Care Home: Copper Beeches

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What the care home does well We found some evidence in care plans of good life histories. As we toured the premises we saw that bedrooms had memory boxes on the doors that were personal. The staff spoke positively about the memory boxes and told us it was something the Activities Organiser was trying to do doing with each individual residing at Copper Beeches. The premises were homely and tidy without being austere, and with a good standard of cleanliness, decoration and repair. No unpleasant odours were present. Antiseptic gel was available at the front door. Everyone using this service was well dressed in freshly laundered attire and appeared to be comfortable in their surroundings. The Expert by Experience joined the second sitting for lunch. He found the lunchtime meals were served plated in generous portions, looked appetising, were suitably hot and tasty. Dessert was a good quality ice-cream with tinned pear. Diners needing assistance from care staff were given support and encouragement to eat their meal. The people who needed assistance with eating had one to one time that was unhurried and at a pace suited to the person. We observed a number of staff on duty through out our visit. They were all courteous and respectful, and got on well with the people who use this service. The two trainee managers are enthusiastic and focused on ensuring that Copper Beeches provides care that is about each individual and their needs, wishes, and preferred lifestyle. They have started to identify ways to engage with the staff to enable delegation of duties that will take this service forward. What the care home could do better: We looked at four care plans of both women and men. Care plans were variable. Some records were clear and showed how care was to be given. In some cases it was clear that general information had been written in all the care plans and not then updated with personal details. Some care plans did not reflect what care was actually being provided. We saw sporadic good examples such as describing a task and how the person does this. For example, "If you give X a towel she will dry herself." "Needs assistance with upper body clothing due to pain in shoulders". Mainly we found that information had been written into the care plan with insufficient detail. For example, under the heading Emotional Wellbeing, the care plan stated "reassurance needed". There was no explanation of circumstances when this may be appropriate or examples for staff of suitable reassurance for this individual. Another example was under the heading of Mobility: "If X becomes unsteady it is to be reported". There was nothing to tell care staff how or to whom it should be reported. In other care plans we could not find information to tell us why someone had moved into the care home or indeed why they needed twenty-four hour residential care. We also found that relationships were not evident in every care plan, for example, one care plan had a good person centred picture profile with clear personal information that could help the care staff to have a better understanding of the person as an individual. Two other care plans did not identify a marital relationship. Copper Beeches has large number of people with high dependency care needs. Staffunderstand about choice of clothing and food however some staff are very robust with a task focus approach. This means that for those people who may lack mental capacity, choice is not always positively encouraged and self-esteem promoted through every day routines and practices that are adapted to suit individuals to improve their daily life so it is meaningful to her/him. The trainee managers are endeavouring to teach and encourage all the staff to embrace person centred care through their individual practice however we found a frustration that most staff do not understand this concept. During a discussion with one of the trainee managers she told us that she had made an unannounced early visit at 0630 the week prior to our visit to see how care staff were working, organising themselves and timekeeping. Breakfast was an issue she had identified and she was hoping to be able to offer more practical solutions, i.e. people who are up early should be able to have breakfast when they are up and ready for it. For some people who choose to get up between 0500 and 0700 this means not waiting until 0800. For those who prefer to get up later it should be clearer that this is an option although with a time limit so people are not arriving for breakfast just before lunch. The trainee manager plans to introduce a member of staff who is delegated to organise breakfast making it freely available when people want it. In her opinion this should cut down on the rush and make it more accessible. She told us that lunch is already served in two sittings and people prefer this because it stops "the stampede." We suggested that could also be considered for teatime meals as this too had been mentioned by several people. In discussion about the care plans we acknowledged that these are being reviewed however including more details about what to do, why and how could aid care staff in seeing that everyone is an individual with different needs. During this visit we found that the expectations from other professionals are too high. There is an assumption that the care staff know what to do and how. For example at recent care reviews the reviewing agencies have expected to see charts on care