Copper Beeches

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

People’s needs were assessed prior to them moving to the service and were regularly reviewed each month or sooner if there were changes. This ensured care was based on up-to-date information. People had detailed care plans and risk assessments which reflected their individual needs. For example, care records included comprehensive information on mobility, nutrition, skin integrity and health conditions such as diabetes and Parkinson’s disease. Care plans were personalised and included people’s preferences, such as how they wished to be supported with personal care and transfers. We observed staff followed these plans in practice, for example when supporting people with hoisting, staff explained each step and checked people’s comfort and consent.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider used nationally recognised tools and systems to monitor people’s health and wellbeing. For example, MUST scores (Malnutrition Universal Screening Tool) were used to assess nutrition, and pressure care tools such as Waterlow assessment and repositioning charts were in place to identify people’s individual risks and manage these. Staff also described using equipment such as airflow mattresses and pressure-relieving equipment to manage risks.

People received care in line with clinical guidance. For example, where people were at risk of skin breakdown or choking, care plans included clear instructions and referrals had been made to external professionals such as tissue viability nurses and speech and language therapists. We observed people’s food was prepared to their required modified levels in line with International Dysphagia Diet Standardisation Initiative guidance (IDDSI).

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff described positive teamwork and communication within the service. A staff member said, “We all work well. The carers do a great job and so do the kitchen staff.” Another said, “I honestly think we excel in teamwork, we really gel well.” Systems within the service supported good team working and regular clear communication such as daily handovers and ‘flash meetings’ where information about people’s needs, risks and changes in condition were shared. We observed staff engaged well with these systems to have important discussions about people’s care, to co-ordinate with each other and share feedback. The discussions were two-way and supported each department in the service to take actions to support good outcomes for people.

Staff worked with external professionals such as GPs and speech and language therapists. Referrals were made when people’s health needs changed. A staff member said, “We work very well as our internal teams and with outsiders, we work well with the SaLT (speech and language therapists) as a good example, they listen to us carers.” A health and social care professional told us, “Staff are always friendly…the new clinical nurse manager appears well informed and helpful when [we] have visited the nursing home."

The provider supported people to manage their health and wellbeing to maximise their independence, choice, and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s health needs were met. For example, staff regularly checked and offered people enough fluids to meet their individual fluid targets to maintain adequate hydration. A staff member told us, “Every morning we check jugs of fluid. We have PCS (an electronic care monitoring system) and throughout the day it comes up as part of hourly checks, nurses check the system too. They then instruct us to increase if not enough fluid has been had.”

Kitchen staff were knowledgeable about people’s nutritional needs. They told us how they adjusted people’s food when required, to support their nutrition. For example, kitchen staff reduced sugar in meals for people with diabetes or increased calories in meals for people who had experienced weight loss by fortifying their foods. Records demonstrated people’s needs were being met through their nutrition. For example, people had successfully gained weight following intervention.

Feedback from people and relatives about the food was positive. A relative said, “The food is too nice, and it makes us hungry going home.”

Staff described how they supported people to access health services, including accompanying them to hospital appointments. A staff member said, “For hospital appointments we would get them ready. We go too sometimes, we go with [person’s name].”

Health and social care professionals told us the service worked well with them to manage people’s health needs and most agreed referrals or discussions around treatment took place in a timely manner. A health and social care professional said, “Requests are sent by the care home and give us adequate time to respond. Any urgent enquiries are also usually followed up by telephone.” Another health and social care professional said, “The nurse sent me a referral requesting that I attend to see this patient as a priority, their concern was to prevent [a deterioration in the person’s health]."

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Systems were in place to monitor people’s health such as daily monitoring charts. Daily meetings were used to review people’s outcomes, including nutrition, skin integrity, and clinical risks. Staff described reviewing care regularly and records confirmed this. This supported timely responses to changes in people’s health.

People experienced positive outcomes. Staff and relatives described improvements in individuals’ wellbeing. A staff member stated, “[Person’s name] has improved… [person] is more relaxed now.” Nurses gave examples of taking action to improve skin integrity for people such as wounds and records confirmed positive outcomes in this area.

A health and social care professional gave an example of how the service had worked well with a person to achieve a positive outcome. They told us, “The service works very close with me. There was a patient that would only agree to treatment [under certain circumstances]. The Administrator organised a date with me and [co-ordinated the circumstances]. This was successful and treatment was given."

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff had received training and demonstrated an understanding of consent and mental capacity. A staff member said, “We treat everyone as an individual, we need to work out if they can understand the conversation and we explain everything. We do not assume people do not have capacity and we work with their advocates.” Care records included mental capacity assessments and best interest decisions where required, with involvement from relevant others.

We observed staff seeking consent before providing care, such as asking people if they were ready to move and explaining what they were doing. Relatives confirmed, “Staff always do (ask permission before care is given).”

Staff described how they supported people to make choices in daily care. For example, staff encouraged people to make decisions about food, activities, and personal care. Staff respected people’s preferences and understood people’s right to refuse care.