Coplands Nursing Home

Coplands Nursing Home is a care home providing nursing and residential care for older people, people with physical disabilities and people with mental health care needs. Coplands Nursing Home is registered to provide the regulated activity to up to 79 people. At the time of our inspection there were 71 people using the service.

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

People were protected from the risk of harm and abuse. There were effective systems and processes in place to minimise risks to people. Risks had been identified, assessed and reviewed. Staff knew how to identify and report concerns. They had been recruited safely and showed good knowledge and skills in relevant areas including medicines administration and infection control. They demonstrated dignity, respect and compassion in interactions.

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.

The provider had a range of quality assurance processes, including systems necessary to maintain safe environments. The registered manager ensured policies and procedures met current legislation and were up to date. People who use the service and staff told us they were asked of their views about the quality of the service.

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 4 March 2021)

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

This inspection was prompted due to being rated requires improvement during the previous inspection and we have received evidence that improvements have made to increase capacity.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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.

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 changed from Requires Improvement to Good. 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 Coplands Nursing Home on our website at www.cqc.org.uk.

Follow up

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

Coplands Nursing Home is a care home with nursing operated by Maria Mallaband Care Group. It is registered to provide accommodation with personal and nursing care for seventy-nine older people who may also have dementia. At the time of this inspection, there were 66 people using the service.

This inspection was carried out due to safeguarding concerns and complaints received by us and the local authority. The local authority had also placed the home on their provider concerns list so that progress could be monitored by them.

People’s experience of using this service:

At the last inspection of 3 September 2020, we found that the service failed to take proper action to safeguard people and to respond adequately to safeguarding concerns and complaints. This placed people at risk of abuse and neglect. This deficiency was a breach of Regulation 13 (1)(2)(3) (Safeguarding Service Users from Abuse and Improper Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the service had taken prompt action and promptly responded to safeguarding complaints so that people were protected from abuse and neglect.

At the last inspection we found that people were not safely cared for. Some risk assessments and care plans were inadequate, and people were not protected from harm. This was a breach of Regulation 12 (2)(a)(b) (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that action had been taken to keep people safe from harm. Comprehensive assessments and care plans were in place to address potential risks to people.

At the last inspection we found deficiencies associated with the administration of medicines. These placed people at risk of harm and was a breach of regulation 12 (2)(b)(g) (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that improvements had been made and people received their medicines as prescribed.

There were arrangements for fire safety. Fire drills and weekly fire alarm checks had been carried out. Deficiencies in the fire safety arrangements had been attended to. People using the service had appropriate personal emergency and evacuation plans (PEEP) in place in case of fire or an emergency. This ensured that staff were fully informed in the event of an emergency.

The premises were well maintained, clean and tidy. Previous deficiencies related to the control of infections had been rectified. The service had taken measures to prevent and control the spread of COVID -19 infection.

At the last inspection we noted that there was inadequate deployment of staff and people were not receiving the care they required. This was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection suitable staffing arrangements were in place. People told us their care needs had been met. The staff rota contain details of which staff was responsible for providing one to one care.

At our last inspection the service did not have effective quality assurance systems for monitoring and improving the quality of the service provided for people. The audits were not sufficiently effective as we noted numerous deficiencies which were not promptly rectified. This was a breach of Regulation 17, Health and Social Care Act (Regulated Activities) Regulations 2014 (Good governance). During this inspection we found that the service had made improvements. Checks and audits of the service had been carried out and action had been taken to rectify deficiencies noted. People and staff had confidence in the management of the service.

At this inspection we found that improvements had been made in people's care. They had been treated with respect and dignity and were consulted regarding how they wanted to be cared for. Their preferences and diverse needs had been taken into account in the delivery of their care. However, the improvements made had been recent and the home had experienced major changes following numerous complaints made. To be rated as good, the home would need to maintain a track record of consistent improvement in the quality of care provided.

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 28 October 2020) and there were breaches of regulation in relation to Safe Care and treatment and Well Led. 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 this focused inspection as we had concerns regarding the service and we wanted to check that people were well cared for. The inspection was prompted in part due to concerns received regarding safeguarding, staffing, the safety of people who used the service and the management of the home. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led. 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 has remained as Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Coplands Nursing Home on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

People’s experience of using this service:

Several safeguarding concerns and complaints had been reported to us and the local authority before the inspection. These related to the safety of people who used the service and the conduct of some staff. The investigation of these concerns was still ongoing. We also noted some deficiencies in the arrangements for safeguarding people which may put people at risk of harm.

