Archived: Copperfields Residential Home

Copperfields Residential Home is a residential care home providing accommodation and personal care for up to 20 people. The service supports older people and people living with dementia. The accommodation is provided across two floors in one building. There were 10 people living in the service at the time of the inspection.

People’s experience of using this service and what we found

Quality assurance processes and audits were not always robust enough to identify shortfalls and to continually monitor, evaluate and improve the service.

Some environmental health and safety checks had not been completed in a timely manner and records of health and safety checks were inconsistent and lacked clarity. For example, emergency lighting, water temperatures and fire training were not up to date.

Staff were not always recruited safely. For example, employment history and reference checks were not documented in every case. However, most of the time there were enough staff to support people safely.

Most risk assessments and care plans were completed accurately and contained enough information for people to provide safe care. A stair gate had been fitted to prevent unauthorised access to the basement and to minimise risks to people. This was a recommendation following the last inspection.

People told us they felt safe in the service and relatives agreed. One relative said, “They genuinely want the best for my mum.”

Medicines were managed safely in line with current guidance. People received their medicines as prescribed by people who were trained to do so. Medicines were ordered, stored and disposed of safely.

People and their relatives were involved in decisions about their care. Relatives had been invited to meetings to discuss and agree care plans. Relatives had been kept informed of any changes by the staff at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 01 December 2020) and there was a breach of regulations. The provider completed an action plan after the last inspection to show us what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations. This service remains rated requires improvement. This service has been requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains the same. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Copperfields Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We have identified breaches in relation to good governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ The registered manager had implemented procedures to minimise the risk of infection from visitors. The service had a designated room that was used for visitors. Visitors’ temperatures were checked and personal protective equipment (PPE) provided. Alternatively window visits were offered by appointment.

¿ The service had enough personal protective equipment (PPE) to meet current demand. Staff were using PPE correctly in accordance with Government guidance. Staff changed into their uniforms in a designated changing area where they also performed their lateral flow test and put on their PPE before entering the home. Uniforms were laundered on site to minimise the risk of cross contamination.

¿ We signposted the provider to Government guidance on Covid-19 admissions and care of people in care homes to support their admissions protocols.

Further information is in the detailed findings below.

People’s experience of using this service and what we found

Most risks to people had been identified and processes ensured mitigation was in place to reduce them. This included ensuring appropriate healthcare professionals were involved in people’s care. However, some risk assessments did not fully reflect the guidance provided by the healthcare professionals. Behaviour management plans needed to be further developed to help staff better understand triggers and strategies to support them consistently and safely. Accessible stair ways presented a potential risk to some people. Individual risk assessments had not been completed to assess this risk and stair gates were not in place.

Some checks to ensure the safety of the home environment had been in place but had lapsed recently following the departure of a staff member who had previously been responsible for these. Safety critical servicing and repairs of equipment continued to be completed by external contractors.

Medicines were not always managed safely. The storage of some medicines and management of bottled liquid medicine did not meet national guidance. However, people received their medicines as prescribed, medicines were booked into the service appropriately and unused medicine was disposed of safely. We have made a recommendation about the management of some medicines.

The registered manager and provider completed checks of the environment and audits of the quality of service provided. However, these were not sufficiently robust to identify the concerns found at this inspection so were ineffective in their use.

There were enough numbers of staff to support people. Recruitment of staff had been problematic and the home was heavily reliant on agency staff to fill vacancy gaps.

Staff had received safeguarding training and people were protected from abuse. Potential safeguarding matters were brought to the attention of the registered manager and had been referred to the local authority safeguarding team appropriately.

There were appropriate measures in place for the prevention and control of infection. However, some wooden fixtures were showing signs of wear which made them difficult to clean effectively. The service was working within current infection control guidance and staff were wearing personal protective equipment (PPE) as required. The service was clean and chemicals were being stored safely.

Opportunities for people to voice their views about the home had been limited, although plans were now in place for this to happen. The provider and registered manager were working through an action plan to improve the quality of the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture by promoting choice and control, independence and inclusion. However, staff faced challenges in making sure people's support focused on them having as many opportunities as possible to gain new skills and become more independent. This was because they supported people with a learning disability and older people. These two groups had different and complex needs which the service did not always find easy to balance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement. (Published 28 February 2020) and there were multiple breaches of regulation. The service remains rated requires improvement. The service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the management of staff, low staffing levels and poor mandatory staff training levels. Further concerns received related to medication management, inadequate and inconsistent care planning documentation and risk assessments, the provider not consistently reporting accidents and incidents and concerns about the safety of the home environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Copperfields on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance at this inspection. We have made two recommendations about risk assessment processes, the management of medicines and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Copperfields Residential Home is a residential care home providing personal care to 15 older people. Some people were living with dementia and other people had a learning disability. The service can support up to 20 people.

