Archived: Copperfield House

This unannounced inspection took place on 18 September 2018.

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

We last inspected this service in February 2018 where we found continued breaches of regulation relating to good governance and infection control. We also identified a breach of regulation in relation to the Mental Capacity Act 2005 (MCA). We found at this inspection the registered manager had worked hard to make significant improvements to the service and has such had met the breaches of regulation.

People’s medicines were managed in a safe way. Risks to people had been considered and information to respond to these risks was in place. There was oversight of accidents and incidents and information relating to these was held appropriately. Staff were aware of their responsibility in relation to safeguarding people from abuse.

People’s needs were assessed before they moved into Copperfield House, however there was a lack of background information on people. We have made a recommendation to the registered provider in this respect. Staff had a good understanding of the MCA and there were no restrictions within the home. Improvements to the paperwork used in relation to capacity assessments had been made, but we have made a recommendation to the registered provider that they should ensure that capacity assessments are decision-specific.

Staff received the training and supervision they should expect and staff went through a recruitment process before commencing work at the home. However, we have recommended the registered provider ensures they are following robust processes when recruiting. Systems were in place to audit and quality assure the care that was being provided. The registered manager had a commitment to improving the service and told us they had learnt from the last inspection and their lack of improvement at that time. The registered manager worked with external agencies and gave people, relatives and staff the opportunity to give their views of the service.

People told us they were cared for by staff who were kind and caring, showed them respect and allowed them to make their own choices. Where people wished to participate in activities outside of their home, staff supported them to do this. Activities within the home suited people and they told us they could participate in them if they wished or spend time participating in their own hobbies if they preferred. When people needed healthcare treatment this was arranged for them by staff.

People told us they liked the food that was provided to them and they were happy with the service they received. They said they were cared for by a sufficient number of staff and we did not see people having to wait for attention. People’s care plans covered all aspects of their care needs and staff knew people’s needs well. No one was receiving end of life care, but the registered manager was working with the local hospice to upskill staff in this aspect.

People were cared for by staff who understood the need to carry out good cleaning processes and staff helped to ensure people were kept safe from harm as health and safety and fire system checks were in place. People knew how to make a complaint but told us they had never felt the need. We read people had complimented staff on the care they received from them.

During our inspection we made three recommendations to the registered provider.

There was a registered manager in post and present on the day of the inspection. 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 did not have robust systems in place for the prevention and control of the spread of infections. Identified parts of the home required cleaning and bath hoists and toilet seats required replacing. The Enviromental Health office had visited the home in February 2018 and downgraded the home from a 5 to a 1 star rating. The kitchen required cleaning, work surfaces required repair or replacing and attention was required in regard to the safe storage of food. The provider had partly complied with findings of the EHO, but further work was needed and an extension to the time was allowed by the EHO.

The provider had not followed the legal requirements of the Mental Capacity Act in relation consent for people. Although some Deprivation of Liberty Safeguards had been applied for, some had not. There was no evidence to show that the provider had undertaken best interest meetings or applied for a DoLS for those who require intervention to keep them safe. Peope told us that staff sought their consent prior to undertaking activities or care with them.

The provider continued to fail to assess, monitor and improve the quality and safety of the service and records about people’s care and treatment were not accurate. When we inspected Copperfield House in April 2017 we had found concerns with the quality audit process. At this visit we found the provider had not taken enough timely action to correct the issues. There was no recorded evidence of how the home was being audited or monitored by the provider.

Risks to individual people had been identified, however risk assessments required reviewing to ensure that all the required information was clearly recorded with guidance for staff on the actions to take to minimise all identified risks.

People were supported to keep safe by staff who had an understanding of the procedures to follow if they witnessed or suspected abuse had taken place. Staff had received training and were able to describe the external agencies to contact should the need arise. Safe recruitment practices were adhered to to help ensure that only suitable people were employed to work at the home. People’s medicines were administered, recorded and safely stored. Accidents and incidents were recorded but there was no analysis of these that would help to prevent a reoccurrence.

