Coppermill Care Centre

Coppermill Care Centre is a care home providing personal care over two floors to up to 52 people. The service provides support to older people, some of whom were living with the experience of dementia. At the time of our inspection there were 46 people using the service.

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

People were protected from the risk of avoidable harm. The risks to people's safety and wellbeing had been identified, assessed and managed. Accidents and incidents were investigated and information about these was shared with the local authority.

Feedback indicated people using the service were happy with the care they received. We saw the staff spent time with people, listened to them and met their needs. Relatives we spoke with told us people were well cared for and thought the staff and management team were good.

People who used the service received their medicines safely and as prescribed. Safety checks were undertaken regularly including fire safety and environment checks.

There were robust procedures for preventing and controlling infection, and the staff followed these.

There were procedures to help make sure staff employed were suitable and had the skills and knowledge they needed. These included recruitment checks, regular training and supervision. The staff told us they were happy working at the service.

The manager was suitably qualified and experienced. They worked well with staff to ensure people’s needs were met in a person-centred way. There were appropriate systems for reviewing people's health and working with relevant health and social care professionals.

People were supported to undertake activities of their choice and told us they enjoyed these. There was an activity plan displayed which reflected the activities undertaken. The staff engaged well with people to find out what they wanted to do.

The provider had effective monitoring systems in place, and ensured they took prompt action when any concerns were identified. Stakeholders told us communication was good and they were happy with the service overall.

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.

Rating at last inspection

The last rating for this service was good (published 20 July 2022).

Why we inspected

We received information in relation to an increase in safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Coppermill Care Centre is a care home for up to 52 older people. At the time of our inspection 38 people were living at the service, some of whom were living with the experience of dementia.

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

People were protected from the risk of avoidable harm. The risks to people's safety and wellbeing had been identified, assessed or managed. The provider had appropriate systems for investigating allegations of abuse, complaints and concerns.

People who used the service received their medicines safely and as prescribed. Safety checks were undertaken regularly, including fire safety and environment checks.

There were suitable systems in place to protect people from the risk on infection and cross contamination. The staff were aware of these and the systems had been reviewed and updated appropriately.

There were appropriate procedures to help make sure staff were suitable and had the skills and knowledge they needed to support people. These included recruitment checks, regular training and supervision. The staff told us they were happy working at the service.

People received personalised care that reflected their needs and preferences. People were supported to maintain good health and had their nutritional needs met.

The provider's systems for monitoring and improving quality were operated effectively and there were systems in place to mitigate identified risks. The provider had processes for learning when things went wrong.

There was a positive culture at the service and people told us the staff treated them respectfully. This had improved since our last inspection.

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.

Since the last inspection, the registered manager had left the service, and the provider was in the process of recruiting to this position. However, there had been improvements in all areas and further improvements were planned. Feedback from professionals, staff and relatives about the service was positive.

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 (published14 October 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook the inspection to see if the provider had made improvements since the last inspection, and to find out how well the provider was meeting the key question not inspected at our last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Coppermill Care Centre is a care home for up to 52 older people. At the time of our inspection 31 people were living at the service. Some people were living with the experience of dementia.

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

There was an increased risk to people's safety and wellbeing because medicines were not always managed in a safe way and infection control procedures were not always followed.

People did not receive personalised care which reflected their needs and preferences at all times.

Not all areas of risk had been identified or mitigated. This meant the provider's systems for monitoring and improving quality were not always operated effectively. The provider did not always have processes for learning when things went wrong.

Whilst we received feedback about a positive atmosphere at the service which had improved under the new registered manager, there were still incidents where staff treated people disrespectfully and there had not been learning from these incidents. The provider had not taken enough steps to promote a culture which was inclusive and respectful towards people's protected characteristics. This was an area the registered manager agreed to work on improving.

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. However, conditions placed on the provider as part of Deprivation of Liberty Safeguards had not always been met.

There had been improvements at the service which included the way care was planned and how this information was recorded. People's healthcare and nutritional needs were being met.

The staff had been recruited in a safe way and had access to a range of training.

The provider had appropriate systems for dealing with and investigating allegations of abuse, complaints and concerns.

Since the last inspection, a new registered manager had started working at the service. They had made improvements in all areas and had plans for further improvements. Feedback from professionals, staff and relatives about the registered manager was positive.

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 rating at the last inspection (published 29 January 2020) was inadequate and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made. However, we identified further improvements were needed in respect of personalised care, managing risks and governance.

This service has been in Special Measures since 28 January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to follow up on action we took at the last inspection.

This report only covers our findings in relation to the key questions, is the service safe, effective, responsive and well-led?

At this inspection, the overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to person-centre care, safe care and treatment and good governance.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Coppermill Care Centre is a residential care home providing personal care for up to 52 people aged 65 and over. At the time of the inspection 49 people were living at the service. The home has three floors, with the first-floor accommodating people living with dementia.

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

The service was not always managed in a safe way. People were at risk of harm as some staff had not completed adequate training including fire training which meant they did not know how to support people in the event of a fire. People’s medicines were not administered or managed correctly. Some risks to people had not been identified or addressed.

The provider carried out pre-admission assessments, but they were not comprehensive and lacked important information on people’s physical and social needs, therefore the provider did not have all the necessary information to make informed decisions about people’s admissions to the home.

The provider failed to ensure people’s nutritional needs were always been met. People were not always offered healthy snacks, but the home did provide people with nutritional and well-balanced meals. Staff did not consistently support people to have choice and control at meal times. People were not always supported to eat in a caring or considerate way.

Some people’s care plans were inaccurate and lacked information about people’s needs, medical conditions and other information which meant staff were not provided with clear guidance to help care for people.