People’s experience of using this service

People could not be assured their choices about their care would be acted on as records were not always accurate.

Quality assurance processes were not always effective in identifying shortfalls in the service. People’s views were not at the centre of looking at ways to improve the service. There had been limited consultation with people about their wishes at the end of their lives.

Although people had been supported appropriately when incidents had taken place, the Care Quality Commission (CQC) had not been notified of all important events, in line with legislation. This is necessary so CQC can be assured that when significant things happen, people's health, safety and welfare is maintained.

We have made a recommendation about the management of some medicines. This was because medicines guidance for administering some medicines was not always followed.

People and their relatives said staff helped them to feel safe. However, there were occasions when people had not felt safe. This was because some people displayed behaviours that challenged themselves and others, including physical aggression.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. Staff faced challenges in making sure people's support focused on them having as many opportunities as possible to gain new skills and become more independent. This was because the supported people with a learning disability and older people. These two groups had different and complex needs which the service did not always find easy to balance.

Staff training was in progress to help ensure they had the necessary skills and knowledge to meet people’s individual needs. Regular agency staff were employed to fill shortfalls in staffing levels. Staffing levels were reduced at the weekend but people and relatives said this did not have a significant impact on them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had access to health care services and staff worked with a range of health care professionals. People were supported to eat and drink enough to maintain their health.

Caring relationships had developed between people and staff. Staff showed patience and understanding when supporting people with their care. There was a structured programme of activities including sensory stimulation, giving people opportunities to get involved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was Requires Improvement (published 5 February 2019). At this inspection not enough improvement had been made and the provider was in breach of two regulations. This service has been rated Requires Improvement or Inadequate for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Enforcement

We have identified breaches in relation to record keeping and informing CQC of significant events. at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Copperfield’s residential home is ‘care home.' People in care home services receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation was provided over three floors. A lift was available to take people between floors. Residential accommodation and personal care were provided for up to 20 older people. There were 14 people living in the service when we inspected. Some people had memory loss or health issues associated with ageing or were living with dementia. There were four people with a learning disability.

We carried out our last comprehensive inspection of this service on 21 March 2018 and we gave the service an overall rating of ‘Requires Improvement.’ After this inspection we received information of concern relating to the safe management of medicines, the management of people’s finances, moving and handling practice, safeguarding employment checks on new staff and the management of incidents and accidents. Therefore, on 17 May 2018 we carried out a focused inspection. At that inspection we inspected the Safe and Well Led domains. After the focused inspection the Safe and Well Led domains were rated ‘Inadequate’. This changed the overall rating for the service to ‘Inadequate’. We asked the provider to tell us what actions they would take with time scales to meet the Regulations.

At our last comprehensive inspection of this service on 21 March 2018 we found three breaches of the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to Regulation 12, safe care and treatment - known risks were not always assessed and minimised. Regulation 17, good governance - quality monitoring systems were not fully effective. Regulation 18, Staffing - the provider had not ensured that staff had completed or had regular training to be effective in their role. At our focused inspection of this service on 17 May 2018 we found two breaches of the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014. The first breach related to Regulation 12, safe care and treatment - there was a failure to manage medicines and infection control risks safely. The second continued breach related to Regulation 17, good governance - the provider's audit systems were not operated effectively to assess and monitor the quality and safety of the service provided.

The provider sent us an improvement action plan telling us how they intended to meet the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014. They told us they would meet the regulations by 30 November 2018.

The service had been in breach of Regulations and rated as Inadequate or Requires Improvement for three inspections since 31 January 2017. At this comprehensive inspection we found improvements had been made. The provider was now meeting Regulations 12 and 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. However, the improvements we found had not fully bedded in at the time of this inspection to demonstrate to us that the provider and registered manager could sustain the improvements they had been making. Therefore, the overall service rating has moved from ‘Inadequate’ to ‘Requires Improvement.’

In November 2018, the provider and the registered manager had started to use a computerised quality audit management system. The provider and registered manager implemented plans to improve the service.

Since our last comprehensive and focused inspections, the registered manager and provider had worked with a consultant who specialised in mentoring social care services to improve their management oversight, auditing the risks systems.

Since our last inspection the providers policies had been replaced and updated. The policies included equality and human rights.

The procedure in place for the safe administration of medicines was now effective and followed published guidance. Staff followed these policies and had been trained to administer medicines. Medicines administration was now audited by the registered manager.