plans that would usually be kept by a care home providing nursing care. Care staff were also being held accountable for making assessments for hoists and pressure relieving mattresses and pads. There was a general frustration about whether this should be the care home staff or the District Nurse Team who should assess and identify such needs. One staff member told us that they were very frustrated and had recognised on their first visit to the care home the over expectations on care staff skills of knowing what and how to do things. We were told by staff that they felt they were "Put in same bracket as nursing homes in the area". The registered manager acknowledged that the preassessment needs to be clearer. Currently people`s abilities are gauged from "moderate" to "severe". The registered manager said this needed to be amended because it was too vast. She agreed there needs to be a consolidation of the service as it is currently and then a critical analysis of how to step back and accept people who have "low" to " moderate" care needs. This will afford the staff and the management team the opportunity to demonstrate their skills in providing qual Random inspection report Care homes for older people Name: Address: Copper Beeches Copper Beeches 90 Plymstock Road Oreston Plymouth Devon PL9 7PJ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Megan Walker Date: 2 9 0 3 2 0 1 0 Information about the care home Name of care home: Address: Copper Beeches Copper Beeches 90 Plymstock Road Oreston Plymouth Devon PL9 7PJ 01752403836 01752408142 Telephone number: Fax number: Email address: Provider web address: www.copperbeechescare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Tui Shirley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Tui Philomena Eliza Shirley,Steven Paul Shirley care home 35 Number of places (if applicable): Under 65 Over 65 0 35 dementia old age, not falling within any other category Conditions of registration: 35 0 The maximum number of service users who can be accommodated is 35. The registered person may provide the following category of service only: Care home only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home Copper Beeches is located in the Oreston area of Plymouth. It is registered to provide accommodation with personal care for up to 35 people within the categories of old age (OP) and Dementia (DE). The home is not registered to provide nursing care. The home is not registered to provide intermediate care. Accommodation is provided over two floors in two originally detached buildings linked by a single floor communal room and reception area. There is a single floor extension to one of the original buildings from where the second floor bedrooms can be reached with use of a stair lift. There are a small number of steps beyond the stair lift to reach the bedrooms on this floor. All accommodation is in single bedrooms, 24 of which have en-suite toilet and basin facilities, and 15 of these have full shower wet room facilities. On the ground floor there is a lounge, a quiet room (library), a music/day room, and a dining room. There is a wireless call bell system throughout the home. The home has an enclosed garden to the side of the house and a sun terrace and garden to the rear of the property. Care Homes for Older People Page 3 of 12 What we found: This was a random inspection undertaken by one regulation inspector to check compliance with regulation. The fieldwork part of this inspection was unannounced and took place on Tuesday 23rd March 2010 between 10:30 and 17:13 with a further planned meeting on Monday 29th March 2010 for two hours. An Expert by Experience joined the site visit on the first day from 10:30 until 14:18 and visited individuals in their rooms during the morning, and ate lunch with the people eating in the dining room on the second sitting. He spoke to ten people using this service and one visitor. The Care Quality Commission (CQC) considers an Expert by Experience as a person who either has a shared experience of using services or understands how people in this service communicate. In our Annual Service Review we identified that the homes annual quality assurance assessment (AQAA) told us We employ a Registered Nurse specialising in nursing care for those over the age of 65 (within our Residential Care category). The homes Statement of Purpose refers, under staffing arrangements, to Registered Nurse and elsewhere states With the recruitment of our registered nurse we exceed the staffing level and training requirements of Regulation 18 of the Care Homes Regulations 2001. Our Registered Nurse (RNA) specialises in the care of those over the age of 65. The homes web site states: First class care overseen by our own nurse(s) who specialises in the care of people with dementia and those over the age of 65. Prior to this visit we had already communicated to the registered manager our concerns about the employment of a registered nurse to work in a nursing capacity in the care home. (Copper Beeches may employ a person who is a qualified nurse to work at Copper Beeches, however the person(s) must not practice as a nurse at Copper Beeches, as the home is not registered to provide nursing care. Any such practice would be deemed illegal.) Part of this inspection visit was to find out if the employment of a registered nurse to work in the care home had influenced people and their families in making their choice to move into Copper Beeches. Also, to ensure that everyone residing at Copper Beeches has access