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Inspection on 04/09/07 for Copperfields Residential Home

Also see our care home review for Copperfields Residential Home for more information

This inspection was carried out on 4th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

The service provides a small and homely environment for older people. All the bedrooms are single and are furnished to individuals` tastes. The meals that are provided are of a high standard and there is always plenty of choice. People in the home can choose to receive visitors when they wish to. Everyone in the home has a care plan that is reviewed with him or her each month. This is also an opportunity for them to give their views on the service they are receiving.

What has improved since the last inspection?

There are some more staff recruited and more staff training has taken place. The Manager is working full time in the home and a deputy Manager has been employed. Some areas of the home have been redecorated and re carpeted. The assessments of people`s needs and the plans to meet these needs have improved and are clearer for staff to follow.

What the care home could do better:

The environment needs to be made safer and easier for people that use wheelchairs. Clear signs should be added to the home to help people who are confused to find their way around. People`s care plans need to give staff guidance on how to support people with their emotional needs and how to support people to keep busy and not to get bored. The staff need some training in supporting people with learning disabilities and the Manager must monitor what staff are doing to ensure that people are not left sitting during the day without anything to do. The Manager must make sure that staff are properly trained and have criminal records checks before they are allowed to work on shift and before they work unsupervised. People must have their nutritional needs monitored and the care plans should include any help they need from the district nurses.

CARE HOMES FOR OLDER PEOPLE Copperfields Residential Home Copperfields Residential Home 42 Villa Road Higham Kent ME3 7BX Lead Inspector Jo Griffiths Key Unannounced Inspection 4th September 2007 11:00 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 Copperfields Residential Home DS0000023919.V342355.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. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copperfields Residential Home Address Copperfields Residential Home 42 Villa Road Higham Kent ME3 7BX 01474 824122 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) Larchwood Court Limited Miss Janet Irene Aldridge Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th April 2007 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 although the home is currently only taking a maximum of 17 people. The home has mainly single bedrooms although there is one double bedroom available if prospective residents wish to share. There is a garden to the rear of the property. The home is not ideal for wheelchair users. The fees charged for this service range from £350 - £495 per week. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the service. The inspector, Jo Griffiths, visited the home on 4th September 2007 between 11.00am and 5.00pm. The Manager did not know the inspector was visiting. To help the inspector make a judgement about the quality of service that is provided at the care home she spoke with some of the people that live there and some of the staff. The Manager was also at the home during the visit and spoke about the improvements that have been made to the service since the last inspection. The Manager completed an Annual Quality Assurance Assessment (AQAA) in June, as this is now required by law. The inspector used this to help inform the judgement of the home. She also had a look around the home and inspected some of the documents and care plans. Since the last key inspection of the home an Enforcement Notice was issued to ensure the provider complies with the regulations. There have been two smaller ‘Random’ inspections since the last key inspection to follow up whether the requirements of the enforcement notice have been met. The home has met the majority of the requirements and some improvements had been noted before this inspection today. What the service does well: What has improved since the last inspection? There are some more staff recruited and more staff training has taken place. The Manager is working full time in the home and a deputy Manager has been employed. Some areas of the home have been redecorated and re carpeted. The assessments of people’s needs and the plans to meet these needs have improved and are clearer for staff to follow. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are provided with most of the information they need about the service, but do not receive clear information about the suitability of the home for wheelchairs users. People have a holistic assessment of their needs, but the home is not currently able to demonstrate that they can fully meet the needs of people with dementia, learning disabilities or physical disabilities. EVIDENCE: The Statement of Purpose was reviewed in June 2007. It provides people with information about the home. The Manager was advised that the document should be made easily accessible to people in the home as it is currently in the policy file in the managers office. The Statement of Purpose does not advise people that the home is not designed for people that use wheelchairs. The Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 9 Service User Guide has also been reviewed. This should be made accessible to service users in a format they can easily read, for example large print, and a copy made available to all people living in the home. The assessments for new two service users were sampled. These are now up to date and link better to the person’s care plan. Assessments are completed in the person’s own environment or hospital before they are admitted to the home. The Manager confirmed that places are only offered if the home is able to meet the person’s needs, however it is evident that this is not always the case. Whilst the home is not a specialist service for people with dementia, and is not registered as such, there are some people who have mild to moderate dementia that are being supported within the home. The Statement of Purpose states that the home is able to meet the needs of these