There was a registered manager employed at the service. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager and the registered provider both worked at the service.

There were four people living at the service who had a learning disability. Because of this we considered whether the care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. We found that the service was meeting people’s learning disability needs and people told us they were happy at the service. Although the service had not been originally set up and designed under the Registering the Right Support guidance, they had developed their practice to meet this guidance and used other best practice to support people. They had applied the values under Registering the Right Support. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The registered manager was aware of the Accessible Information Standard (AIS) and its requirements and made information available to people in different formats.

Staff consistently demonstrated they shared the provider's vision and values when delivering care. People were supported to maintain friendships and contacts with those they chose. Activities were planned to assist people to their purpose and pleasure in life.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s needs were assessed and their needs were recorded. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans.

People’s right to lead a fulfilling life and to a dignified death was understood and respected at all levels. People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face, by using feedback forums or by responding to formal provider quality surveys.

There continued to be enough staff on duty to meet people’s physical and social needs. The registered manager checked staffs' suitability to deliver personal care during the recruitment process.

Staff received training and supervision and continued to be that matched to people’s needs effectively.

We observed that staff were friendly and caring. There were appropriate systems in place to enable propel to make complaints. Incidents and accidents were reported and appropriately investigated.

People were supported to eat and drink according to their needs, staff supported people to maintain a balanced diet.

The premises and equipment were regularly maintained and checked to minimise risks. The service was clean and odour free. Staff followed the provider's infection control policy. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns by the registered manager. Emergency response contingency plans were in place.

The registered manager had sent statutory notifications to CQC when required. The CQC rating from our last inspection had been displayed.

Copperfield’s residential home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care and support for up to 20 people. There were 15 people using the service at the time of our inspection, who were living with a range of health and support needs. These included diabetes and dementia. Some people had mobility difficulties, sensory impairments and one person received their care in bed. The accommodation was provided over three floors. A lift was available to take people between floors.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider and the registered manager assisted us during the inspection.

At the last comprehensive inspection on 21 March 2018, the service was rated requires improvement overall. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Copperfield’s residential home on our website at www.cqc.org.uk.

We undertook this focused inspection because we received allegations of concern about the service made by former staff. The allegations of concern related to the safe management of medicines, the management of people’s finances, moving and handling practice, safeguarding checks on new staff and the management of incidents and accidents. We checked to see if the service was Safe and Well led. This report only covers our findings in relation to those requirements.

At the time of this inspection, to safeguard people we were working in liaison with other agencies. The local authority had visited the service to check on people’s safety and care. The police had been investigating some of the allegations about the management of people’s finances. The police had also carried out an investigation into possible links between a fall a person had in the service and their subsequent death. We also used our powers under Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to look at this during this inspection.

At this inspection we found people were not at serious risk of harm. The registered manager and provider were still in the process of reviewing and acting upon the findings from our comprehensive inspection on 21 March 2018. At this focused inspection we could not corroborate all of the allegations we had received. However, we found medicines were not managed to minimise the risks of harm. Medicines were not audited by the registered manager or provider to check if people had received their medicines as prescribed. When people’s medicines had been changed, the changes were not appropriately recorded on medicine administration records (MAR’s). Medicine counts could not be audited back to the prescription amounts.

There was a lack of organisational oversight into auditing medicines.

Risks assessments had been updated and were in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. However, the information recorded for staff to follow in people’s risks assessments did not always match other information in peoples care plans. We could not be sure that people were not at risk of potential harm from staff using incorrect methods of care. Also, not all risks were mitigated by actions to reduce risks.

The premises and equipment in the service was clean, odour free and maintained to protect people from infection. Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and carried personal protective equipment like disposable gloves and apron’s.

However, at the time of the inspection seven small dogs were on site. We observed that the dogs had access to the patio areas of the garden used by people living in the service, which may present an infection risks if the patio was not regularly cleaned and washed down.

Safety systems in the service, like fire alarms were serviced by an engineer and tested to maintain people’s safety. General risks within the service had been assessed and maintenance issues were reported and dealt with in a planned and timely manner.

Recruitment policies were in place. Safe recruitment practices had been followed. The management employed enough staff to meet people’s assessed needs. Staffing levels were kept under review as people’s needs changed.

Staff were deployed in sufficient numbers to meet the needs of the 15 people currently living at Copperfield’s. People’s care was delivered safely and staff understood their responsibilities to protect people who were frail from potential abuse. Staff had received training about protecting people from abuse. The management team had access to, understood the safeguarding policies of the local authority, and when needed followed the safeguarding processes.