People were supported by staff that had received training, supervisions (one to one meetings) with their line manager. Staff told us that they had regular supervision where they were able to discuss their roles and the people who lived at the home and this was confirmed when looking at the staff records. People were provided with a choice of home cooked meals and alternatives meals were also available. The environment was suitable to the needs of people who had mobility difficulties and dementia.

People’s privacy, dignity and independence were promoted by staff. People told us that staff respected them as people and they respected their privacy and dignity.

Staff responded well to people’s needs or changing needs and care plans were written and reviewed with people and their relatives, although as we have reported these were not always accurate. People had opportunities to take part in a variety of activities that interested them. Information about how to make a complaint was available for people, their relatives and visitors.

People had opportunities to give their views about the service through meetings and surveys.

Staff felt supported by the manager. The provider was aware of their responsibilities in regard to sending Notifications about significant events to the Care Quality Commission.

The provider was in breach of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured that care and treatment was provided with the appropriate consent in line with legal requirements of the mental Capacity Act 2005, had continued had failed to ensure that systems for the prevention of the spread of infections were robust . The provider had also continued to fail to assess, monitor and improve the quality and safety of the service and records about people’s care and treatment were not accurate. You see what action we told the provider to take at the back of the full version of the report.

A registered manager was 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.

Copperfield House is registered to provide the regulated activity of Accommodation for persons who require nursing or personal care to a maximum of 16 people. Some of the people who lived at the service needed care and support due to dementia sensory and /or physical disabilities.

We last inspected Copperfield House on the 7 September 2016 where we identified concerns with the call bell system, the premises and staff recruitment processes. The provider sent us an action plan telling us what they were going to do to put things right. At this inspection we found actions had been taken to ensure the regulations had been met and the home had improved in regards to these. The provider had applied for and received basic disclosure checks for all staff employed at the service, but not for the enhanced checks. Since our inspection the provider has forwarded evidence that applications for enhanced checks had been submitted. Each bedroom had a working call bell that could be used to summon staff. The work in relation to the premises was in progress. The provider told us in their action plan that this work would be completed by the end of June 2017.

People were at risk because the arrangements in place to prevent and control the spread of infection were not being followed despite staff having received training. Medicines were suitably administered but not all recordings of medicines were accurate. Staff had not received an annual appraisal of their roles that would provide the opportunity to implement any improvements, if required, to ensure people received safe and effective care.

People did not always experience person centred care. There was a lack of meaningful activities for people to take part in. People told us that activities did not always take place and they mainly watched the television or did their own things. Not all people’s care records included all the information staff would need to ensure that their assessed needs were met. Not all people’s dietary needs were known by staff where their medicines may be affected by certain foods. We have made a recommendation about this.

The provider did not have effective systems in place to assess, monitor and improve the quality and safety of the service, such as regular audits.

People and their relatives told us they felt the home was safe. They told us that staff were kind and they had no concerns in relation to not being kept safe. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.

There were enough staff deployed at the home to ensure that people’s assessed needs could be met. It was clear that staff had an understanding about people’s life histories, preferences and how to attend to people’s needs. Staff had received training appropriate to their roles but were not always using this training in practice where it related to infection control.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way. People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people. The registered manager logged any accidents and incidents that occurred but they had not analysed accidents to identify any patterns or trends and take appropriate action.

People were supported by staff to have a choice of different foods. People were able to access external healthcare services when required and professional involvement was sought by staff to help people maintain good health.

People were treated with respect and their privacy and dignity was promoted by staff. Individual staff were very kind and caring towards people. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. Relatives and visitors were welcomed and there were no restrictions of times of visits.

A complaints procedure was available for any concerns. This was displayed at the service. No complaints had been received by the service since our last inspection.

The provider had commenced the process to ascertain the views of people, relatives and associated professionals about the care provided and how the home was run.

During this inspection we found the provider was in breach of four Regulations of the Health and Social Care Act 2018 (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.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We inspected Copperfield House on 7 September 2016. The inspection was unannounced. The service was last inspected in June 2014 when it was found to be not meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “(I am) perfectly safe.” An external professional told us “I believe people are in capable hands.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Most staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to an acceptable standard although there were some gaps highlighted in the analysis of training we completed. Staff received updates about important skills such as moving and handling, fire safety, infection control and first aid. Staff also received training about the needs of people with dementia.

