actions the staff needed to take to meet their health and social care needs. There were many personal preferences in the care plans in regards to personal hygiene, and social activities. However it was difficult to assess whether people were receiving the care that was contained in the care plan. Risk assessments were generally in place and any actions needed to protect the person was included in the care plan. Staff spoken to said they were able to read care plans whenever they needed to. The care plans showed evidence that a more ‘person centred care’ approach has been adopted. Care plans inspected showed staff have worked hard to try and ensure a more personal approach to care is taken in the care plans and a move away from the more clinical approach. This is good practice. Evidence was seen to show all were risk assessed in areas of: nutrition; pressure area care; continence; moving and handling and falls. These were reviewed monthly. People were weighed regularly and dieticians were involved when needed. The Tissue Viability nurses in the community were also referred to those people who had developed wounds. The records showed evidence that people who live in the home are referred to other health care professionals when this is needed. One relative said, “The staff are more responsive to acute needs than they were before. Mum is seen a lot quicker by medical staff now.” Other health care professionals were contacted as part of the inspection. Their feedback highlighted that some referrals made by the staff were unnecessary. This is an area that needs further investigation by the manager. A random sample of the medication charts showed no unexplained gaps in the administration records. Routine prescribed medications and controlled drugs were stored and recorded correctly. One incident in a care file was identified as a concern. The person living in the home was hiding medication in her room, which was found by staff. This suggests that the correct administration of medication was not being adhered to. This should be reviewed to ensure registered nurses ensure an individual takes their medication correctly when administered. The majority of people spoken to during the inspection said staff were helpful and kind. Comments such as: ‘Staff are nice, friendly and caring.” “We have witnessed them always being gentle with others, we would not want them in Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 13 any other home”. “Staff are lovely people. All the staff seems to care.” “They always knock on my door before they enter.” This was observed during the inspection. Staff were observed over the course of the inspection. They were seen as polite and helpful. They spoke to residents during the course of their duties and involved them in conversations. Those residents moved using a hoist were spoken to and reassured by the staff throughout the process. This was good practice. However, there were strong concerns about the way in which peoples’ privacy and dignity was being upheld and supported within the home. The following are some examples of concerns: • • • • • People in one unit were observed to be unkempt, especially their hair. A person was wearing clothes that were very dirty, but no one noticed. Plastic bibs were automatically put on people before meals. Two people were observed as having dirty nails, which looked like excrement. The majority of people in one unit had no teeth. They did have false teeth but they were not in. One individual said that his teeth were missing but no one had helped to replace them. There was no explanation for this. One individual was sleeping on a mattress on the floor of his bedroom. There was a care plan in place with agreement from family. However, the mattress had a very strong smell of old urine, as did the whole room. People in clear need of assistance with eating their meals did not receive it and ended up eating non-finger foods with their hands. Some people said the time they had to wait for their call bell to be answered was too long. This caused them distress when they needed to use the toilet facilities. One gentleman was having clear difficulties with his trousers falling down. He did not receive adequate attention to assist him with this problem. People were seen sitting in chairs in extremely awkward positions but not receiving assistance to be made more comfortable. • • • • • Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 14 These examples were fed back to the manager and the area manager at the feedback session. They gave firm assurances the above would be looked into as a matter of priority. Mealtimes were observed in two units within the home. The observations of mealtimes provided both positive and negative experiences for people. Breakfast was served with no restriction on time. People were able to get up when they chose. This was good practice. It is important that this practice should be closely observed to ensure that it is a system, which is especially beneficial for the people who live there and not for staff working systems. A recent complaint pointed out that a relative living at the home was in bed far too long and that their personal care had been neglected as a result of this. People were provided with a choice of meal whenever possible. For those who were unable to make decisions for themselves, choices of finger foods were made available to them. This was mainly provided to people in the specialist dementia unit. There are many people in the other unit with dementia but this service was not provided. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 15 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 and 15 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The provision of opportunities for people to get involved with activities and social interaction is very limited. EVIDENCE: During the observation there were no activities offered in the lounge area, people were sitting in chairs or wandering around, many looked bored or were asleep. The radio was playing but no one appeared to be listening and a small TV was on in the lounge area, but there was no discussion as to the channels or radio programmes. Many people would have been unable to see the TV. Two people were taken in to the garden for a short walk. There were no books or daily newspapers around. This evidence was seen in both units. Two relatives confirmed there had been activities and outings up until the activities co-ordinator left at Christmas but since then, there had been not as much going on. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 16 However, in the afternoon the unit manager explained staff attempt to take people out to the local supermarket, activities organiser did come in the afternoon for a short while and was seen talking to people on a one to one basis for a short while. The management team have acknowledged the poor provision of activities for the people living here. They have acted upon it but have come across problems with staff. Firm commitments were given to improve in this area. People were seen making choices about times of rising and retiring, some people were going to use the smokers room etc. Visitors were seen in the unit, all were welcomed by staff and appeared comfortable, three talked with said they were unrestricted as to when they visited and the staff were welcoming. Mealtimes were observed in two units within the home. The observations of mealtimes provided both positive and negative experiences for people. Breakfast was served with no restriction on time. People were able to get up when they chose. This was good practice. It is important that this practice should be closely observed to ensure that it is a system, which is especially beneficial for the people who live there and not for staff working systems. A recent complaint pointed out that a relative living at the home was in bed far too long and that their personal care had been neglected as a result of this. The manager in the dementia unit was aware many people only like a little to eat at a time and sometimes prefer food they can eat whilst they are moving around. To ensure they eat a healthy diet food is offered regularly over the day, staff extra snacks are available throughout the day. People in the dementia unit were observed to being encouraged to have enriching drinks. This was not observed in the other unit, which also had a significantly large number of people with dementia. People were provided with a choice of meal whenever possible. For those who were unable to make decisions for themselves, choices of finger foods were made available to them. This was mainly provided to people in the specialist dementia unit. There are many people in the other unit with dementia care needs but this service was not provided to them. In one unit the mealtimes were not seen as the social occasion they could be. Most of the residents in one of the units received their food whilst sitting in the chairs they had been sat in all morning. There was little effort seen to make it a social event where people are enabled to sit around the table and see other people and chat. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 17 In one unit the mealtime system was very disorganised. People were left watching other people eat and did not get their food for a long period after. People struggled to eat their meals, as they did not get the necessary assistance. In one unit there were a lot of drinks on offer during lunchtime meal, however, in the other unit lunch was served but no drinks were provided until the serving process was nearing completion. There was mixed feedback about the standard of food served in the home. Those who could give feedback about the food served in the home said things like, “The food is of a good standard.” “The food suits me.” “The food isn’t good enough. The meals are not for my generation.” “The suites are sometimes quite poor.” “The temperature of the meals is OK.” The management of the home have worked on the quality of the food served in the home. They do recognise that there are problems and gave commitments to review this service. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 18 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 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People are confident their complaints will be appropriately dealt with. Staff possess a good awareness of ‘safeguarding adults’ . Procedures are correctly followed when issues arise in this area. EVIDENCE: The home has a complaints policy in place. People who use the service are provided with information about complaints in the Service User Guide and also at various points throughout the units. This was confirmed through conversations with people during the course of the inspection. People spoken to said they were confident they knew how to complain. They also expressed confidence that any complaint they made would be looked into appropriately. One couple spoken to did say that they had complained but no one had ever responded to this. When this was brought to the attention of the manager she was able to identify the conversation she had with this couple but said that it was not put through the system as a complaint. She gave firm assurances that this would be followed up immediately after the inspection. The complaints process used by the home was reviewed and improvement was seen form the last inspection. Complaints referred to the home by the Commission for Social Care Inspection were investigated through the homes’ Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 19 internal complaints policy. The appropriate timescales were met and outcomes were identified. The record of complaints kept by the home also showed that those complaints recorded were appropriately investigated. People said that the staff were respectful and pleasant. This was evidenced over the course of the inspection. Staff spoken to were able to give a sound understanding of safeguarding issues. They understood what procedure to follow if they felt a vulnerable person had been abused in any way. Training in safeguarding has been rolled out to the majority of the staff at the home and records seen confirmed this. The home has recently worked with the Leeds Safeguarding Adults team regarding specific allegations of abuse about the care of some people who live in the home. The evidence showed the manager had responded well to these situations and followed the correct procedures. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 20 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, 25 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The standard of the environment provided to people living in the home is inconsistent and in need of improvement. EVIDENCE: The actual home is a purpose built development on one level and is suitable for the needs of the people that it has been designed for. It was evident that there is an ongoing refurbishment programme that includes redecoration of all areas, including refurbishment of living accommodation and peoples’ bedrooms. The environment of the specialist dementia unit has undergone some significant work to try and assist individuals with memory reorientation. Staff in the dementia unit have tried to improve the hallways Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 21 using memorabilia and pictures and have tried to create a bar area with a slot machine. They have also tried to improve the gardens by having rabbits and hens. This is good practice. However, evidence was found to show that the standard of the environment in the specialist unit was significantly lower than that of the other unit inspected. Minutes from residents meetings showed that relatives said they were happy with the personal care provided, but they were unhappy with the standard of the environment. Although there is acknowledgement of the refurbishment programme, there were problem areas that should be dealt with as soon as they were identified. Examples of this were: • • • • • • • • • • • • Shower curtains ripped in a bathroom. Blinds in bathrooms broken and ripped. Dividing curtains missing in bathrooms. (Potential privacy/dignity issues) One bathroom door did not have a lock. (Potential privacy/dignity issues) Bath panel hanging off and posing potential injury. Bedrooms with rusty looking beds. Quilt covers with holes in them. No valances on beds. Beds with only duvet covers on and no duvets. Unpleasant odours in rooms. Unpleasant stains. Poor standard of lighting in bedrooms, which poses potential problems for people with dementia. On entering the specialist dementia unit there was an unpleasant smell and generally the level of cleanliness was poor. Examples of this were: door handles were sticky; the lounge carpet looked stained and chairs had marks on them. The door to the gardens glass was dirty. The garden area was in need of tidying, the benches were either badly positioned or in need of repair. The chicken run had a broken table in it and parts of the fencing needed securing. There was a hosepipe left out and the door, which opened into the bin area, was not locked because the gate needed adjusting. This was a serious risk, as it gave people access to the waste bins. The unit manager explained there was only one handyman for the whole building. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 22 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 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Staff working in the home are recruited and trained to a good standard. However, not all people are assured that the staffing levels within the home meet the care needs of all those that live there. EVIDENCE: The home has been experiencing long-term problems with the staffing levels. The manager has devised strategies to try and combat these to ensure the correct levels of staff are on duty at all times. Evidence was seen to show the action taken has improved the sickness levels within the home. The Commission still receive notification of shifts that have not been filled with agency or the internal staff bank. These have become less frequent recently. The manager is confident that staffing levels are nearing the set levels for the home. There was a lot of feedback from relatives and staff in relation to staffing levels in both units. People were confident that the staffing levels in the dementia unit met the needs of the people that were living there. Staff appeared to have time to spend with people. In the other unit there seemed to be a different opinion. The general opinion was that there was not enough staff on shifts to Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 23 meet peoples’ care needs. Examples of comments made were, “The staff are great but they are overworked. They don’t get much time to interact with residents.” You can’t knock the staff. They are really nice. There just aren’t enough of them!” “There needs to be at least one more person on each shift.” Staff observations during the inspection did back some of the comments made. These were discussed with the manager at feedback and it was recommended that staff levels are reviewed as well as staff working systems. The recruitment files showed evidence that staff are recruited to a good level. All the necessary checks were obtained before a person started employment. One new member of staff had a criminal history. Evidence was seen to show how the home dealt with this issue and the process they put in place to monitor the situation. The training provided to staff has improved. The staff trainer is the clinical nurse manager, who has come from another home within the organisation. She explained how she has attempted to put the records in order following the last inspection. Evidence was seen to show the records were in order and staff had received training in different areas. Induction follows the Skills for Care common foundation induction standards. The Induction follows policies and procedure and lasts two days. People then go on to different units and are assigned a mentor. The records inspected showed staff receive training in mandatory areas such as moving and handling, infection control, fire training and food handling. A large proportion of staff have now received training in Safeguarding Adults, health and safety and First Aid. Training in areas such as nutrition and dementia, continence and tissue viability. Domestic staff are provided with training in infection control and COSHH. Only 40 of staff have received training to National Vocational Qualification Level 2 standard. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 24 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, 33, 35 and 38 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use this service benefit from an improved management infrastructure that helps to keep them safe and protected. EVIDENCE: The manager has been in post for nearly one year. She has is a Registered Nurse and has received training at a management level. During the course of the inspection the manager provided evidence to show the home had put into practice clear strategies for improving the standard of care provided in the home. These strategies included: improvements in the assessment process for people living in the home and also prospective residents; providing improved Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 25 care planning; reviewing staffing levels and staff shortages; communication and leadership. The previous inspection report highlighted a large number of requirements that needed action and that has been taken by the manager since she took up position. She