Staff recruitment was not always safe. Staff training had not always been completed. The provider failed to evidence how staffing numbers were decided as the service was not completing dependency assessments to determine staffing levels to ensure there was enough staff to meet the needs of the people.

People and their relatives told us staff were kind although our findings did not suggest a consistently caring service or a service that was always respectful of people and their needs.

People's end of life wishes were not always documented appropriately. This meant in event of a death staff, would not always be aware of people's preferences. The provider did not have effective processes in place to handle complaints.

Many of the people living at the home were living with dementia but the environment was not dementia friendly which meant the environment was not always meeting the needs of the people living there. People, did not always receive respectful or dignified care. There was a lack of person-centred practices to ensure people's needs were met. People's care records did not have up to date information to guide them about how best to support people.

Staff had not received up to date training which meant they did not always have the appropriate knowledge and skills to meet people's needs.

Quality assurance processes were ineffective. There were no effective auditing systems in place since the manager left and the nominated individual did not always have good oversight of the day to day running of the service. There was a risk people might receive inappropriate care.

We observed some occasions when people were not cared for in a dignified way. People and their relatives told us staff were kind although our findings did not suggest a consistently caring service or a service that was always respectful of people and their needs. However, we observed some positive interactions between staff and people during the daily activity sessions.

The nominated individual was not able to provide evidence of safeguarding incidents having been fully documented. We recommended the provider seek and implement national guidance in relation to safeguarding adults and record information accurately. People had access to external health care professionals when they were unwell.

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

The last rating for this service was good (report published 29 June 2017)

Why we inspected

This was a planned inspection based on the date of registration.

Enforcement

We have identified breaches of regulations in relation to person centred care, safe care and treatment, staff recruitment, staff support, dignity and respect, meeting people's nutritional needs, complaints and good governance. 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration,

we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of

inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as

inadequate for any of the five key questions it will no longer be in special measures.

The last inspection took place 9 and 10 April 2015.

Coppermill Care Centre provides accommodation for up to 52 older people. The service supports people with a range of needs including supporting older people living with dementia. There were 50 people using the service at the time of this inspection.

The registered provider also owned two other care services.

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.

The registered manager had been in post for approximately two months and was in the process of assessing what areas worked well and if there were parts of the service that could be improved for the benefit of people using the service.

Feedback from people using the service, relatives, staff we spoke with and professionals was positive about the service.

People’s care records included people's needs and preferences, although some of the information was generic and would benefit from being reviewed and amended to include more person centred details on how to support a person.

We made a recommendation for the provider to seek national guidance on writing person centred care plans and information relevant to the person.

Staff continued to receive support through one to one and group meetings. Although we saw no evidence that an annual appraisal had taken place in 2016, staff confirmed they had received an appraisal of their work. Training on various topics and refresher training had been arranged that were relevant to staff member's roles and responsibilities.

We saw information about people’s needs had been reviewed on a regular basis.

People had access to the health care services they needed and their nutritional needs were being met.

People received the medicines they needed safely and the registered manager had introduced a daily record for staff to record that they had counted and checked people’s medicines and associated records.

There were checks and systems in place to check the fire procedures and that equipment protected people in the event of a fire.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. There had been no safeguarding incidents since the last inspection.

There were checks on a range of areas in the service to ensure people received good care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

There was a complaints procedure available and people or their relatives felt able to raise any complaints with the registered manager.

We met with the director, the head senior and four members of staff. We also spoke with seven people who use the service and two relatives. We found improvements at this inspection visit. We viewed eight care records and they contained an assessment for the individual and where possible had been completed prior to their admission to ensure the service was able to meet their needs. The provider had introduced a new care plan format and we found these care plans contained more detailed information about people's individual needs including their likes, dislikes and preferences. The care plans also promoted people's independence by detailing what people were able to do for themselves so that staff encouraged people to maintain these skills. Care records had been reviewed each month and where possible people or their representatives had signed to agree their contents.

We saw that identified risks were assessed and action taken to minimise these. For example, we saw risk assessments relating to falls, nutrition, behaviour, wheelchair use, non-compliance with medication and the risk of developing pressure ulcers.

Feedback from people using the service was positive and we observed positive interactions between staff and people using the service. The two relatives were also happy with the service and told us, 'they [staff] are very caring, well-meaning and helpful.' Another relative told us, 'I am very satisfied.'

We spoke with nine members of staff, 10 people who were using the service and six relatives who were visiting the home. We were unable to speak with many of the people using the service as they had complex needs that meant they were unable to share their experiences with us. However, we observed care practices, reviewed records and spoke with family members in order to gain some insight into their experiences of living at the home.

We found that people using the service and their relatives were asked for their views about the service. One person said, "I made suggestions to the food committee" and another said "If I don't like something I tell the manager and he does something"

People told us about the activities they participated in. One person said, "I do bingo, we spend time in the garden and do singing activities." Another person told us, "four of us went out to the bunny park."

People spoke positively about the food provided at the home. One person said, "the food is excellent" and we received other comments such as "they give you a choice of food" and "some of it is marvellous."

Staff were able to demonstrate that they would take appropriate action if they had concerns about a person's safety and the people we spoke with told us they felt safe. One person said, "I feel safe here, it is a smashing place, they are kind."

We found that the home had effective systems in place for managing medicines and infection control.

Staff received training and support to enable them to care for people and there were quality monitoring systems in place to ensure the home was operating effectively.

We found that care plans did not sufficiently inform staff about the action they should take to meet people's needs. In addition to this they were not person centred and therefore were not individual to the person.

We found that there was inadequate monitoring of people's physical condition and any injuries people sustained. Appropriate records were not maintained and people's care plans were not updated to reflect their changing needs.

Although staffing levels were sufficient to meet people's needs, we found that people were not supported to engage in meaningful activities during the weekend.