people. This is accepted by the Commission, providing that the home can evidence that their needs can be met. Through inspection of the care plans and observation of practice it was evident that the emotional well-being of people with Dementia was not being properly addressed or met. Staff were observed to be kind and patient when attempting to reassure people that were distressed, but did not demonstrate the skills or understanding of the specific emotional support needs of people with dementia. Staff are currently undertaking training in this area, but the care plans do not support staff to meet people’s needs in this area. There is one person whom has a learning disability living in the home. The person does not use verbal communication and the staff do not appear to have the skills and understanding of how to interact effectively with them. Some staff training is needed in this area. An Occupational Therapist has carried out an assessment of the premises with regard to its suitability for the currents residents of the home. There were a number of comments and recommendations made which have been included in the section of this report that relates to the environment of the home. The Occupational Therapist report shows that the environment is not currently appropriate for people with dementia or for people that use wheelchairs. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have a care plan that meets their personal care needs. They would benefit from further improvement of the plans to ensure their health care needs are recorded accurately in the plan. People’s physical health care needs are met and their medication is managed safely. Some people would benefit from more person centred support for their emotional well being. People living in the home are treated with respect and their privacy and dignity is maintained on most occasions. Their wishes for the end of life have been noted but not reviewed to ensure they are still what the person wants. EVIDENCE: Each person has a care plan and these are up to date. The care plans have improved since the last inspection as they now give more directive information Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 11 for staff to follow when supporting an individual. However, there is still some further work to be done with regard to the specific needs of people with Dementia. The care plans do not guide staff on how to ensure the emotional well-being or people who may be confused and distressed. There are no plans in place that recognise the importance of regular interaction and reminiscence work with people with dementia to ensure they are occupied and feel valued within the care home. Staff practice was observed and whilst well meaning and kind they did not demonstrate the skills to support people to maintain a good state of mental well-being. The staff are not provided with the information they need within the care plans to effectively support people with dementia. People’s social needs have now been addressed within the care plan but not in a particularly individual way. The care plans could be further reviewed to improve this. Each person has a review of their care plan once a month and the reviews now reflect the areas of the care plan. This is good practice and records of the reviews are being kept. Peoples primary health needs are being met and records are kept of all involvement by health care professionals. The care plans do not always indicate that check up appointments have been made for people but staff were able to confirm that appointments had been made. Those spoken with said that staff are quick to respond if they request to see a GP or have a health concern. People have an assessment of their nutritional well being, but the home is unable to monitor anyone’s weight, as they have been unable to purchase appropriate scales due to funding restrictions. There was evidence of the involvement of the district nurse for the prevention and treatment of any pressure sores, but the care plans do not reflect where staff are required to replace any dressings that have fallen off. Staff told the inspector that the district nurse had instructed them to do this. People living in the home have the opportunity to join a weekly exercise session within the home. Some people said they would also enjoy a walk outside sometimes and whilst this was arranged on the day of the inspection for one person there was no recorded evidence of this being usual practice. People’s medication is managed safely within the home. There is currently no one who has requested to self medicate. Senior staff administer medication and have undertaken a 12 week training course with a local college. The deputy Manager carries out regular observations and competency checks of each senior staff. Staff were seen to treat people in the home with kindness and respect during the inspection and people spoken with said the staff were generally very friendly. There are no longer any people in the home that are required to Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 12 share a bedroom and peoples mail was seen to be distributed to them in their own rooms. Some people require the use of the hoist and for ladies that wear skirts this is not a particularly dignified procedure. The Manager was advised to contact a specialist to review the slings used by each person in the home to ensure it is the correct size and most appropriate one for them. The wishes and requests for some residents for the end of life have been recorded but these have not been reviewed in the care plan to ensure they stated wishes are still relevant. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People would benefit from more occupation during the day. They can receive visitors when they wish to, but do not have regular opportunities to go out in the local community. People are supported to make their own decisions in some areas of life. People enjoy the meals and are offered a varied menu that meets their needs. EVIDENCE: People that live in the home were observed to be under stimulated for the majority of the inspection. Staff were attempting to interact with people as best they could but did not have the skills or time to do so with all people in the home. Some people spend most of their time in their own rooms and some sit in the lounge areas. Some people were seen to be quite confused at points of the day and became very distressed and disorientated. Most people spent the morning becoming anxious about when lunch would be arriving. There is a large clock in the dining room that most people are able to read. A large clock Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 14 would be useful in the lounge as this may help people to orientate themselves throughout the day with their activities. There are some set activities provided in the home on two afternoons a week by an external worker. Records are kept of these sessions and show consistent participation from several of the more able residents and they say they really enjoy these. The Manager has consistently stated at previous inspections that people do not want to take part in activities. There were no activities taking place on the day of the visit and people spoken with said they were bored. People’s care plans have not been written in a person centred way to ensure that they are occupied. Whilst formal activities may be rejected there was clear evidence that people enjoy more informal activities. It was observed that one person, whom had been quite distressed during the morning, had independently taken herself off to dry a few dishes after lunch and was really enjoying this activity. The person’s confusion lessened and their state of mental well being greatly improved. This is an example of an important activity that helped the person retain a sense of importance, but unfortunately it was not acknowledged by the staff on duty, the Manager or within the care plan. The Manager informed the Commission in the Annual Quality Assurance Assessment (AQAA) in June 2007 that weekly trips outside the home had begun. However, on inspection of records and discussion with people in the home, the Manager and staff this had not yet happened. One person was taken out for a walk during the inspection, but records evidenced that this was not regular practice. A number of old time theatre shows are being planned by the Manager. These will be really positive for people in the home. Visitors are welcomed in the home and people can see their visitors in private in their rooms or in one of the lounges. One person has been supported to move bedrooms recently to be nearer another person in the home with whom they have developed a friendship. People are supported to manage their own financial affairs for as long as they are able, but they can choose to deposit money and valuables with the home for safekeeping if they wish. People can bring their own personal possessions with them when they move to the home. The menu is varied and everyone is offered a choice of meals. This includes vegetarian meals and any individual dietary needs. A variety of meals were seen to be served at lunchtime according to people’s requests. The chef has been in post since the last inspection and has developed a good understanding of people’s preferences and needs. Mealtimes are a social occasion and most people choose to eat in the dining room, although people can choose to eat in their rooms. Records are kept of what people eat for lunch and dinner but not for breakfast. The chef said that biscuits, snacks and supper are offered, but there are not records of this maintained. Accurate records of all the meals people have should be maintained to allow the Manager and chef to monitor people’s nutritional well-being. This should include a record of supper to ensure Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 15 that people do not have to go longer than twelve hours between their last meal at night and breakfast in the morning. People spoken with said they enjoyed the meals. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People know how to make a complaint if they need to. People in the home are at some risk from new care staff being left to support them unsupervised. EVIDENCE: The Manager reported in the AQAA that there had been one complaint received by the home since the last inspection. She was unable to find the complaints record at the time of the inspection, but later phoned CSCI and told the inspector that the complaint was logged within the complaints book and had been resolved. The complaints procedure informs people of how to raise their concerns should they need to. There are also monthly care reviews for each person to which relatives are invited. There are a few complaints leaflets in the hallway, but it may benefit people in the home if this was kept fully stocked for people to access. The Manager and provider have updated their knowledge in Safeguarding Adults and most staff have attended training. Some of the new staff have not yet completed the course as they are on their induction. The Manager must ensure training is planned and booked. During the inspection two new carers were left in the home whilst the manger and senior carer went to do an assessment. The new care staff had a POVA first check, but had not yet received their full CRB back. The new staff had been working within the home Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 17 for two weeks and have not yet completed training in areas of safe care practice. The Manager must ensure they are not left to work unsupervised until their full CRB check is received. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment meets the needs of most people in the home but improvements are required to meet the needs of wheelchair users. People that have dementia would benefit from clearer signage around the home. The home is clean and well maintained. EVIDENCE: The home is generally kept clean and well maintained. There is a new handyman in post who is at the home most days to do general repairs and decoration. Some bedrooms have been redecorated and re carpeted since the last inspection. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 19 An Occupational Therapist carried out an assessment of the premises in June 2007. A number of recommendations were made to improve the property. The general outcome of the report was that the home is not currently suitable for people that use wheelchairs. It is also stated that there is not clear signage around the home, which is particularly important for people who have dementia and may be confused or disorientated. The key recommendations that were made in this report are as follows. A copy of the full report is held at the home. • • • • • • Cars must not be parked in front of the ramp to the front door. Internal doors should be widened to the recommended minimum of 7580cm for wheelchair users. Way finding signs should be added to the home for toilets, bedrooms, bathrooms and the lift. People in wheelchairs should not be housed on the first floor as the lift is not big enough for them to be accompanied by staff safely. Careful consideration should be given to the rooms accommodated by people in wheelchairs as some are small and do not allow safe space for wheelchairs and equipment and for staff to move people safely. The downstairs shower room door should be widened as above, the shower unit should be replaced with one that has a regulated temperature. The lock should be replaced with one that is easier for people to open using one hand. The shower chair should be replaced with one that enables staff to provide hygiene care for people while seated. People should have an individual assessment by a qualified person to ensure the right shower chair is available for them. It is recommended that the downstairs Wc be relocated as the room is below minimum recommended sizes to move safely. Improve the lighting on the stair wells. Consider contrast of colour for handrails, door handles and light switches to aid people with visual difficulties. • • • • During the inspection people that use wheelchairs were seen to struggle to manoeuvre through doorways and narrow corridors. The Manager must inform the commission how improvements will be made to ensure that people that use wheelchairs can be safely and comfortably accommodated. People with dementia were observed to be confused and disorientated at times. They would benefit from clearer signage around the home. Most people’s bedrooms have been personalised with their own belongings. One person, whom has dementia, was very confused about why they were at the home and thought they were just visiting. When the inspector viewed this persons bedroom there were not many personal belongings in there. It is recommended that the Manager help the person obtain more sentimental and Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 20 personal belongings from their previous home to help them settle and recognise the bedroom as their own space. The garden has been tidied and is now a safer and more pleasant environment for people to use. There is no garden furniture for people to sit on and the Manager is planning to purchase some. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff employed in the home to meet people’s basic needs but they would benefit from more staff to support them to go out of the home. Staff are generally recruited following safe procedures but some are working on shift before all the documentation confirming their safety to work with vulnerable people is received. Most staff are trained in basic areas of care, but do not yet have the skills required to support the diverse needs of the people in the home. New staff are working unsupported without receiving adequate training. EVIDENCE: The rotas were inspected and showed that during the day there are between two and three staff on duty per shift. The Manager stated that agency staff are used to fill the empty shifts where possible and that regular staff from the agency are supplied. Where agency staff are not available there are only two staff on duty. The Manager said this is the minimum staffing level but it is sufficient to meet the needs of the people in the home. When there are only two staff on duty this would not allow people to be supported to leave the home for any activities. As described in the lifestyle section of this report Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 22 people would benefit from opportunities to go out of the home and as such three staff would need to be on duty for this. Most of the staff have either completed an NVQ award or are working toward this. Some staff are currently undertaking training in Dementia. The Manager must ensure that staff are supported and guided in best practice when supporting people with Dementia. There have been some new staff employed since the last inspection. The recruitment files for new staff were inspected and these showed that safe practice was followed when employing new workers for the home. The new staff have had a POVA check and are currently working on their induction workbooks, but have not yet completed any of the required training courses. The Manager stated that these new staff are working as extra numbers on the rota until they have completed their training and received their CRB disclosures. However, the rotas showed that some of these new staff were being used to fill shifts on the rota. During the inspection the Manager and senior carer left the home to carry out an assessment of a new person looking to move in. This left two new care staff in the home alone. Neither have undertaken any training and both are still undertaking their induction. Through discussion with the new carers it was clear that they were not yet familiar with all the names of the people in the home and were unclear about their care plans. The rest of the staff employed in the home have completed their training courses. There is a senior carer allocated to each shift whom is able to give out medication. The Manager has not yet drawn up a training plan for the home to address the ongoing need to training updates and new courses to meet the needs of people in the home. Staff would benefit from some training in working with people with learning disabilities and non verbal communication as there are two people with learning disabilities now using the service. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager is qualified and experienced, but does not always fully ensure the safety of people in the home through the deployment of competent and trained staff. People in the home have regular opportunities to give their views of the service. The quality of the service is monitored at regular intervals. The health and safety of people in the home is generally protected by they are at some risk from recent occasions where they are supported by unsupervised and untrained staff. EVIDENCE: Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 24 The Manager holds the Registered Managers Award and is a qualified social worker. She is based at the home full time and has a part time deputy Manager and several senior carers. The Manager has made some improvements to the home since the last inspection but still needs to focus on providing skilled staff to support people who have dementia and people that have learning disabiltities. The Manager has not ensured that the care plans