Incidents and accidents were recorded and checked by the management team to see what steps could be taken to prevent incidents happening again.

The provider had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. There was an up to date procedure covering the actions to be taken in emergency situations.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Copperfield’s residential home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care and support for up to 20 people. There were 15 people using the service at the time of our inspection, who were living with a range of health and support needs. These included diabetes and dementia. Some people had mobility difficulties, sensory impairments and one person received their care in bed. The accommodation was provided over three floors. A lift was available to take people between floors.

At our last inspection on 31 January 2017, the service was rated ‘Good’ in the Effective, Caring and Responsive domains and ‘Requires improvement’ in the Safe and Well Led domains. The overall judgement rating for the service was ‘Requires Improvement’ and we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 12 Safe care and treatment. This was because we found that the risks from fire were not adequately mitigated by the procedures and control measures in place within the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question, safe, to at least good. We received an action plan dated 14 April 2017, which stated that the provider has met the regulation on 13 April 2017. At this inspection we found improvement had been made to this area. However, we identified other issues which needed to be addressed to protect people's health, safety and well-being.

At this inspection, we found the service remained ‘Requires Improvement’.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People's safety had been taken into account regarding fire safety. The service had been inspected by the Fire services and there was a fire risk assessment carried out. Fire fighting equipment was in place and regularly maintained.

There were no assessments about choking for people who were known to be at risk, and no guidance for staff about actions to take in the event of a choking incident. Assessments about other types of risk however, were detailed and offered staff advice about reducing the likelihood of them happening.

Recruitment procedures were not always followed in line with the provider's policy. This meant effective checks were not completed before new staff began their employment.

People were not always supported by staff who had consistently received the necessary training to fulfil the role of the work they were employed to do.

Quality assurance processes had not picked up and addressed the issues we found during this inspection. The shortfalls identified during the inspection were not known to the registered provider as they had not identified them as part of their own monitoring systems.

Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

People told us they received their medicines as prescribed and staff ensured that medicines were recorded as given at the time of administration.

There were enough staff to keep people safe. The registered manager had appropriate arrangements in place to ensure there were always enough staff on shift.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people to maintain good health and access healthcare services when they needed to. They understood people's healthcare needs and knew when to refer them for specialist support. Relatives said staff kept them informed about their family members' health.

Staff displayed compassion and kindness, and were empathetic if people became anxious or distressed. They took the time to sit with people and chat to them about the things that were important to them such as their families and the things they liked to do.

People received care that was responsive to their needs. Staff worked in a flexible way in response to people's needs.

The registered manager carried out assessments prior to people coming to live at the service. Relatives and external professionals were involved so that important information was not missed.

Care plans were person-centred and identified people's abilities and preferences.

People told us that the food was good, they had a choice, and there was enough food available for them. Menus were based on healthy eating choices and people's dietary needs and preferences.

Mealtimes were relaxed and staff socialised with people while assisting them with their meals. Staff encouraged people to drink and remain hydrated.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain

relationships with people that mattered to them.

People told us that if they had any complaints they would tell one of the staff or the manager. The service's complaints procedure was displayed and people were also given a copy of this.

Relatives and visitors were welcomed at the service and were complimentary about the care their family member's received.

People and relatives told us the service was well led and the staff provided good quality care. Staff told us morale and communication was good, and teamwork effective. The atmosphere at the service was positive.

We found breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The home provides accommodation and personal care for older people, some of whom may be living with dementia. People’s needs varied, but people had predominantly low to medium needs. Only one person required the use of a hoist due to their physical mobility needs. The accommodation was provided over two floors. A lift was available to take people between floors. There were 14 people living in the service when we inspected.

At the previous inspection on 15 December 2015, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in relation to people’s care not always taking account of the recommendations made by health and social care professionals. The provider sent us an action plan telling us what steps they would be taking to remedy the breaches in Regulations we had identified. At this inspection we checked they had implemented the changes and we found improvements.

There had not been a registered manager employed at this home since 25 August 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had appointed a manager who had been in post since July 2016, but they had not registered with CQC at this inspection. Not registering a manager with CQC limited the providers rating or this home to requires improvement. We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after an application had been made to the appropriate supervisory body as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made.

People’s care was delivered safely and staff understood their responsibilities to protect people living with dementia from potential abuse. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The premises and equipment in the home was clean, odour free and maintained to protect people. Safety systems in the home, like fire alarms, were serviced by an engineer and tested to ensure people’s safety. Risk within the home had been assessed and maintenance issues were reported and dealt with in a planned and timely manner. However, the fire procedure in place advocated a ‘stay put’ policy. Staff were aware of the procedure, but did not know how to use the evacuation chair that had been placed on the first floor. Also, the most recent fire risk assessment completed by a qualified consultancy company did not identify any additional protections needed for people who may not be able to evacuate the premises quickly. We have referred this to the fire service.

