CARE HOMES FOR OLDER PEOPLE
Copper Hill Nursing Home Church Street Leeds West Yorkshire LS10 2AY Lead Inspector
Hebrew Rawlins Unannounced 3 August 2005
rd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Copper Hill Address Church Street Leeds LS10 2AY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2771042 0113 2719324 Bupa Care Homes (CFH) Ltd No 2741070 Mr Charles David Hitch Care Home with Nursing 180 Category(ies) of Old Age (150) Terminally Ill (10) dementia Over registration, with number 65 (30) Mental Disorder Over 65 (30) Physical of places Disability (8) Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: That No person under the age of 65 with a physical disability be placed on the dementia unit Date of last inspection 1/3/05 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 all levels of confusion, mainly with a diagnosis of dementia related conditions and nursing requirements.The Home is comprised of six bungalows providing care for a total of 180 residents. Each bungalow contains its own lounge facilities and kitchenette. The 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. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 3rd August 2005 by three inspectors. The purpose of the inspection was to ensure the home continues to provide a good standard of care for its residents. The Registered Manager was on duty and made him self-available throughout the inspection. Service users and staff present at the visit were made aware of the inspection through discussion with the inspectors They were invited to give their views on the care and services provided. Comment cards/questionnaires were left for residents, visitors and other professionals, thereby giving the opportunity for anonymous feedback. This inspection started at 10.15am and ended at 6.15pm, in addition to the time spent in the home, time was spent preparing for this inspection. Records were inspected and these included resident’s care plans and staff recruitment files. What the service does well: What has improved since the last inspection?
Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 6 Most staff had done training in dementia care and challenging behaviour and some nurses and senior care staff are doing a level 3 Dementia care course. Care assistants said they were enjoying the dementia care training and it was helping them in their work by giving them a better understanding on residents’ behaviour. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,5. Service users are provided with information to enable them to make an informed choice about the home. The admission process is good and includes introductory visits. EVIDENCE: The Service User Guide and Statement of Purpose were noted to require revision to take account of management changes at the home. The admission of new service users takes places after a trial visit to the home by the service user and a full assessment of their needs. Relatives who had visited the home said they had been given the opportunity to look around and had been given good written information about the services offered. The relatives of a resident recently admitted to the home were not aware of having received a contract at the time of admission. Pre-admission assessments had been completed in the sets of care records seen. Relatives and residents were aware that a review of the placement would take place after the first 6 weeks. The nurse in charge on said that preCopper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 10 admission assessments are done and that that all new admissions have a review after 6 weeks. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11. The health care needs of residents are met and care plans provide clear and detailed instructions for staff to follow. Residents are treated with respect and their privacy is upheld. The care plans seen were reviewed monthly but the plans were not always updated to reflect changes identified by the review. The records seen do not make it clear who was involved in the review and if the care plans were discussed and agreed. It was not clear if the homes pressure area care policy is based on the guidelines issued by the National Institute for Clinical Excellence (NICE). Service users are treated with respect and their privacy is upheld. EVIDENCE: Care plans are available setting out how personal and health care needs will be met. The extent to which social care needs are addressed varied. In some of the records seen efforts had been made to address the social aspects of care but in others while social care needs had been identified plans had not been put in place to address these needs. The care plans seen were reviewed monthly but the plans were not always updated to reflect changes identified by the review. The home operates a system of 6 monthly reviews where residents and/or their representatives are invited to discuss the care being provided, however the format used to record these does not make it clear who was involved in the
Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 12 review and if the care plans were discussed and agreed. The manager said the organisation would soon be implementing a new format for care records that will make the care records easier for staff and residents and/or their representatives to use. The home uses the Waterlow score to identify the risk of pressure sores, the care plans put in place in response to identified risk did not always contain enough detailed information such as the type of pressure relieving equipment in use. It was not clear if the homes pressure area care policy is based on the guidelines issued by the National Institute for Clinical Excellence (NICE). One resident had a pressure sore that had developed in April and there was no evidence that advice on the treatment of this wound had been obtained from either a GP or the tissue viability nurse specialist. Risk assessments were done to identify the risk of falling but in some files care plans had not been put in place to set out how the risk would be managed. Nutritional risk assessments had not been completed in all of the records seen. On units the daily records tended to focus on aspects of physical care and gave very little indication of how people spend their time. The records showed that residents have access to a range of health and social care professionals such as G P s, physiotherapists and social workers. Resident’s or relative’s wishes in respect of death and dying have not been established in all cases. Staff interaction with service users was observed during the inspection and service users were treated with respect. Service users spoken to confirmed that they have are able to have visits from family and GP /District Nurses in their own bedrooms. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15. The daily routines are flexible and organised around the needs and capabilities of residents but this was not fully supported by the records. Service users are offered choices in all aspects of daily living, and their visitors are made to feel welcome. Resident’s are not always given a good, varied and nutritious choices at meal times. The meat is not always prepared in accordance with religious and cultural requirements of residents and residents in the home are not made aware of the meat sourcing. EVIDENCE: Preferred times to getting up and going to bed are recorded. Residents said there were no activities on their unit but some went to other units to join social events there. One resident said she enjoyed being able to sit outside in her wheelchair and visited the chickens in the garden. Relatives spoken with said they were happy with the provision of activities, one relative said how much they had enjoyed a recent party organised to celebrate a wedding anniversary. The hobby therapist visits the units every day and keeps a record of activities; these showed that residents are given regular opportunities to go out as well as taking part in social events on the unit. In one unit the care records had social care assessments but no social care plans.
Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 14 It was evident that daily routines are flexible and organised around the needs and capabilities of residents but this was not fully supported by the records. Several people said they thought it was a great idea having chickens in the garden. Residents and relatives said visits could take place at any time and in private. Relatives said that the unit had a “family atmosphere” and they felt the staff cared for them as well as caring for the residents. Visitor said they were kept fully informed about their relatives care and said the staff were “very kind”. Residents can have private phones fitted in their rooms and one resident had a mobile phone. Residents said the breakfast is good and that they enjoyed the cooked breakfast that is provided. There is no choice at lunchtime, staff said the alternative to the published menu is salad, sandwiches or an omelette but residents spoken to were not aware of this. The evening meal is nearly always soup and sandwiches; one resident’s daughter was bringing her salads from the local supermarket because she was fed up with soup and sandwiches. Residents said they are not offered anything to eat after the evening meal, just a drink at about 7.30pm. Relatives on one unit said there was plenty of food. Because this unit cares for people with dementia addition food is offered between meals, for example sandwiches are served with afternoon tea instead of cakes or biscuits. One resident said that the food is often cold when it is served, when this is mentioned it improves for a few days but them goes back to being cold again. On one house, relatives said they had noticed food left out in the kitchen on several occasions and were concerned that this was not safe. There were records of special dietary requirements but no record of food likes and dislikes. In order to meet the religious dietary needs of one service user the home states that all meat used is halal. The home should ensure that advice is obtained to ensure that the meat is then prepared in accordance with religious and cultural requirements and that all its service users are made aware of the meat sourcing. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18. The home provides clear information on how to make a complaint about the service. It includes reference to the Commission for Social Care Inspection if people want to take a complaint outside the home. Staff had an understanding of adult protection but all staff must have adult protection training if they and residents are not to be at risk. EVIDENCE: Talking to staff, they are all clear on their responsibility about reporting any allegations of abuse. However there are some staff that have not yet had adult protection training. Relatives spoken with stated their views are listened to, taken seriously and action is taken to resolve issues. The manager stated he does his best to make sure residents rights are protected and that they are safe from abuse. Residents said are aware of the complaints procedure and how to use it. The manager was in the process of investigating an alleged adult protection incident. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,2526. Some work on the environment is required to create a homely environment. The taps in the home create the opportunity for potential for cross infection throughout the home. Unit kitchen needs to be cleaned and upgrade. More thorough cleaning of resident’s bedrooms and communal areas is needed. Carpets are in need of replacing and tiles in shower room are badly stained. Some dining room furniture was looking the worse for wear and tear. The security and safety of residents in those rooms with patio doors must be looked at, as well as ventilation to those rooms. The staff on one unit have gone to a lot of trouble to create a stimulating environment for residents. EVIDENCE: Overall impression was that units seen are showing signs of wear and tear and in need of refurbishment. Many bedrooms have vinyl flooring, which does not create a homely environment. In some of the rooms seen residents had personal possessions such as pictures, photos and ornaments. The taps in the sink in resident’s bedrooms and communal bathrooms have a push down lever mechanism with the water only flowing whilst the lever is pressed down. This means that washing both hands together is very difficult and the water does
Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 17 not flow long enough for hands to be washed properly which brings into question cross infection. A lounge carpet was badly stained and in one area several cigarette burns. Unit kitchens were not clean and in need of upgrade, current fittings are more suited to institutional setting then a home. Generally the décor in the unit looks dated and tired. More thorough cleaning of resident’s bedrooms and communal areas was noted to be required on all units. Relatives of service users consulted during the inspection stated that particular attention needed to be paid to areas, which are difficult to reach and to lounge chairs etc. During the inspection two resident’s rooms visited had stained mattresses, on one the cover sheet had the local hospital name. The home was found to be superficially clean but deep cleaning is required for example under the cupboard in the dining room and dried food stuck to chair arms. Corridor carpet needs replacing and tiles in some shower rooms are badly stained. Carpet in smokers’ room has numerous cigarette burns. Some dining room furniture was looking the worse for wear and tear. Some bedrooms on the unit have access via patio doors to the garden. The home must ensure that the security and safety of residents in these rooms is maintained through the issue of keys to residents. It was noted that in these bedrooms the patio doors were the only form of ventilation. The staff on one unit have gone to a lot of trouble to create a stimulating environment for residents, for example they have put lots of black and white photos and old movie posters around the unit and the doors on the communal toilets near the lounge have been painted bright yellow to help distinguish them from other rooms. Apart from the problem with socks going missing in the laundry no other concerns were raised. The gardens are well kept and easy for residents to get access to. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30. The home has a robust interview process when recruiting staff and training is now high on the home list. The home should review its staffing level to ensure residents are not kept waiting for long period of time. EVIDENCE: Residents said they did not think there was always enough staff on duty and they sometimes had to wait a long time for the bell to be answered. In one room the commode that had been used early morning had not been emptied at 11.00am and the resident said that sometimes it was not emptied and the bed was not made by lunchtime. On the day of the inspection one unit was short one member of staff because of an emergency escort. Several staff recruitments files were looked at. References were in files and Criminal Records Bureau checks were completed. A member of staff said that most staff had done training in dementia care and challenging behaviour and some nurses and senior care staff are doing a level 3 Dementia care course. Care assistants said they were enjoying the dementia care training and it was helping them in their work by giving them a better understanding on residents’ behaviour. One member of staff said she had attended training on adult protection last week, this was a seminar organised in house. Housekeeping staff said they had training on fire, moving & handling and COSHH and had also done “personal best”. The domestic supervisor said all
Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 19 new staff has one-day induction covering all mandatory training before they start on units. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37,38. The staff respect the manager, he has not been the manager of the home for long and is working hard to provide a quality service for residents. There are a few things he needs to address like formal supervision for all staff and several issues raised in the body of this report. EVIDENCE: There is no formal supervision for nurses, one unit manager said she was working on doing appraisals for nurses and then would start supervisions. Care staff supervision has not taken place this year. On one unit a nurse said he had appraisal in Jan 05, but nothing since then. The unit manager is away (at another home) so he was not sure what was happening with other staff. Two care assistants spoken to say they had supervision every month (unit manager) when she was there.
Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 21 Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 2 3 2 x 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x x 2 3 3 Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 4 Requirement The Service User Guide and Statement of Purpose were noted to require revision to take account of management changes at the home. Care plans should reflect changes identified by the review. It was not clear if the homes pressure area care policy is based on the guidelines issued by the National Institute for Clinical Excellence (NICE). Risk assessments were done to identify the risk of falling but in some files care plans had not been put in place to set out how the risk would be managed. Nutritional risk assessments should be completed for all residents. The daily recordsshould not just focus on aspects of physical care. Resident’s should always be given a good, varied and nutritious choices at meal times. Meat should always be prepared
J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Timescale for action 3/10/05 2. 3. 7 7 15 15 3/10/05 3/10/05 4. 7 15 3/10/05 5. 7 15 3/10/05 6. 7. 7 15 15 16 3/10/05 3/10/05 Copper Hill Nursing Home Version 1.30 Page 24 8. 9. 18 19,21 13 23 in accordance with religious and cultural requirements of residents and residents in the home should be made aware of the meat sourcing. All staff must have adult protection training if they and residents are not to be at risk. Some work on the environment is required to create a homely environment. The taps in the home create the opportunity for potential for cross infection throughout the home. Unit kitchen needs to be cleaned and upgrade. A thorough cleaning of resident’s bedrooms and communal areas is needed. Carpets are in need of replacing and tiles in shower room are badly stained. Some dining room furniture was looking the worse for wear and tear. The security and safety of residents in those rooms with patio doors must be looked at, as well as ventilation to those rooms. All staff should have formal supervision. 20/11/05 20/11/05 10. 26 23 3/10/05 11. 26 23 20/11/05 12. 36 18 3/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 27 Good Practice Recommendations The home should review its staffing level to ensure residents are not kept waiting for long period of time. Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Copper Hill Nursing Home J52 J03 S1333 Copper Hill V231953 150605 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