Risk assessments had been documented. These risk assessments covered areas such as the risk of falling, behaviour which challenged the service and choking. We however, noted that some of these risk assessments were not comprehensive and did not include sufficient guidance for minimising the risks.

We examined arrangements for the care of people with behaviour which challenged the service. We found that this was not well managed. In one instance, where a person with behaviour which challenged the service had sustained injuries, we saw no analysis of previous incidents and no subsequent guidance to prevent re-occurrences. Care plans and risk assessments were not updated following these incidents.

Medicines had not always been given as prescribed. We noted that there were two instances when medicines were not given to people. There were discrepancies in the medicines stock of people identified on the day of inspection.

The premises were clean and tidy on the day of inspection. We however, noted that there were deficiencies related to the control of infections and this placed people at risk of harm. A recent visit by the local health authority infection control nurse just prior to this inspection made recommendations for improvements.

Staff were recruited with care and the service had carried out the necessary recruitment checks before care staff could commence work. Staffing levels had been reviewed and this indicated that there was sufficient staff. We however, found that the deployment of staff was not satisfactory. The staff rotas examined did not identify which care staff was responsible for providing one to one care for people who needed it. We had also received complaints that some people were not receiving all the care needed as staff did not always respond to their needs or answer the call bells.

There were deficiencies in the fire safety arrangements as noted in the fire authorities report of 21 October 2019. At the time of inspection, remedial work was nearing completion. We however, noted that the personal emergency and evacuation plans (PEEP) of two people had not been adequately completed to ensure that staff were fully informed in the event of an emergency.

The home had quality monitoring systems. Checks and audits had been carried out. These included checks and audits of care plans, medicines, health and safety checks and checks on the maintenance of the home. The audits were not sufficiently effective as we noted numerous deficiencies which were not promptly rectified.

Following concerns expressed by us and the local authority, the service had voluntarily suspended all admissions into the home and updated their action plan for rectifying deficiencies and improving people’s experiences of the service. At the time of writing this report several deficiencies still needed to be rectified.

The registered manager had been suspended and resigned from his post just prior to this inspection. Staff informed us that they had found their management to be unsupportive and morale had been low. An interim manager was in place at the time of this inspection.

Rating at last inspection:

The service had been inspected on 8 February 2018 (published 23 March 2018) and was rated as Good. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected:

We undertook this focused inspection due to recent safeguarding concerns and complaints received. This report only covers our findings in relation to the Key Questions Safe and Well-led. 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 has deteriorated to Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Coplands Nursing Home on our website at www.cqc.org.uk.

Enforcement:

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 breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014 in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing).

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 this service at a later date to check compliance.

Our previous inspection on 2 June 2016 found a breach of Regulation 18 HSCA RA Regulations 2014 Staffing. We rated the service as “requires improvement”. During this inspection on 8 February 2018 we found that the service had taken the necessary action and made improvements. The required staff training had been provided. The service is now rated as “Good”.

There was a registered manager in post at the time of our inspection. 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.

There were suitable arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse. Risks in relation to treatment and care provided were assessed and risk management plans ensured that identified risks to people were minimised. The service followed safe recruitment practices and sufficient staff were deployed to ensure people’s needs were met. There were suitable arrangements for the administration of medicines and medicines administration record charts (MAR) had been properly completed.

The premises were kept clean and tidy. Infection control measures were in place. There was a record of essential maintenance of inspections by specialist contractors. Fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The dietary needs of people had been assessed and arrangements were in place to ensure that people received adequate nutrition. People were mostly satisfied with the meals provided.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS.

Care workers worked well as a team and there was effective communication among them. They had received a comprehensive induction and training programme. There were arrangements for support, supervision and appraisals of care workers. There were enough care workers deployed to meet people's needs. Care workers had been carefully recruited and their files contained the required documentation.

Care workers prepared appropriate and up to date care plans which involved people and their representatives. The home had a varied activities programme to ensure that people received social and therapeutic stimulation.

Care workers communicated and interacted well with people. There were opportunities for people to express their views and experiences regarding the care and management of the home. Regular residents’ and relatives' meetings had been held. Complaints made had been carefully recorded and promptly responded to.

Comprehensive checks of the service had been carried out by the registered manager, deputy manager and senior officers of the company in areas such as health and safety, complaints and accidents. Audits were carried out by the area manager and senior managers of the organisation. They included checks on care documentation maintenance of the home and staffing arrangements.