The manager involved people in planning their care by assessing their needs prior to and after they moved into the service. People were asked if they were happy with the care they received on a regular basis.

The structure of the staff team had changed since our last inspection. Care staff were now supported by other staff who did the cleaning and laundry. There was a new cook and most of the care staff team had been recruited since our last inspection. When new staff started working at the home, they received a five day induction and followed a recognised pathway of basic training to gain the skills required to meet people’s needs. We observed that staff knew people well, staff displayed a kind and caring attitude and people had been asked about who they were and about their life experiences. This helped staff deliver care to people as individuals.

There were policies and a procedure in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs, community nurses and they accessed opticians, dentists and foot care professionals. People’s health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

We observed staff were welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. Staff were trained and understood the importance of respecting people’s privacy and dignity.

Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. The risks in the home were assessed and the steps to be taken to minimise them were understood by staff.

Managers ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. There was an up to date procedure covering the actions to be taken in emergency situations.

Recruitment policies were in place. Safe recruitment practices had been followed, before staff started working at the service. The manager ensured that they employed enough staff to meet people’s assessed needs. Staffing levels were kept under review as people’s needs changed.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink.

If people complained, they were listened to and the manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

The provider and the manager consistently monitored the quality of the service and made changes to improve the service, taking account of people’s needs and views. The manager of the home had provided leadership to new staff, they had undertaken training for their role. The provider and manager developed plans to improve the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection we found that documents were now up to date, they were being completed accurately and contained more detail. In respect of people's individual care and support we found that people's care was provided as agreed and reviewed at least monthly. Records showed that any health issues were followed up with health professionals and their recommendations were followed by staff.

This meant that people's personal records were now accurate, fit for purpose and any risk regarding poor record keeping had been reduced.

At the last inspection on the 17 April 2013 we looked at a variety of records which included care plans, daily records, medication charts, staff records, and policies and procedures. We saw that records were not always kept up to date, or completed in enough detail. This meant peoples care and support could be compromised.

The provider sent us an action plan in response to our visit, within the agreed timescale. This set out how the provider would ensure on-going compliance and the timescales for completion.

During this inspection we found that not all the plans of care had been dated or signed by staff and the person who used the service to show they had been agreed with. We also saw risk assessments that had been undertaken but the management strategy to minimise the risk was not documented. Some risk assessments were not available on file, for example we saw no detailed mobility and skin integrity risk assessments and no management strategy for one person who was prone to pressure sores. This meant that both people who lived in the home, and staff could have been put at risk of harm.

We found that the daily records contained information such as people's personal hygiene care, their general health. However, the details within the daily reports were not consistent. For example, we saw some staff recorded if one person sat in her chair in the afternoon as had been requested by the district nurse while others didn't. There was no reason given why the person had not sat out in the chair if that was the case. Often there was little detail recorded so it was difficult to see if the support given by care workers cross referenced with the care plans. This meant people may not have received the care that had been agreed with them or requested by health professionals.

We saw fluid charts for one person, which had not all been completed fully. for example with the person's name and date. The amount recorded had not been added up daily and it was not clear if staff recorded all the fluids the person had drunk. On one sheet it showed the person drank only 100mls, another day it added up to 700mls. We also noted that the amount recorded were 100 or 200mls in most cases, we queried if this was the amount given rather than the amount drunk. The amount showed that the person was not drinking sufficient fluid to stay hydrated. No action had been taken or recorded to show this had been addressed. The lack of accurate records meant that people could become dehydrated.

We saw that policies and procedures were available, these had been reviewed in January to ensure they remained up to date and in line with any new regulations or guidance changes.

We found that the home had a relaxed and friendly atmosphere, and people said that they liked living there. People said they were comfortable living at Copperfield. They told us they had been involved in discussions about the help they needed and their preferred day to day routines. They said that the staff supported them as needed and looked after them well.

We found that the home had reliable staff recruitment processes in place.

People said that the home was always kept clean and smelled fresh.

People said they knew who to speak to should they have any concerns, but said that they had no complaints.

Comments from people that used the service included 'I can get up and go to bed when I want', 'The staff are very good, they are always there to help and I have meals in my room when I don't feel like going down stairs'

We found that not all the records kept by the home were signed and dated and some information could have been more detailed. Peoples' personal information was kept securely.