has adopted a much more hands on approach within the home and this was evidenced through talking with the people who live there, their relatives and friends. Those people spoken to all knew that she was the manager and many had conversations with her regarding care issues. Unit managers said that improvements had been made in the area of communication. They said there were clearer lines of communication within the home to ensure things did not get missed. Staff spoken to said they received regular supervision with a senior team member and that appraisals are also provided yearly. Evidence was seen to show that this did take place. Regular team meetings are also held to provide carers with information regarding changes within the home and also to provide updates about care. The supervision records were kept in the office of the unit which was left with the door open on a number of occasions. The office also contained personal information regarding people who lived here. The door to the other unit was also left open on the other unit also. Information received from health professionals who enter the service said they had concerns regarding communication with the home and felt that this had a negative impact on the care of the people living there. Some comments from doctors were that the staff ‘sometimes seek inappropriate advice and some problems should be dealt with by the staff nurses.’ ‘People who are terminally ill have been admitted to hospital inappropriately, even after discussions with doctors and their relatives have taken place.’ ‘People under my care were not given the influenza vaccine. I only found this out through a random check.’ ‘Nurses seem to refer us all identified cases and this is not appropriate.’ These and other comments highlight that there are issues with communication with visiting health professionals that need addressing. The organisation has a quality assurance system that monitors the standard of care within the home. An outside agency is responsible for this and a brochure is printed and made available to interested stakeholders. A recent audit of the home has been carried out and the brochure was seen. This should be more readily available in the six different units, so that all will have the chance to see what the standard of care in the home has been assessed at. The Statement of Purpose, the Service User Guide and the most recent inspection report should also be made available in all the units. Regular audits of more general systems within the home are kept. Evidence was seen to show things such as care planning documentation, food, accidents, complaints and staffing are regularly reviewed. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 26 The financial records of people the home looks after were randomly inspected. These showed no irregularities and all receipts for any transactions were kept. The systems adopted to protect peoples’ monies were seen as stringent. All received monthly interest on the monies that were held. Health and safety records provided by the home showed appropriate checks on equipment such as hoists, wheelchairs, bed rails and other equipment are carried out regularly. Evidence to show checks on electrical equipment systems, gas appliances and fire safety equipment were seen. The inspectors identified that the guidance used by the nurses on how to safely use bed rails was possibly out of date. It was recommended that they ensure this guidance was correct. Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 27 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 2 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP2 OP10 Regulation 5(1)(ba) 12(4)(a) Requirement Timescale for action 31/12/07 3 OP12 16(2)(m) (n) All residents should be provided with a copy of the home’s terms and conditions. The privacy and dignity of people 31/12/07 living in the home must be upheld and promoted at all times. 31/12/07 All residents must be enabled to take part in social and leisure activities that meet their needs and expectations. This will improve the quality of their lives whilst living in the home. This must be clearly documented with a care plan provided. (The previous timescales of 20/02/06 and 31/01/07 have not been met) Those areas of the home in need of refurbishment should have clear timescales identified. Residents and their representatives must be informed of the planned work. Carpets and floor coverings must be reviewed to ensure they meet the satisfaction of the resident 4 OP19 23(1)(b) 31/12/07 Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 29 5 OP26 16(2)(k) 23(2)(d) 18(1)(a) 6 OP27 7 OP28 18(1)(c) 8 OP37 17(1)(b) group. Resident representatives should be consulted if the resident is unable to air their view. (The previous timescale of 31/03.07 was not met.) People who live in the home must be provided with a good standard of cleanliness. There should be no malodours. The registered manager must review the staffing levels to ensure there is enough staff on duty to meet the care needs of the resident group. The registered person must ensure at least 50 of the carers are trained to NVQ Level 2 standard. (Previous timescale of 31/03/07 was not met.) The registered person must ensure that the personal information of residents is properly protected in line with the Data Protection Act. (The previous timescale of 31/12/06 was not met.) 31/12/07 31/01/08 28/02/08 31/12/07 Copper Hill Nursing Home DS0000001333.V351431.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. Refer to Standard OP1 Good Practice Recommendations It is recommended that the home inform residents and their representatives about being able to have carpets in their rooms if they wish. This information should be included in the Statement of Purpose and the Service user Guide. The manager should review the use of bibs for residents when meals are served. Not all residents may need one of these and a napkin may be more suitable. It is recommended the manager ensures the guidance for the use of bedrails in the home is up to date. The registered person should work closely with the residents and their families to make their bedrooms appear more attractive, comfortable and homely. It is recommended that the seating arrangements in lounges are altered to ensure televisions are able to be viewed by all. 2. 3. 4. OP15 OP38 OP19 Copper Hill Nursing Home DS0000001333.V351431.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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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