Care Home: Copper Hill Nursing Home

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What the care home does well What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Copper Hill Nursing Home Church Street Leeds Yorkshire LS10 2AY Lead Inspector Catherine Paling Key Unannounced Inspection 12th August 2008 09:30 12/08/08 09:30 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 Copper Hill Nursing Home DS0000001333.V368999.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. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copper Hill Nursing Home Address Church Street Leeds Yorkshire LS10 2AY 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) 0113 2771042 0113 2719324 www.bupa.com BUPA Care Homes (CFHCare) Ltd Mrs Verity Taylor Care Home 180 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (150), Physical disability (8) Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 150 Dementia, over 65 years of age - Code DE(E), maximum number of places: 30 Mental disorder, excluding learning disability or dementia, over 65 years of age - Code MD(E), maximum number of places: 30 2. Physical disability - Code PD, maximum number of places: 8 The maximum number of service users who can be accommodated is: 180 18th September 2007 Date of last inspection Brief Description of the Service: Copper Hill is owned by BUPA Care Homes and is located in the Hunslet area of Leeds. The home accommodates up to 180 people providing personal care with nursing. The home is split into six houses each with 30 bedrooms. There are four houses providing personal care with nursing, one providing personal care only and one providing specialist dementia care. There are attractive garden areas with outdoor seating close to each house and ample car parking space giving easy access to all parts of the home. Each bungalow contains its own lounge facilities and kitchenette. The home is close to a range of local amenities that include supermarkets, a church, post office, banks and a variety of other shops. There is a good bus service into the city centre of Leeds. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 5 Information about the service is provided in the form of a statement of purpose and service user guide available from the home. Copies of the previous inspection reports are also available at the home. The home should be contacted directly for up to date information about fees. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit by three inspectors over two days. Inspectors were at the home from 09:30 until 17:25 on the 12th August and from 09:25 until 17:30 on 13th August 2008. The purpose of our inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection we looked at accumulated evidence about the home. This included looking at any reported incidents, accidents and complaints. We used this information to plan the visit. We looked at a number of documents during the visit and visited all areas of the home used by the people who live there. We spent a good proportion of time talking with the people at the home as well as with the manager and the staff. We spent time on the dementia care unit and three of the nursing units. We asked the home to provide some information before the visit by completing an Annual Quality Assurance Assessment (AQAA). We sent survey forms to the home before the inspection providing the opportunity for people to comment on the service, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A small number of surveys were returned and some of their comments are included in the report. What the service does well: Everyone moving into the home has a full and detailed pre-admission assessment of their care needs. The assessment of people’s care needs is repeated at intervals to make sure that care needs are not overlooked. This means that staff have good information about how to look after people properly. The specialist care provided to people on the dementia unit is good. Staff are specially trained to work on this unit and have the appropriate skills to care for this specific group of people. Staff said; • “This is very rewarding work, I love it”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 7 The care plans and the approach to care is person centred and there is appropriate involvement of other healthcare professionals when necessary to make sure that people get the care and support they need. Healthcare professionals said: • ‘Current team very effective and caring and highly conscientious’ People said: • We are very satisfied with our mums care. All of the staff are good and we are always welcomed whatever time we visit. They keep us informed about doctors visits, etc.” The home also responds well to complaints and safeguarding issues meaning that people are protected. People said: • Don’t often have to complain, got satisfactory answer when we did. What has improved since the last inspection? Documentation of people’s individual care needs has improved greatly. Care plans are written in a person centred way. This means they provide clear personal detail about care and support. The arrangements for the provision of activities and occupation have improved and we saw enthusiatic activities organisers working with people to provide ocupation and stimulation. We saw staff treat people with dignity and respect. Tasks were completed in a relaxed and unhurried way. People said: • They treat them well, all treated as individuals, generally they are very kind. • They are very well looked after. • “There are advantages and disadvantages with all of these places, but on the whole the care is good here”, The registered manager has worked hard over the last year to build up her staff team and to improve the service provided to the people living at the home. People living at the home and their relatives feel that things are improving. People said: • There was a time when I was not happy but things have turned around now” Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 8 • • • Don’t worry about mum at all” Been a big turnover of staff recently, but the new ones seem good, a good team. Have been short staffed in past, used a lot of agency staff, things have been better lately. Staff training has also improved with the appointment of the training manager. Staff feel that there is a good level of training to help them understand the people they look after and care for them properly. Staff said: • The training is really good, anything you need you get”. 