CARE HOMES FOR OLDER PEOPLE
Copperfields Residential Home 42 Villa Road Higham Kent ME3 7BX Lead Inspector
Jo Griffiths Announced 18 October 2005 09:30 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. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Copperfields Residential Home Address 42 Villa Road Higham Kent ME3 7BS 01474 824122 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) Larchwood Court Limited Miss Janet Irene Aldridge CRH Care Home 20 Category(ies) of OP Old age (20) registration, with number of places Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Care for older people with dementia is restricted to 2 older people whose dates of birth are 12/03/17 and 10/08/15. Date of last inspection 24/05/05 Brief Description of the Service: Copperfields is set in a residential area in the village of Higham near Gravesend. Shops and amenities are located within a short walking distance. The home is registered to provide residential care and support to 20 older people and has a range of single and double bedrooms and a number of communal lounges and dining areas. There is a garden to the rear of the property. Some areas of the home are accessible to wheelchair users. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced. Regulatory Inspectors Jo Griffiths and Helen Martin carried out the inspection. A number of residents were spoken with and some records were inspected. What the service does well: What has improved since the last inspection? What they could do better:
It is recommended that the assessment document be reviewed to ensure that all areas of residents needs can be identified. Care plans should contain only the most up to date information and where specialist professionals have been involved this should be recorded. It is recommended that a qualified person carry out an assessment of the premises and an appropriate toilet frame is still required to safely assist residents with mobility difficulties. It is recommended that toilets and bathrooms be clearly signposted to help residents with dementia find their way around. Commodes used by residents should be stored properly in the home. The Manager must ensure that the home is warm enough for the residents and the home must be kept clean and free from unpleasant odour at all times. It is recommended that the torn curtain be replaced or removed. The quiet lounge should be fitted with a call point for residents to attract staff attention and the assisted chair for one resident must be repaired. The risk of confused residents wandering from the home should be assessed and the door buzzer used to reduce the risk where needed. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 6 Toiletries must be labelled for individual residents to avoid the risk of spread of infection. Cleaning products must be stored safely. The upstairs windows must be fitted with safety restrictors to protect residents. Medication procedures must be reviewed to ensure that all medication is stored and administered safely. This includes purchasing a lockable medication fridge and reviewing residents’ medications with the GP if they are refusing them regularly. The Manager was advised that the practice of disposing of medication down the toilet must cease immediately. The menu should be reviewed to ensure it offers sufficient choice to residents, particularly those with special nutritional needs. It is recommended that advice be sought from a person with nutritional training. Residents’ nutritional needs should be assessed. Water glasses provided in residents’ bedrooms should be changed daily. It would be helpful to residents to have the menu and the programme of activities for the home displayed in a format appropriate to their needs. The Manager continues to be registered to manage two homes. This means that she cannot focus her time fully on managing this home. The application form that potential staff complete must ask for their full employment history and details of any criminal cautions. Arrangements should be made for staff to be regularly supervised. Following the annual quality review of the home the results must be sent to CSCI. 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. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 6 Residents have their needs assessed before moving to the home. Whilst residents feel their needs are met they would benefit from further support from specialist professionals. EVIDENCE: Residents have their needs assessed before they move to the home. The assessment identifies most areas of their care and support needs, but it is recommended that the Manager refer to the list under standard 3 to ensure all areas are covered. The residents spoken with said they were happy in the home and felt that generally their needs were met. There are a number of residents in the home with very specialists needs, for example, confusion, Parkinson’s, stroke and visual impairments. There was no evidence in the care plans that specialist advice and support had been sought to help in the care of these individuals. The Manager gave some examples of where this had happened in the past and it is recommended that there is reference to this within the care plan. The home does not provide intermediate care and therefore standard 6 is not applicable.