to NHS services in accordance with guidance and legislation. This includes access to specialist nursing, medical, dental, pharmaceutical, chiropody and therapeutic services and care from hospitals and community health services according to need. Since the last key inspection we have received information from other organisations as well from other people with an interest in the service that gave us concern about how well outcomes are being met for the people using this service. On our arrival we were met by the registered manager who is also one of the registered providers. We made a brief tour of the premises with the registered manager and the registered provider. There is a choice of three sitting areas, i.e. the music room, a television lounge and a quiet room referred to as the library. Occupants of the latter indicated that they valued the peace and quiet this room afforded them. The furnishings were of good quality, comfortable and clean. The bedrooms visited were clean, well decorated and homely with items of personal memorabilia on display. To the rear is a large patio. To the side is a secure patio with seating and tables for smokers. Care Homes for Older People Page 4 of 12 We found that the people who spoke with the Expert by Experience were confident that the care staff sought visits from GPs as and when requested. They confirmed that the District Nurse team also calls as necessary. If a person has a fall The paramedics are called to check them over, and decide if they should be taken to hospital for treatment. Several people mentioned that a nurse was on duty Monday to Friday but no one admitted to needing or receiving any professional attention or assistance from her. We had an open discussion with the registered manager about the employment of a registered nurse to work in a care home that is not registered to provide nursing care. We also raised our concerns about the personal professional practice and training a nurse requires to retain a nursing registration. We spoke about our concerns for any nurse employed to work in the home potentially being compromised because legally a nurse cannot work in a clinical capacity in a care home not registered with the CQC to provide nursing care. We found that the person concerned knows she cannot intervene clinically and will call in relevant professionals as needed. She also confirmed that although she does not take any clinical responsibility however she is able to use her key skills for the benefit of the people living in the care home. We were told that new uniforms were being made without the title Nurse on them. We were also reassured that the relevant professional body is fully aware of the situation and had provided guidance to ensure continuation of nursing registration . The Expert By Experience spent some time talking to the Activity Organiser and observing the mornings activities and routines around the home. The Activities Organiser explained that she was a member of the care staff. As she has always enjoyed activities and crafts she is now employed for half of her hours to focus on providing activities and group craft work for people living at Copper Beeches. The other half of her time she is still employed to work as a carer. The registered manager later confirmed this and reiterated how beneficial it was having an Activities Organiser who is also employed as a member of the care staff so knows and is known by the people living in the home well. Other staff commented about her enthusiasm and creativity that the people using this service enjoy. On the days the Activities Organiser does not work, a carer provides some activities. We found the monthly diary indicates that activities are available most mornings and afternoons. These include armchair aerobics, seasonal craft work, singing sessions with outside musicians, and Church visitors. Some people occupied themselves with jigsaw puzzles, reading, knitting and watching television whilst others sat in the Music Room (main lounge), watching people arriving and passing through. The Activities Organiser showed the Expert by Experience photograph albums of recent events such as a Halloween party (to which relatives were invited and attended) and a cookery session held in the dining room with some of the people living here. Once a month there is an outing in a minibus to attractions such as the Aquarium and a Circus. One-to-one activity includes conversation, visits to a local pub and shopping. Two pet rabbits are available for stroking. A complementary therapist attends once a week and currently has six clients. The local Library Service exchanges library books every nine weeks. During the afternoon of our visit there was a musical session that seemed to be popular and had a few people up and dancing with some of the staff. Care Homes for Older People Page 5 of 12 One person told the Expert by Experience I would like to pick up the hobbies I used to do when at home. Several people commented adversely on the repetitious repertoire of some of the entertainers who kept playing music-hall type songs from long ago, adding that they would like to hear some good classical music instead. We found that opinions about the food served at Copper Beeches were various including , A good cook here, Food very good, Alright, Cant complain, Food not perfect, Chips revolting, Same things each week, Always thin and wet ham and chips on Mondays, Food very samey, Frequently we have the same puddings more than once a week. We observed the chef approach people