The inspection took place on 1 and 2 December 2015 and was unannounced.Copper Beeches provides accommodation and nursing care for up to 40 older people, who are living with dementia. The home is situated in the village of Rake in Hampshire.
Copper Beeches did not have a registered manager in post at the time of our inspection. An application for registration was submitted on 2 December 2015. 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.
At the last inspection on 26 August 2014, we asked the provider to take action to make improvements to staffing levels and care and welfare. This action has been completed.
The provider used agency nurses to staff the home. Although checks were carried out prior to agency nurses working in the home, the provider failed to check the practice of nurses. During our inspection an agency nurse administered medicines in an unsafe way. The provider took immediate action to keep people safe.
A range of tools were used to assess and review risks to people such as risk of poor nutrition, skin damage or risk of falls. Risks had been considered appropriately and plans put in place to mitigate those risks.
Staff had completed safeguarding training and were able to explain to us how they protected people from abuse. Staff knew how to report concerns both internally and externally. The safeguarding policy was available for staff to review.
There were enough staff on duty to meet people’s needs. We noted that staff had sufficient time to meet people’s care needs and also their emotional needs with friendly interactions ensuring people felt supported at all levels.
Medicines were stored safely in locked cabinets in the nurses station, the medicines trolley was secured to the wall when not in use. Room and fridge temperatures were checked daily to ensure medicines were stored at the correct temperature. An efficient system of stock ordering was maintained and medicines for disposal were recorded and stored safely.
Recruitment and induction practices for permanent staff were safe. Relevant checks such as identity checks, obtaining appropriate references and Disclosure and Barring Service (DBS) were completed.
Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food hygiene and health and safety. Staff told us they had had an appraisal but had not had recent supervision meetings with their line manager. We were told that supervision meetings with staff had slipped but they were in the process of being reinstated.
People were asked for their consent to receive care and treatment. Some people had a cognitive impairment and were unable to communicate verbally. Where people lacked capacity to make specific decisions, the provider acted in accordance with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People were supported to have sufficient to eat and maintain a balanced diet. Food was prepared in the kitchen of another home on the same site and transferred in food trolleys at mealtimes. The menu included two choices including a vegetarian choice. People with specific dietary requirements such as a gluten free diet, a diabetic diet or a pureed or soft diet were catered for. People who were at risk of malnutrition were identified through risk assessment and appropriate actions taken in terms of referral to GP and dietician, dietary supplements and regular monitoring of people’s weight.
People were supported to maintain good health through access to ongoing health support. A GP surgery was held in the home once a week and access to other health professionals was evident from records.
The home had a pleasant atmosphere and people received care from staff, delivered in a kind and compassionate manner. Staff responded promptly to people requesting assistance and they did so in a patient and attentive way. Some people were unable to communicate verbally and staff were able to anticipate those people’s needs.
People were treated with dignity and respect. Staff described how they spoke to people in a way which they would understand. A member of staff told us they always went straight to the living room when they arrived on duty to say ‘Good morning’ to people.
People were involved in decisions about their care as much as possible. Staff told us they showed people different clothes from their wardrobe so they could choose what to wear. Where people were unable to choose in this manner they listened to families who told them the type of clothing their family member liked to wear.
People were supported to be as independent as possible. Staff described how some people were able to eat unsupported but required constant encouragement and supervision. Staff encouraged people to eat for themselves rather than supporting them to eat which maintained people’s independence.
Care summaries in people’s rooms provided staff with information about repositioning, moving and handling, wound care and consistency of food and fluids. We saw staff deliver care in line with these needs. A handover sheet included key details about people’s care needs, which included diagnosis, medication and diet. This was particularly important for nursing staff who were all agency staff. A handover took place in between each shift so that key information was passed between shifts to ensure consistency of care. There was some inconsistency in care plans but this did not impact on the quality of care delivered.
People were supported to take part in social activities of their choice. Planned Christmas activities included a sing along, Christmas shopping outing, music performed by an outside entertainer, Christmas baking and Christmas films.
The home was responsive to concerns and complaints from people and staff, and provided regular opportunities for people and staff and relatives to provide feedback.
There was a positive and open culture within the home. Staff said they felt able to raise concerns and there was good morale. Staff commented on how the atmosphere had improved since the recruitment of the manager and the overarching manager. They felt confident raising concerns and were reassured that if a mistake had been made, they would learn from it.
The manager and the overarching manager told us they were dedicated to promoting good care across the board. Good care was evident in the home, where people’s physical, social and emotional needs were met. Staff were happy and confident and this translated into the level of care they provided.
Staff told us they understood their role and responsibilities. They had been given job descriptions and were aware of their responsibility to keep people safe. Staff had completed the relevant training to ensure they were able to carry out their responsibilities. There was a system of quality assurance in place to ensure the quality of care provided to people and to drive improvements to the service.
During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we asked the provider to take at the back of the full version of the report.