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. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 9 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 Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 10 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): 3 (Standard 6 does not apply to this service) People who use the service experience good quality outcomes in this area. All people have their needs assessed before they are admitted to the home. The information available to people and their families gives them the information they need to decide if they want to move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated – ‘All prospective residents undergo a pre-admission assessment to ensure the home can meet any identified need and the placement will be appropriate. Service Users and their relatives/advocates are encouraged to visit and assess Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 11 the quality, facilities and suitability of the home. We provide comprehensive written information for prospective clients.’ We saw that pre-admission assessments take place for people before they move into the home. Unit managers or other senior staff carry out the preadmission assessments. We saw good detail and this information is used to develop a preliminary care plan so that staff have some information on people’s needs and how to support them as soon as they move in. The assessments are person centred and focus on people’s strengths. The person and their relatives are fully involved in the assessment and it is clear that information is gathered from a variety of sources. This includes care managers, social workers and community psychiatric nurses. In one case one person had been admitted at very short notice to one of the nursing units. Staff made arrangements to complete an assessment before admission so that they could be sure that they would be able to look after this person properly. This is good practice. The reason for the emergency admission and the support needed from staff was clear in the records. Specialist equipment had been provided on admission. People said: • • • A person laughed and smiled when asked if he liked the home. Very nice here thank you. Relative- chose here because we had heard good reports. Staff showed a good understanding of their role in helping people to settle in when they first move in. They said they encourage them to socialise, meet other people, get to know staff and become familiar with the environment. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. Care plans have good personal detail about the care people need so that staff are able to look after them properly. People are protected by safe medication practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated – “All residents have comprehensive personal care plans individual to their identified needs. There are company specialists both regionally and nationally who can be consulted for advice and support at any time. Self care is encouraged. All residents have a nutritional screen. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 13 Every resident is registered with a General Practitioner of their choice (within the constraints of access to G.P.s). The recently updated Medication policy meets the criteria of the National Minimum Standards and the guidance from the Nursing & Midwifery Council and the Royal Pharmaceutical Society”. “The standard of documentation i.e. care planning has improved and is now more person centered and more detailed than previously.” We looked at a small number of individual care records on each of the four houses we visited during the inspection. We looked at these records in depth as part of case tracking process. Our findings were confirmed by observation and discussion with individuals, their carers and their relatives. People whose care we looked at in depth had a wide range of health and personal care needs, including people with dementia, diabetes and skin damage. Help and advice is sought from health care professionals to make sure that people get the special help they need to maintain their health. People are escorted to appointments or health care professionals attend the home as required. One relative said, “They are always very prompt in getting the doctor if my husband needs it”. Specialist equipment is available, such as hoists and hospital beds this makes sure that people’s special health care needs are met. End of life plans are being developed and in the case of one person there was evidence of the involvement of the community palliative care team the GP, the dietician and the tissue viability nurse. The involvement of other healthcare professionals supports the home staff in making sure end of life care is effective. Health care professionals said: • Current team very effective and caring and highly conscientious • Requirement is for consistency • Prolonged staff stability would be helpful Comments