Recruitment processes were not satisfactory. There was an application form, and written references. Most staff had an enhanced Disclosure and Barring Service check, but this was not completed by the service provider, but by previous employers. There was not a disclosure and barring service check on two staff files. This meant the registered provider could not assure us that all staff were suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals. However records of when people had last seen a dentist and optician were variable. The registered manager said he would look into this, as the dentist did see people regularly.

There were enough staff on duty and people said they received timely support from staff when it was needed. However there were not call bell’s in each person’s bedrooms. This meant people did not always have a suitable way of alerting staff if they needed support for example in an emergency. We did however observe staff being attentive to people’s needs.

The building was satisfactory to meet people’s needs, for example there were suitable adaptations for people with physical disabilities such as a passenger lift and hoists to assist people in and out of the bath. However, decorations in some areas of the home needed improvement as they had become shabby and looked neglected.

The service had some activities available which were either organised by staff, or through an external entertainer. However some people did say there was little to do and they would like more activities.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were very happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included “Lovely, very nice” and “Pretty good.” People said they were offered an alternative meal if they did not want what was on the menu. People said they received enough support when they needed help with eating or drinking.

Staff were seen as kind and caring. “(Staff are) very kind,” “The people here are nice,” and “They look after me very well.” One relative said “(My relative) is treated at all times by kind, attentive and skilled staff who ensure (their) needs are met and nothing is ever too much trouble.”

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. We were told management were “Okay, very nice” and “Spot on.” There were satisfactory systems in place to monitor the quality of the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them, and from looking at records.

For further evidence supporting our summary please read the full report.

Is the service safe?

We saw that people who used the service were treated with respect and in a dignified way by staff. We saw that safeguarding procedures were in place and staff understood their responsibility the people that they cared for.

The service was clean, hygienic and safe from hazards.

We looked at staff training arrangements that were in place and saw that staff were provided with appropriate training to ensure safe and appropriate care was provided for the people that used the service.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. This meant that people were protected from the risk of unlawful restraint.

Is the service effective?

People`s needs were reviewed with them and included their families a part of the process. The process and outcomes of the reviews were not recorded in people`s care records and risk assessment were completed. This had a minor impact on people that used the service. This meant that staff did not have access to historical information that supported the care and treatment that people received. This had a minor impact on the manner in which people`s care needs were being met.

Is the service caring?

We saw that people were supported by staff, who spoke to people in a polite and respectful manner. People told us that they were treated with "dignity and respect"

Staff told us about the people that they supported. They knew people`s support needs and told us about their likes and dislikes. Staff took the time to talk and to listen to what people said, and they encouraged people to take part in activities such as playing board games. Family links were maintained and family and friends were encouraged to visit.

Is the service responsive?

We saw that people were encouraged to take part in activities, such as board games or sing a longs, and were given the choice to take part or not. People told us that they were able to go out with their relative as and when they pleased.

Is the service well led?

Staff told us that they were clear about their roles and responsibilities, and that they had a good understanding of the values of the home. Staff were updating people`s daily care records: Staff told us that risk assessments and monthly reviews were held with people and their family members; but none of these reviews had been recorded. Care record seen had not been updated since March 2013 and September 2013. The manager told us that he "was not aware that the care records had not been updated". We found that there were short falls in relation to records maintained at the service.

Our judgement can be seen on the front page of this report.

Relatives of people using the service were very happy and positive about the quality and standard of care of the service. Relatives told us that they know the staff, their relatives are "Well cared for, do special things". Another relative told us "Very kind carers". We spoke to one person using the service who told us that they were "Happy with routine".

During our follow up visit we spoke with staff and reviewed documentation in relation to supporting staff, quality assurance and maintaining accurate records of care.

We saw that there up to date supervision records and that arrangements for recording training had improved.

We noted that the quality assurance arrangements had improved and that care plan records were up to date and subject to regular review.