to ascertain their preferred choice of lunch between meat or vegetable lasagne both with salad. We were told that chicken pie, salad or jacket potato were available as alternatives for anyone choosing not to eat lasagne. We found that lunch is served in two sittings. The people who either need assistance with eating or who are able to eat independently with prompting and encouragement with their meals and drinks eat at midday. The second sitting is at 1300 and some staff also join this sitting. We observed the care staff giving people support and encouragement to eat their meal. The people who needed assistance with eating had one to one time that was unhurried and at a pace suited to the person. We were told that at teatime there is a choice of soup, sandwiches, sausage rolls and various items on toast. During the evening drinks are served and biscuits are available. The people who spoke with the Expert by Experience told him that they could choose the time they got up and the time they went to bed, however some people also commented that breakfast is served at 0800 which meant getting up an hour before in order to be ready. The registered manager told us that breakfast is served from 0800 and is an open-ended event until quite late into the morning. We found that risk assessments did not follow good practice guidelines to include ensuring that any restraint (e.g. wander mats, locking doors, wheelchair straps, stairs) is recorded in such a way that reflects it is only used in the best interest of the person, records are made, consent and mental capacity are considered and opinions of a suitably qualified person outside of the home is sought. We had a very open and honest conversation with the registered manager and the two trainee managers about the future of Copper Beeches with regards to the management arrangements. They told us that the registered manager was planning to move towards being a registered provider only because she felt doing both jobs i.e. registered manager and registered provider, was too much along side the daily management of the home. In the long term she plans to seek to register someone else as the manager for the home. With this in mind, the registered manager has arranged for two of the deputy managers to start management training. They are learning the operational aspect from the registered manager and will shortly be starting a workshop with a local training company that links NVQ L4 Leadership & Management course with one-to-one coaching one day per month about the Health and Social Care Act 2008. They both acknowledged they need more confidence to supervise staff however we agreed that this will increase as they take on more responsibility for managing the home. A change in their job title should also reflect to both staff and outside professionals the change in leadership. We also talked about a review of the current staffing structure and the delegation of responsibilities to senior staff to relieve the trainee managers to fully embrace their new role. What the care home does well: Care Homes for Older People Page 6 of 12 We found some evidence in care plans of good life histories. As we toured the premises we saw that bedrooms had memory boxes on the doors that were personal. The staff spoke positively about the memory boxes and told us it was something the Activities Organiser was trying to do doing with each individual residing at Copper Beeches. The premises were homely and tidy without being austere, and with a good standard of cleanliness, decoration and repair. No unpleasant odours were present. Antiseptic gel was available at the front door. Everyone using this service was well dressed in freshly laundered attire and appeared to be comfortable in their surroundings. The Expert by Experience joined the second sitting for lunch. He found the lunchtime meals were served plated in generous portions, looked appetising, were suitably hot and tasty. Dessert was a good quality ice-cream with tinned pear. Diners needing assistance from care staff were given support and encouragement to eat their meal. The people who needed assistance with eating had one to one time that was unhurried and at a pace suited to the person. We observed a number of staff on duty through out our visit. They were all courteous and respectful, and got on well with the people who use this service. The two trainee managers are enthusiastic and focused on ensuring that Copper Beeches provides care that is about each individual and their needs, wishes, and preferred lifestyle. They have started to identify ways to engage with the staff to enable delegation of duties that will take this service forward. What they could do better: We looked at four care plans of both women and men. Care plans were variable. Some records were clear and showed how care was to be given. In some cases it was clear that general information had been written in all the care plans and not then updated with personal details. Some care plans did not reflect what care was actually being provided. We saw sporadic good examples such as describing a task and how the person does this. For example, If you give X a towel she will dry herself. Needs assistance with upper body clothing due to pain in shoulders. Mainly we found that information had been written into the care plan with insufficient detail. For example, under the heading Emotional Wellbeing, the care plan stated reassurance needed. There was no explanation of circumstances when this may be appropriate or examples for staff of