sufficiently guide staff in supporting these people with specialist needs. The provider sends out questionnaires each year as part of a review of the quality of the service. It would benefit people in the home and prospective residents if these results were made available for them to see. Each person in the home ahs a monthly review meeting to look at the care provided and their individual care plan. The deputy Manager oversees health and safety issues in the home and reports any required work to the handyman. It would be useful to formalise the checks made on health and safety in the home. There are risk assessments in place for staff to follow for each person in the home. Equipment is provided for the safe moving and handling of residents, but some changes are recommended by the Occupational Therapist to ensure staff are safe when moving people within small rooms. Some new staff are working on shift unsupervised without having completed their training courses in areas of safe moving and handling, first aid, fire safety, infection control and health and safety. The Manager has stated on the AQAA that the Department of ‘Essential Steps to infection Control’ document has not been used. It is recommended that this be implemented to ensure infection risks in the home are minimised. The home does not generally deal with people’s financial affairs but will hold small amounts of money for safekeeping. Where this is done records are kept and storage is secure. Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 25 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 X 2 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 1 2 2 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 26 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. Standard OP7 Regulation 15(1) Requirement Service users care plans must direct staff on how to meet the assessed needs of the service user. This requirement was made at the inspection of 12.04.07. It has been partially met but the Manager must now ensure that the care plans address the specific emotional support needs of people with Dementia. The plans must also address the specific support needs of people with a learning disability. 2. OP11 12(2) Service users stated wishes in the event of death must be reviewed regularly with them to ensure they are still relevant. This requirement was made at the inspection of 12.04.07. It has not been met. 15/10/07 Timescale for action 15/10/07 Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 27 3. OP8 12(1) Suitable methods of monitoring the weight of service users at risk of poor nutrition must be introduced. This requirement was made at the inspection of 12.04.07. It has not been met. 31/10/07 4. OP1 4(1)(2) 5 (1) The Statement of Purpose and Service User Guide must clearly state the range of disabilities for which the home is suitable. The registered Manager must ensure people with Dementia and learning disabilities have their needs clearly addressed through the care plan. The Manager must ensure that the home is able to meet these people’s needs. People’s needs with regard to pressure area care must be clearly addressed in the care plan. Where staff are instructed to replace dressings by a district nurse this must be included in the care plan and evidence provided of staff competency to do this task. The registered Manager must ensure that people are consulted with about their social interests and that they are supported to keep busy and active as they choose during the day. People’s social needs and how and when these will be met must be added to the care plan. This should include opportunities to go out of the home and there must be sufficient staff on duty to support this. The Manager must ensure that DS0000023919.V342355.R01.S.doc 31/10/07 5. OP4 12 (1)(a) 30/09/07 6. OP8 12(1)(a) 15/10/07 7. OP12 OP13 OP27 16(2)(m) 31/10/07 8. OP18 13(6) 05/09/07 Page 28 Copperfields Residential Home Version 5.2 OP29 OP31 OP38 9. OP22 OP19 23(2)(a) new staff do not work in the home unsupervised until a CRB disclosure has been received. The registered Manager must ensure that the environment is suitable for people that use wheelchairs and for people with Dementia if the home is to continue to provide a service to people with these needs. The Provider must inform CSCI how they intend to address the recommendations from the Occupational Therapy report and any proposed timescales. 15/10/07 10. OP30 OP31 18(1)(a) The registered Manager must ensure that staff receive the training they need to safely support people before they work on shift and unsupervised in the home. The Manager must ensure that staff are trained to support people with learning disabilities and people that do not use verbal methods of communication. 15/10/07 11. OP15 17 An accurate record must be 30/09/07 maintained of all meals offered to and taken by people in the home. This must include a record of breakfast, snacks and supper. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000023919.V342355.R01.S.doc Version 5.2 Page 29 Copperfields Residential Home 1. 2. Standard OP20 OP30 Service users would benefit from the garden furniture being replaced. It is recommended that a training plan for the home be developed to ensure there is continual personal development for staff and that updates are provided when needed. It is recommended that the Statement of Purpose be clearly displayed in the hallway. It is recommended that the Service User Guide be produced in a format that people in the home can read. 3. OP1 4. OP10 It is recommended that the hoist slings be reviewed by an appropriately qualified person to ensure they are correct for each person and that they will maintain the persons dignity. It is recommended that a large clock be placed in the lounge areas to enable people to orientate themselves throughout the day and reduce anxiety. It is recommended that thought be given to furnishing rooms for people with dementia with their belongings to help them feel at home and reduce anxiety and confusion. It is recommended that the results of the annual quality review of the home be published for people in the home and their relatives to see. It is recommended that the ‘Essential steps to infection control’ tool be used and that the health and safety checks of the home be formalised. 5. OP14 6. OP24 7. OP33 8. OP38 Copperfields Residential Home DS0000023919.V342355.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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