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 11 Residents care plans are detailed and meet their needs, but they do not accurately reflect input from specialists. Their health needs are generally well met and residents know they will be cared for according to their wishes at the end of their life. Residents are at risk from current medication practices. EVIDENCE: Residents have a plan of care and these are detailed and regularly reviewed. However, where the care plans have been updated the previous information has not always been removed. This makes it difficult for staff to clearly follow the plan and to know which information is the most up to date. Care plans do not reflect where there has been input from other professionals for specific areas of residents health needs. Examples include, speech therapy, the Association for the Blind and the Parkinson’s society. Residents are supported to access the GP as needed and there is regular contact with the district nurse team. It was required in the inspection reports from October 2003 onwards that an appropriate lockable medication trolley be purchased. The Manager stated that this has now been ordered. There were a number of concerns regarding medication practice. Tablets that have been ruined are, on some occasions, flushed down the toilet. An immediate requirement was made at the inspection
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 10 for this practice to cease. There is no guidance for staff on when PRN medication should be administered. This should be agreed with the GP. Staff handwrite some entries on the MAR sheets. The pharmacy should usually provide a new printed sheet, but where this is not possible the home should have a written protocol for safely hand writing entries onto the sheet. This should include two staff checking the entry. Lists of medication that residents are prescribed are repeated a number of times throughout the medication file and the care plans and they do not all correspond. This is unclear for staff to follow. One resident has been continually refusing a medication for 6 months. This must be reviewed with the GP. Medication including eye drops is still being stored in the kitchen fridge. A lockable medication fridge must be obtained. There are no risk assessments for residents who administer their own medication. Residents wishes for the end of their lives have been discussed with them and recorded within their care plan. The home aims to continue to support residents to remain in the home for as long as their needs can be met. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 11 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, 15 Most residents are satisfied with the activities provided. They are provided with a balanced diet but do not have sufficient choice within the menu. EVIDENCE: Residents described a range of activities available in the home. The programme of activities has been recently reviewed and it remains a recommendation that this be displayed for residents to see what activities are planned for the week. This must be in a format appropriate to their needs. The menus do not provide an appropriate choice of hot meals for residents, particularly for vegetarians. There is a choice of a main hot meal at lunchtime and if you do not want this you can have a jacket potato and salad. There is a separate menu for people who are diabetic but this also is the same for those who require soft diets. Advice should be sought from someone who has completed training in nutrition. It was recommended at the last inspection that the menu be reviewed as it was designed in 2003; this has not happened yet. The menu is still not displayed in an appropriate format for residents as recommended previously. Water jugs are provided in residents’ bedrooms, but the glasses were very dirty. There was no evidence that residents nutritional needs have been assessed. One resident requires her food to be liquidised and said sometimes this is done separately. The resident says she does not mind it being blended together but a consistent approach should be agreed with the resident.
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 12 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) EVIDENCE: These standards were not inspected on this occasion. Standards 16 and 18 were met at the last inspection. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 13 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, 22, 23, 24, 25, 26 Residents live in a home that is appropriate for their some of their needs. They have access to sufficient shared and personal space. Residents did not feel the home was warm enough and there were some areas that were dirty and had an unpleasant odour. The home has not been properly assessed for specialist equipment. EVIDENCE: The home’s premises is appropriate for the needs of the current group of residents and it is well maintained. There is adequate shared and personal space and residents said they were happy with their rooms. The home has one assisted bath and one assisted shower for use by residents. A suitable fixed frame has not yet been fitted over the toilet. Commodes for use by some residents at night are stored in the garden during the day. It is recommended that an appropriately qualified person carry out an assessment of the premises with regard to facilities for disabled residents. There are no communication signs for residents with dementia in the home, for example clearly signed toilets and bathrooms. There is no call point in the quiet lounge. This causes difficulty for one resident who regularly uses this lounge and needs staff
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 14 support to walk. One resident has an assisted chair to help them stand but this was not working properly. Most residents have a lock on their bedroom door and all have a lockable space. Some areas of the home, particularly around the ground floor bedrooms, had an unpleasant odour and a bedroom chair was found to be stained and very dirty with food remnants. The Manager was asked to rectify this immediately. The net curtain on the back door was torn and dirty. The home did not feel particularly warm and some residents were complaining that they were cold. The laundry room was very dirty. It was required at the last inspection that toiletries are not shared between residents. Some unlabelled toiletries were found in storage cupboards outside the bathrooms. A bar of soap was found in the shower room. Again, an immediate requirement was issued for this practice to cease. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 15 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) 29 Residents are generally protected by safe recruitment procedures, but some review of the application form is required. EVIDENCE: Staff files were inspected at random and these contained the appropriate checks to ensure residents are kept safe. The Manager was advised that the application form must ask for a full employment history and for details of any cautions in addition to criminal convictions. Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 16 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, 33, 36, 38 Residents do not benefit from a Manager who is responsible for just one home. They are consulted on their views of the home. Staff are not appropriately supervised and residents health, safety and welfare are not fully protected. EVIDENCE: The Manager of the home continues to be registered for two homes. Efforts to recruit a suitable person for the other home have been unsuccessful. This means that the Manager cannot commit sufficient time to each home to be able to manage effectively. The Manager sends questionnaires to residents to seek their views on the home. It is a requirement that the results of the annual quality assurance exercise be summarised and sent to CSCI. Staff are still not receiving supervision frequently. There are some risks to residents from poor storage of cleaning products and some first floor windows are not restricted. The home has a buzzer on the front door to alert staff if confused residents attempt to wander from the home. During the inspection one resident was very confused and wanting to leave the home. The buzzer was not on at this time.