about the nursing units included: • “I think that the care is excellent,” • “There are advantages and disadvantages with all of these places, but on the whole the care is good here”, • “I never feel alone here”, • “We are very satisfied with our mums care. All of the staff are good and we are always welcomed whatever time we visit. They keep us informed about doctors visits, etc.” • “ Don’t worry about mum at all” Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 14 • • • “There was a time when I was not happy but things have turned around now” “The food is good, and I am also satisfied with standard of the laundry, considering its such a large place”. “Very satisfied” Where people had been identified as needing specialist moving and handling equipment, such as hoists, handling belts, slide sheets, these were seen to be in place. Risk assessments were in place for the use of bed rails, where indicated. Our observations also included two people from different cultural backgrounds during the course of the visit. One of the nursing staff was able to communicate with one person in her own language. The nurse said that there were other members of staff, who could also communicate with the lady, and there was evidence that they were getting a list of key words together so that all staff could achieve a basic level of communication. People look well cared for clean, tidy and well groomed. Attention had been paid to detail. People had very clean glasses, women had their nails painted if they wanted and people had their hair styled as they wished. Staff were patient and kind when interacting with people. They were discreet and respectful of people’s dignity when attending to any personal care needs. They gave reassurance and explanations for any tasks such as moving and handling that they needed to support people with. This seemed to give people confidence in the staff. People have care plans and risk management plans which have been developed from their pre-admission assessment information. The care plans focus on their strengths and abilities while providing information on what they need help with. We saw that social care was given high prominence in the care plan files, with a Map of Life and Lifestyle Profile included for each person. Some life story work has also been done with people. These provided some really good information about the person’s past and their interests. Staff said it was good to have this information to be able to talk to people about their families and friends and past lives. This is good person centred practice. It was also clear whether or not the person had an active religious faith. The plans are reviewed regularly. This involves the person their relative and their key workers. Staff were able to accurately describe the care they give as detailed in the care plans and it is clear that staff have a good knowledge of people’s needs. Staff talked about the importance of understanding the way in which people communicate their needs and wishes. And also the importance of listening to people and the different ways in which they may communicate. One said, “We must always be patient, calm and give people plenty of time”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 15 Risk assessments have been carried out for identified risks to people. These include moving and handling, nutrition, falls and pressure ulcers. Relatives spoke highly of the care and support given to people on the dementia unit. These are some of the things they said: • • • (Name of person) is always clean and tidy, well cared for. They treat them well, all treated as individuals, generally they are very kind. They are very well looked after. These are some of the comments people made in surveys: • Sometimes because of staff limitations needs not met as quickly as could be • Generally happy with care • The care and attention given to all the residents is excellent and is above reproach Relatives said they had been involved in drawing up care plans. They said they came to regular reviews and were kept well informed of any changes involving their relative. We saw that the section in the care plans on the relatives’ expectations was well used by staff. This is good practice and reminds staff of the importance of communicating with peoples families in order to provide the best care. The home uses a monitored dosage, pre-packed system for medication. All nursing staff have been trained to use the system. A record is kept in the home of medication ordered. This is checked against medication delivered and recorded as correct before any medicines are dispensed. Photographs had been taken of all people who use the service, which makes sure they are clearly identified on the medication records. Medication records were checked and found to be in good order. The supplying pharmacist provides good support. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. People are supported in maintaining contact with their family and friends and visitors are welcomed at the home. People are occupied in a way that meets their individual strengths. People are provided with a nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated – “The home has an open visiting policy taking account of residents wishes. Have appointed 4 Activitiy Organisers to provide a varied activity programme to the service users including group sessions and one to ones. Better evidence to support that activities is provided. We encourage the personalisation of residents’ individual space with their personal belongings”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 17 “Aim to provide two more activities organisers to provide a wide range of activities for the residents enjoyment,therefore giving each unit at least 24 hours activities.” “The introduction of the BUPA Menu Master helps us to ensure the menu meets the nutritional needs of the residents.Training given to staff on meal presentation, with particular attention to the presentation of soft diets. Presentation of the environment ,i.e tablecloths, flower arrangements etc has improved to make meal times a pleasurable experience. We have started the BUPA Night Bite system to ensure that food is available 24 hours a day”. It was clear that there is a big committment to improving the opportunities for stimulation and occupation of people living at the home. We saw enthusiatic activities organisers working with people to provide ocupation and stimulation. The manager is committed to employing one activities organiser for each house. Records are kept of activity sessions. The programme of activity has been developed based on the interests of people. Activities include, arts and crafts, bingo, making hanging baskets, sing-a-longs, beauty treatments, group games, quizzes and some outings. We saw that opportunities for social activity are well-developed on the units we visited. Information about planned weekly activities, concerts and other events, including craft sessions at a local Day Centre, is displayed on the notice boards in each of the houses. The programme is adapted and changed to suit people’s wishes. People said: • Are trying to get activities going. Always ask if activities happening anywhere in Copperhill. Would be nice to go for a ride in a minibus. Some exercises would be good. • It would be nice if they had more time to spend just sitting and chatting and giving more homely care • The lady who does activities works very hard • Always something going off here, we had a lovely Spanish day the other week (relative) • They made sure he sent me flowers for our anniversary (relative) • They always try to involve (name of person), keeps him entertained. • They involve mum as much as they can, it has also improved a lot lately. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 18 Over the two days of our visit we saw people enjoying playing dominoes, snakes and ladders and bingo. Music was on in the background, and some people were singing along. On one house people were being encouraged to reminisce, for example, who remembered the songs that were being played, and who their favourite musicians and singers were. One activities coordinator said that some event ideas come from the BUPA head office, such as the “mini-cruise” with each house being a different port of call, or a tea promotion. People’s social needs and interests are recorded in their care plans. This means that staff know what sort of activity they may be interested in. Staff had good knowledge of people’s past interests and hobbies and tried to incorporate this into daily life for people. For example, singing along to Irish music, encouraging people to get involved in some gardening or providing sports magazines for people interested in sports. Some people with dementia who are comforted by nursing “babies” have dolls available to meet this need. Books, magazines and soft toys are available and left out for people to use. On the dementia unit the patio area of the garden has been developed in to an area where chickens and rabbits are kept. People who live at the home seemed to gain a lot of pleasure from these. Some were happy to observe them; others were more involved and could pet the rabbits or help with feeding of the chickens. A wooden gazebo has also been recently added and is going to be part of a planned sensory garden. Again, people who use the service were planning to be involved in some of the gardening activity for this project. People were gently encouraged to be involved in activity. Some people were falling asleep frequently but staff tried to wake them and keep them more stimulated. This was sometimes just to have a conversation now and then. Staff said they felt they had plenty of time to just sit and chat to people or to get involved in activity organised by the activities organiser. The dementia unit is relaxed and life seems to go at the pace of people who use the service. Cleaning staff said they work around what people want. One said, “If someone wants a lie in we just go back later to clean, it’s not a problem, no rigid routines here”. Care staff also said they did not work to hard and fast routines. They said they make sure people are treated as individuals. One said, “They can get up, have their meals, walk about as they like”. Meal times are not meals is available. dislikes of people. relatives and staff. Copper Hill Nursing Home rushed and are seen as a social occasion. A choice of two The chef said that menus are arranged based on likes and This information is gained from people at the home, their If people refuse food, alternatives can be prepared quickly DS0000001333.V368999.R01.S.doc Version 5.2 Page 19 for them. Meals can be served in people’s bedrooms or in the dining areas. Staff are sensitive to the needs of people who find it difficult to eat and need help and encouragement with this. Staff sit with people helping them feel comfortable and unhurried which helps people relax and respond in time. Food looked appetising and people were offered as many choices as required to encourage them to eat. Special equipment is used such as plate guards, to help people maintain their independence. Menus are varied and nutritionally balanced. There is food available 24 hours per day. Trolleys of food and drink go round every few hours. This makes sure that people are encouraged to maintain their weights. Finger food is available for those who find that easier to manage. This is good practice in dementia care. Staff have been trained in meeting people’s nutritional needs. They gave good examples of how they make foods more appetising and nutritious for people. The chef is very involved on the units and had been developing “smoothies” (the banana one was sampled), primarily for people on soft diets, as they were missing out on cakes, pastries, etc, that others enjoy mid-morning and midafternoon. People said: • Would be better if there was at least 2 extra staff on care at meal times to tend to patients that need changing • Choice of dishes usually available but could be hotter • Very nice thank you (the food) • Food is always nice. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 20 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): 16 and 18 People who use the service experience good quality outcomes in this area. People living at the home feel that their views are listened to and taken seriously. People feel safe at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated: “We have a clearly defined company complaints policy with agreed timescales for managing complaints. The information that accompanies the policy is prominently displayed in the home. The policy includes a three tier framework including the home, the regional management team and the national Quality and Compliance department. BUPA Care Homes has robust policies for dealing with allegations of abuse or neglect. Staff can not only raise concern within the home they have access to senior staff outside the home. There are well documented procedures for reporting under PoVA should the need arise”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 21 Records are kept of complaints received and information provided to us shows that complaints are taken seriously and properly investigated. The complaints procedure is made available to relatives and people who live at the home. People living at the home and the relatives we spoke to said that they would tell staff about any concerns they might have. Everyone said they were comfortable speaking with the unit managers and would have no hesitation in speaking to them if they felt something was wrong. People said: • If not happy, talk to person in charge. • We have brought minor things up and everything has always been dealt with. • I wrote a letter and got a response. • Have complained but think BUPA always have a management answer for you. • Don’t often have to complain, got satisfactory answer when we did. • Family go every day and have no problems sorting things out with staff • There is always one of the nurses ready to help if necessary • Senior staff always available to help sort out any problems we may have • The staff on Churchill are excellent and always happy to help. They need a medal There have been a number of referrals to the adult safeguarding team over the last year. The manager has demonstrated through the referrals and action taken that any safeguarding concerns are taken very seriously and that there is full cooperation with the local authority safeguarding team in investgations Staff were familiar with safeguarding adults procedures and have received training on abuse and the protection of vulnerable adults. Staff were aware of the different types of abuse and how to report any concerns. All staff were very clear on their responsibilities to report any suspicions or allegations of abuse. This makes sure people are protected well. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 22 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): 19 and 26 People who use the service experience good quality outcomes in this area. Refurbishment plans will make sure that people continue to live in a comfortable, safe and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated – “Standards with general cleanliness improving. Evidence of routine maintenance and decoration of the premises. Improved gardens for our residents enjoyment”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 23 “To continue with the improvements already initiated across other units and departments. We have plans to redecorate and enhance some of the communal areas and bedrooms on some of the units”. The provider recognises the need for major refurbishment of the majority of the home. A major refurbishment project is due to start in September 2008 and people living at the home and their relatives have been involved in choosing soft furnishings. People said: • Could do with a blind for the conservatory roof • Could do with wood floors not carpet • Communal areas clean. Individual bedrooms need more thorough attention • Residents sometimes spill food/drinks on furniture etc. which is not cleaned • The rooms need total refurbishments. The cleaners do their best but in an EMI unit there is a constant need for cleaning up. We carried out partial tours of the four units we spent time on. Overall all areas were clean and fresh smelling. There was a whole range of specialist equipment provided and in use by the people living there. We saw bedroom health and safety checklists in care plans and evidence that portable electrical equipment had been tested for safety. We also saw detailed safe working procedures for staff. A lot of the bedroom fitted furniture is now looking shabby, as does a lot of the paintwork and décor, where it has been damaged by equipment, for example, wheelchairs. The dementia unit is about to undergo a major refurbishment. The environment is going to be designed to enhance and compensate for the abilities of people with dementia. The unit manager said the whole unit will be re-decorated, re- furnished and supplied with new bedding and curtains. New laminate flooring is to be provided for bedrooms. All of this will greatly enhance the environment and make it more comfortable for people who use the service. Some good attempts have already been made to make the environment easier for people to find their way around. Corridors have been themed in either reminiscence themes or old film themes. People have door furniture and keepsake boxes that enable them to recognise their own rooms. The unit manager is hoping that more use of colour contrast will help people further. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 24 People are encourged to personalise their rooms and to bring familiar pieces of furniture in with them. Secure door entry systems are in place to ensure people are kept safe. On entering the dementia unit and in some parts of it there was a slight malodour. The planned refurbishment should help with this. A relative said that they didn’t think chairs were wiped down frequently enough after episodes of incontinence. Some people who had poor posture control were sat in chairs that did not support them properly or look comfortable. Discussion took place with the dementia unit manager who said she had asked for occupational therapist referrals for people. She said there was a long waiting list and if specialist seating was recommended, it was often difficult to obtain funding. An area of this unit has been designed to replicate a pub. This area is well used and people seemed to enjoy being sat there, reading the paper, socialising and having a beer. Relatives said they always found the unit clean but many said they were looking forward to the re-furbishment. One said, “It’s about time, all looking a bit tired and worn”. Another said, “Not happy with the standard of bedrooms, door knobs hanging off, doesn’t look as clean as it should do”. There are good systems in place for hand washing in all areas of the home where clinical waste or bodily fluids are handled, and good measures to prevent the spread of infection. Staff had good knowledge on infection control and what they do to prevent the spread of infection. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 25 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): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. The staff are well trained and people are looked after by competent staff. People are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated – “There are comprehensive Human Resource policies to aid effective recruitment and staff management. We maintain the correct numbers of staff agreed with the inspectorate and taking account of the individual needs of the residents. We perform appropriate CRB, PoVA and NMC PIN checks for staff. There is a training matrix specific to the home that identifes the training requirements of the staff”. “Need to continue to train staff up to the required NVQ standard”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 26 “Leadership on the units has improved by employing experienced and skilled unit managers”. There has been a significant turnover of staff in the last twelve months as the registered manager has built up her staff team and this resulted in a lot of bank and agency staff use. However the senior staff team is now largely complete and the active monitoring of sickness levels has greatly reduced sickness levels. Staff told us about the high level of training that is provided and expected of them. New starters have to complete a two day induction that includes mandatory training as well as safeguarding training. Once induction has been completed staff move onto the structured training programme available to all staff. Bank staff get the same induction and mandatory training. Nurses also told us that they have plenty of opportunity to keep up with their clinical skills, including palliative care, stoma care, etc. People said: • Staff are very good – helpful. There is always someone around • Staff do not always respond to my requests – because in my opinion they are short staffed • Staff are very kind and patient with him, even if he is being aggressive. • They are all lovely, all good friends to us. • Hands on staff are lovely, fantastic. • Been a big turnover of staff recently, but the new ones seem good, a good team. • Have been short staffed in past, used a lot of agency staff, things have been better lately. • Usually enough staff around except if anyone is sick. • Staff work very hard. • Oh yeah, we get on very well with staff. (resident) During the time of our visit there were enough staff on the units we visited. Staff felt they had enough staff to meet people’s needs well and get involved in activity. Rotas showed good staffing levels and cover provided for sickness. All staff including the cleaners interacted well with the people living in the home. There was an excellent rapport; people were cheerful and responded well to people’s requests. This made for a lively atmosphere with lots of laughter and good humour. Staff said they were well trained and felt they had everything they needed to do their job properly. Dementia training ranged from basic awareness training Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 27 to a three day more intensive training. Staff were able to say how this training affected their practice. Comments included: • • • It prepares you well, they don’t leave anything out. It teaches you to get to know people well and to know that everyone is different. I talk to people more, get to know their likes and dislikes. Staff spoke highly of their induction training and on going training. One said, “The training is really good, anything you need you get”. Staff said they had a good team and they felt well supported. One said “We pull together well, couldn’t wish for better support”. Staff were also really positive about working with people who have dementia. One said, “This is very rewarding work, I love it”. We saw well organised recruitment files with evidence that all the required checks are carried out before people are employed at the home. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 28 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): 31, 33, 35 and 38 People who use the service experience good quality outcomes in this area. The management of the home is well organised and practices promote and safeguard the health, safety and well being of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated – “The current level of management and support personnel is sufficient to maintain compliance, however tighter definition on individual roles may help to further improve things”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 29 “Regular Health & Safety meetings with a standardised agenda giving staff the opportunity to communicate on Health and Safety issues. The minutes from these meetings go to the Regional Manager. There are regional and national experts available within the company for advice and guidance if required. There are dedicated Health & Safety staff within the Quality and Compliance directorate. BUPA Care Homes has a comprehensive suite of Policy and Procedure manuals that are regulalrly reviewed by experts and updated when required. BUPA Care Homes has an annual customer satisfaction survey. Residents may handle their own finances should they wish to do so”. “BUPA Care Homes has achieved Investors In People (IIP) acreditation”. What we could do better – “To further develop the training plan. Train more staff in NVQ qualification. Further develop relationships with some of the external professionals. Plans for next 12 months – “To further develop the activity provision within the home. Refurbishment is planned on most units with an in depth refurbishment of the dementia unit. BUPA Care Homes are developing further standardised operating procedures to assist staff to comply with policy and standards. To continue to improve on the iniatives already established”. The registered manager of the whole site is an experienced nurse and manager. She provides clear leadership and direction to her staff and has made significant improvements at the home over the last 12 months. Information provided in the AQAA demonstrates that she has a clear idea of what still needs to be improved for the people living at the home. The registered manager has worked hard to make sure that each of the units has a capable and committed manager. Those managers we met over the time of the visit clearly relished their roles and provide good leadership to the staff on their units. Significant improvements have taken place with these appointments. People said • “Over the last six months Fenton House has shown marvellous improvement. The facilities are very clean and welcoming the staff very accommodating and helpful. Am very impressed with the unit manager. Feel much happier”. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 30 Staff said that they got good support from the unit managers. They also said that the registered manager and clinical services manager were supportive and were seen on the units. The manager of the dementia unit is a qualified nurse with good experience in dementia care. Staff said they got good support and supervision from her. They said she was approachable and would always make time for them. They said they felt listened to if they made suggestions. Relatives comments• • • • “We are invited to meetings to express our opinions or worries” “Have meetings but not very often” “Never seen the site manager” “Can go to unit manager with anything” Comments on thank you cards• • “Thank you for all the kindness and concern you showed in looking after my mother” “You do a difficult job in a very professional way” The dementia unit manager has recently set up a support group for relatives. This means they will be able to meet up and share their worries or concerns about dementia and its effects. Meetings with relatives and people living at the home are usually based on the individual units. Notes are kept of these meetings and as one manager said ‘communication is key’. Unit managers also meet with their own staff and the notes of these meetings on one unit gave a good and clear record of the topics discussed. The whole focus of the meetings was to improve person centred care. The registered manager meets regularly with all the unit managers and the emphasis is towards improvements in the service provided at the home. The result of the annual satisfaction survey is used to produce the annual action plan to address any identified shortfalls. Areas included in the 2008 action plan are to improve communications and activity provision. There was a recent satisfactory check of residents finances completed by Leeds City Council. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 31 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP19 OP28 Good Practice Recommendations Ways of providing specialist seating should be looked into so it can be provided for those who may need it. This is so that people are made more comfortable. The commitment to training a minimum of 50 of the care staff to NVQ Level 2 standard should continue. Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. Extracts may not be used or reproduced without the express permission of CSCI Copper Hill Nursing Home DS0000001333.V368999.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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