suitable reassurance for this individual. Another example was under the heading of Mobility: If X becomes unsteady it is to be reported. There was nothing to tell care staff how or to whom it should be reported. In other care plans we could not find information to tell us why someone had moved into the care home or indeed why they needed twenty-four hour residential care. We also found that relationships were not evident in every care plan, for example, one care plan had a good person centred picture profile with clear personal information that could help the care staff to have a better understanding of the person as an individual. Two other care plans did not identify a marital relationship. Copper Beeches has large number of people with high dependency care needs. Staff Care Homes for Older People Page 7 of 12 understand about choice of clothing and food however some staff are very robust with a task focus approach. This means that for those people who may lack mental capacity, choice is not always positively encouraged and self-esteem promoted through every day routines and practices that are adapted to suit individuals to improve their daily life so it is meaningful to her/him. The trainee managers are endeavouring to teach and encourage all the staff to embrace person centred care through their individual practice however we found a frustration that most staff do not understand this concept. During a discussion with one of the trainee managers she told us that she had made an unannounced early visit at 0630 the week prior to our visit to see how care staff were working, organising themselves and timekeeping. Breakfast was an issue she had identified and she was hoping to be able to offer more practical solutions, i.e. people who are up early should be able to have breakfast when they are up and ready for it. For some people who choose to get up between 0500 and 0700 this means not waiting until 0800. For those who prefer to get up later it should be clearer that this is an option although with a time limit so people are not arriving for breakfast just before lunch. The trainee manager plans to introduce a member of staff who is delegated to organise breakfast making it freely available when people want it. In her opinion this should cut down on the rush and make it more accessible. She told us that lunch is already served in two sittings and people prefer this because it stops the stampede. We suggested that could also be considered for teatime meals as this too had been mentioned by several people. In discussion about the care plans we acknowledged that these are being reviewed however including more details about what to do, why and how could aid care staff in seeing that everyone is an individual with different needs. During this visit we found that the expectations from other professionals are too high. There is an assumption that the care staff know what to do and how. For example at recent care reviews the reviewing agencies have expected to see charts on care plans that would usually be kept by a care home providing nursing care. Care staff were also being held accountable for making assessments for hoists and pressure relieving mattresses and pads. There was a general frustration about whether this should be the care home staff or the District Nurse Team who should assess and identify such needs. One staff member told us that they were very frustrated and had recognised on their first visit to the care home the over expectations on care staff skills of knowing what and how to do things. We were told by staff that they felt they were Put in same bracket as nursing homes in the area. The registered manager acknowledged that the preassessment needs to be clearer. Currently peoples abilities are gauged from moderate to severe. The registered manager said this needed to be amended because it was too vast. She agreed there needs to be a consolidation of the service as it is currently and then a critical analysis of how to step back and accept people who have low to moderate care needs. This will afford the staff and the management team the opportunity to demonstrate their skills in providing quality care that meets individual needs. 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 set out on page 2. Care Homes for Older People Page 8 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 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, 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 1 7 15 Care plans and risk 31/05/2010 assessments must contain accurate information that is regularly reviewed to enable staff to provide care in a safe and consistent way. This will ensure staff will be aware at all times what care an individual needs. 2 8 12 Systems must be in place to ensure people receive the finer details of care that allows them to make decisions about their lives. This will ensure that care staff involve people in their care. 31/05/2010 3 14 18 Staff must be trained in such 28/05/2010 a way they understand how to make time to enable and encourage people living in the home to make decisions with respect to their care and so far as it is possible to ascertain take into account their wishes and their feelings. Page 10 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This means everyone living at the home will have a good quality of life and feel valued as an individual. 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 Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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