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 3 3 3 2 3 3 2 1 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 x 2 x x 2 x 2 Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 18 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 OP9 Regulation 13(2) Requirement The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that, a) A safe protocol must be in place if staff are required to make handwriiten entries onto the MAR sheet. b) An appropriate lockable medication fridge must be obtained for the storage of medication that requires a low temperature. c) Clear and accurate records of residents medication must be maintained. d) Medication must be disposed of safely. e) The GP must be contacted with regard to the resident who has refused their medication regularly for 6 months.
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Timescale for action 01/12/05 01/12/05 01/12/05 18/10/05 01/12/05 Version 1.40 Page 19 f) A risk assessment must be completed for any resident who manages or administers their own medication. g) An appropriate medication trolley must be obtained. This was first required following an inspection in October 2003. The Manager stated that this has been ordered. h) Clear guidance must be in place for when staff should administer as required medications. 2. OP22 23(2) (c)(l)(n) The registered person shall, having regard to the number and needs of the service users, ensure that, (c) equipment provided at the home for use by service users or persons working at the care home are maintained in good working order. In that, The assisted armchair for one resident must be repaired. (l) Suitable provision is made for storage for the purpose of the care home. In that, Commodes used by residents must not be stored in the garden. (n) Suitable adaptions are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled. In that, An appropriate frame must be fitted around the toilet.
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc 01/12/05 01/12/05 01/12/05 01/12/05 01/12/05 01/12/05 Version 1.40 Page 20 A call point must be fitted in the quiet lounge for use by residents. Part one of this requirement was not met following thelast inspection. 3. OP25 23(2p) The registered person shall, 19/10/05 having regard to the numbers and needs of the service users, ensure that ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. In that, The home is kept suitably warm for the residents. 4. OP26 13(3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home. In that, toiletries must be not be shared between residents. This was not met following the last inspection. 5. OP26 16(2k) The registered person shall, having regard to the size of the care home and the numbers and needs of service users, keep the care home free from offensive odours. 31/10/05 18/10/05 6. OP26 23(2d) The registered person shall, 18/10/05 having regard to the number and needs of service users, ensure that all parts of the care home are kept clean and reasonably decorated. In that, armchairs must be kept clean and the torn curtain Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 21 replaced. 7. OP29 19(1b) schedule 2 The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in schedule 2. In that, The following must be obtained A full employment history. Details of cautions in addition to criminal convictions. 8. OP31 8(1)(b)(iii ) The registered provider shall appoint an individual to manage the care home where the registered person is not, ordoes not intend to be, in full time day to day charge of the home. In that, The Manager must not be registered for more than one establishment. This requirement has not been met following the last 2 inspections. 9. OP33 24(2) The registered person shall supply to the Commission a report in respect of any quality review conducted by him and make a copy of the report available to service users. The registered person shall ensure that persons working at the home are appropriately supervised. The registered person shall ensure that all parts of the home to which service users have 01/12/05 01/12/05 01/12/05 10. OP36 18(2) 01/12/05 11. OP38 13(4a) 01/12/05 Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 22 access are, so far as reasonably practicable, free from hazards to their safety. In that, Window safety restrictors are to be fitted to first floor windows following risk assessment. Cleaning products are to be stored safely. The risks of confused residents wandering from the home are to be appropriately assessed and minimised. 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 OP3 Good Practice Recommendations It is recommended that the manager ensure the assessment of residents needs cover all areas under standard 3. It is recommended that care plans include details of any input by other professionals. It is also recommended that out of date information be removed from the care plan. It is recommended that the activity programme for the home is displayed in a format appropriate to the needs of the residents. It is strongly recommended that the menu be reviewed following advice from someone with nutritional knowledge. At least 2 choices of hot meal should be available each day and the menu should be displayed in a format appropriate to the needs of the residents. Residents nutritional needs should be assessed and agreement should be made on a consistent approach to
Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 23 2. OP7 3. OP12 4. OP15 liquidising the meals for one resident. Water glasses should be changed daily in resdients bedrooms. It is recommended that an appropriately qualified person assess the premises with regard to equipment for disabled residents. It is recommended that toilets and bathrooms be clearly signposted for residents with Dementia. 5. OP22 6. OP22 Copperfields Residential Home H56-H06 S23919 Copperfields V246519 181005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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