Care Home: Copper Beech Services

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What the care home does well The home is well managed by and experienced manager who is well regarded by staff. This continuity in management provides more positive outcomes for service users. Provides a good standard of individualised care for service users. Supports and encourages service users to lead an independent life according to their needs and strengths. Service users benefit from a competent and committed staff team that ensures consistency of care for service users. What has improved since the last inspection? There was sound evidence that overall outcomes for service users had improved and was continuing to improve. The recording of information about service users has improved enabling staff to meet needs more efficiently. The fabric of the building has improved and additional adaptions have been installed for the benefit of service users. What the care home could do better: The manager has identified that the service could be providing better access to social and community clubs for the benefit of service users. To encourage greater participation of service users in meal preparation. With the help of communication tools support service users to participate more fully in residents meetings. Key inspection report Care homes for adults (18-65 years) Name: Address: Copper Beech Services Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Newman     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Copper Beech Services Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344755555 01344773174 copperbeechannexe@norwood.org.uk bucketsandspades@norwood.org.uk Norwood Ravenswood Ltd T/A Norwood Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Nadine Carly Hodge Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) The maximum number of service users to be accommodated is 16 Date of last inspection Brief description of the care home Copper Beech Services is part of Ravenswood Village and is now registered to provide support and care for eight adults with learning disabilities. The service is now provided on one site. The service has evolved and developed into a specialist residential resource for people Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 16 2 4 0 3 2 0 0 9 Brief description of the care home whose needs are within the autistic spectrum. The home is a purpose built single storey building. All of the service users are accommodated in single bedrooms. The home has equipment to assist the more dependent service users. Within the service two of the bedrooms are located within individual flats, to enable their more complex needs to be met through the provision of dedicated staffing and higher ratios, though they may also spend time with the group. The home manages a wide range of need, including challenging behaviour, epilepsy, and autism. The aims and objectives of the home are to provide a secure and comfortable home; encourage and support residents to make decisions and choices in their lives; support and assist service users to make and maintain satisfying relationships; assist service users to develop their skills; and enable service users to engage in valued day time occupation and use the community facilities. The fees range from £66,896 to £123,058 per annum. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that was conducted over the course of three days and included a visit to the service of 3 1/2 hours duration. Time was spent observing practise in the service and talking to staff and the manager. Two staff members were spoken to in private. A range of documentation was seen and the communal areas and some bedrooms were seen. There was considerable evidence that the outcomes for all service users have improved since the appointment of the current manager. Information held about the service by the Commission and information provided by the home prior to the inspection was used in the formulation of this report. All outcome areas were good with two areas being judged as adequate. No requirements or recommendations were made as a result of this inspection. The provider has a range of policies and procedures relating to equality and diversity. Care Homes for Adults (18-65 years) Page 6 of 27 From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, racial or cultural needs. No complaints have been received about this service by the Commission since the last key inspection. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident that they will have their needs fully assessed to ensure that the service can meet those needs prior to a place being offered. Evidence: Evidence was obtained from information provided by the service prior to the inspection, from documentation seen during the visit and from discussions with the manager and staff. No new service user has moved into the home since the previous requirement that more robust pre-admission assessment procedures should be followed. In discussion with the manager it was evident that the last service user to move into the home was thoroughly assessed and a range of meetings with various health care professionals was held in order to discuss the individuals needs and the appropriateness of the placement. The written records for all this work had not been collated into a single file for ease of access to relevant information. However, it was accepted from discussions with the manager and the business manager that any prospective service user Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: potentially moving into the home would be subject to stringent assessment where records would be maintained in a logical and accessible format. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users assessed and changing needs are well understood but are not always appropriately reflected in their individual plan of care. Service users are encouraged and supported to make decisions about their lives and to take managed risks where appropriate. Evidence: Plans of care were seen in respect of three service users. Some were detailed and the service is in the process of adopting a uniform format. Information was accessible but not always up to date and evidence of regular review was not always present. This is despite a requirement being made at the last inspection with regard to plans of care. The service is now 11 months further on and significant progress was in evidence but not consistent across all care plans seen. A key worker system is in place but this is often a shared responsibility with other staff members. Consideration should be given to implementing a primary key worker system where assistance is provided by other nominated staff. This would have the advantage of clearly identifying those responsible for ensuring plans of care and other key worker tasks are carried out. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Daily diaries are completed for each service user and these are used to record the interventions of staff. Formal reviews involving relatives and other professionals are arranged at least annually. It was evident from observations and discussions conducted throughout the visit the service users are supported to make appropriate decisions such as choice of food, activities and bedtimes. A range of risk assessments is in place that are individual to each service user. In theory these are linked to clear practise guidelines but was not always consistently observed in those plans of care seen. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users take part in a variety of occupational and leisure activities both inside the home and within the local community. They are supported with appropriate relationships and to maintain links with family and friends. Service users are enabled to choose from a healthy diet. Evidence: Service users are encouraged and supported to lead fulfilling lives appropriate to their needs, wishes and preferences. Each service users has an individual programme of activities including a range of leisure pursuits, swimming, music sessions, day centre attendance, horse riding, art and reflexology for example. Activities are conducted within the home and form part of the plans for individuals. Community access is actively supported and encouraged and this is an area the manager wishes to expand and improve upon in order to provide more access to Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: community and social clubs and day services external to the village. All service users have a holiday according to their individual needs and preferences. This may take the form of day trips if this is more suited to the needs of the individual. The home has two dedicated vehicles but does use other forms of transport on occasions. Evaluations are made about whether each trip is appropriate for individuals and this work could be more effectively recorded. The arrangements for the provision of food is overseen by the staff team as a whole. The menu was seen and it provided evidence that a wide range of healthy foods prepared from raw ingredients are provided in the home based upon individual choice, preference and needs. There are some special dietary needs within the home including diabetic and soft foods. These are catered for appropriately. A food safety inspection was carried out by the local authority on 18.2.09 when a four star rating (very good) was awarded. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support in the way they prefer and their physical and emotional health care needs are very well met. Service users are protected by the homes policies and procedures on dealing with medicines. Evidence: The plans of care seen provided information about the personal and health care needs of individual service users. Preferences in relation to personal care was recorded very clearly in some files but could be improved upon in others. However, it was clear from discussion with staff and the manager that the personal care needs of service users is well understood. Daily routines are flexible and bedtimes and mealtimes are not rigidly enforced but take account of individual timetables. All service users have a range of health checks that are undertaken on a regular basis. Their general health and well being is closely monitored by staff and changes are reported without delay. It was evident from documentation seen and from discussions throughout the visit that a wide range of health care professionals care called upon according to individual service users needs. All appointments and outcomes are recorded. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Verbal evidence was presented that indicated that the staff team under the direction of the manager had enhanced the lives of the service users living in the service and this had been noticed particularly with regard to those service users who had transferred from other homes within the village. There are no service users who currently administer their own medication. The home has recently changed its medication provider and positive outcomes have been noted since the change took place. All staff who administer medication have received appropriate training with regular refresher training being provided. The medication prescribed for individual service users is reviewed regularly as needs change and at least on an annual basis. A pharmacist from the Primary Care Trust reviewed the medication procedures within the home on 20.1.09 and considered that all the standards were met. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have their views listened to and are protected from abuse, neglect and self-harm. Evidence: There is a robust and comprehensive complaints procedure in place that is provided by the organisation. Information provided by the service prior to the visit confirmed that no complaints had been received by the service since the last inspection. No complaints or concerns about this service have been received by the Commission. All staff have received training in safeguarding adults and of those two staff members spoken to in private both demonstrated a sound understanding of the principles of safeguarding adults. All service users, monies are now administered from the home and is overseen by the manager. The systems are subjected to management review and occasional external audit. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a homely, safe and comfortable environment that is mostly maintained in a clean and hygienic condition. Evidence: The communal areas and some bedrooms were seen. A range of improvements have been made to the home since the last inspection including complete refurbishment of the main bathroom and improvement to a shower room and disabled toilet. In addition, more appropriate crockery and tableware has been purchased and adaptions such as sounding proofing, over head hoist and privacy and safety film have been fitted to identified windows. Further improvements are scheduled and include new curtains in communal areas, new flooring in disabled toilet and two bedrooms have been identified for re-decoration. Generally the home was clean but it was noted that some carpets were in need of hoovering and cobwebs and sellotape attached to the walls were in evidence in some communal areas. Of the two offices one was particularly cluttered and there were numerous boxes of old paperwork being stored in the dining room awaiting transfer to the archive facility on the village. These deficits do detract from the overall homely feel of the service. There is a cleaning schedule which forms part of the shift plan. However, the plan seen did not indicate or identify what staff were responsible for the Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: various tasks and just stated that it was all staff responsibility. In discussion with the manager she indicated that this was in the process of changing so that individual named staff would be allocated particular tasks including cleaning duties. It was hoped that this would improve the overall cleanliness of the home. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by competent, well-trained and qualified staff and are protected by the homes recruitment policies and practises. Evidence: The organisation provides a comprehensive staff training programme that includes National Vocation Qualification training, specialist learning disability awards and ongoing core training including moving and handling, food hygiene, fire awareness and safeguarding adults. All new staff are required to undergo induction training to Skills4care standards and guidelines. It was confirmed in discussion with staff that induction is provided and expected of all new staff. Once induction has been completed staff move to more advanced training such as NVQ. The training department is well organised and notifies services when updates or refresher training is due for individual staff. Each staff member has a training profile where copies of training certificates are maintained. Access to these files was not possible on the day of the visit to the service as the manager had left the key in her car which was not on the village. Positive interactions between service users and staff were observed throughout the course of the inspection. Overall staff appeared confident in their roles and those spoken to indicated that they were well supported by the management within the Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: home and by fellow team members. A shift planner is posted in the hallway but this was mostly empty of photographs of staff members on duty. The manager intends to bring this planner up to date so that service users can see at a glance who is coming on to shift. Staff meetings are held regularly and staff spoken to felt that they were useful. Communication between staff was considered to be good with a range of tools being used to support this including a staff communication book and regular shift hand overs. The organisation has a robust recruitment system that is administered centrally. Evidence was accepted from information provided by the service and from knowledge of the organisation that no staff member commences employment within the home without having provided all the necessary documentation as dictated by the regulations. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in a manner that reflects the views of service users. The health, safety and welfare of service users and staff are promoted and protected. Evidence: The home is run by an experienced manager who is registered with the Commission and is well qualified. Of those staff spoken to all indicated that they felt well supported by the manager and she was described as fair and approachable. A range of systems for monitoring the home are undertaken and arranged by the organisation. Regular Regulation 26 visits are undertaken and separate lay monitoring visits take place that are recorded. The manager confirmed that she had sent surveys to family members and to date has received three responses. These responses will be evaluated together with any others received and the findings will be incorporated into a business plan which is being drawn up for the service. Direct feedback from service users is gathered through observation of responses and through knowledge of individual preferences and needs. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: A wide range of health and safety checks are undertaken and documentation seen included checks on portable appliances, the electrical installation, gas appliances, legionella, the fire warning system and fire fighting equipment. It was noted the a fire risk assessment was available and was in date. Prior to the visit the manager provided information regarding a health and safety audit that was undertaken by the Health and Safety Manager for the village on the 12.11.09 and resulted in positive outcomes for the systems operating within the home. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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