Archived: Copper Hill Care Home

At the last inspection in August 2015 we found the provider had breached one regulation associated with the Health and Social Care Act 2008. This was in relation to medicines administration.

We told the provider they needed to take action and we received a report in September 2015 setting out the action they would take to meet the regulations. At this inspection we found the service had followed their action plan and improvements had been made with regard to this breach.

Copper Hill is a large home, spread across six separate units located on the outskirts of Leeds city centre. It provides residential services, nursing care services and dementia care services for a maximum of 180 people.

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 and associated Regulations about how the service is run.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Accurate and up to date records in relation to people’s care and treatment were not always maintained. Health care and treatment of people who used the service did not always meet their assessed needs and people were not consistently provided with meaningful and stimulating activity. You can see what action we told the registered persons to take in relation to each of these breaches of the regulations at the end of the full version of this report.

Overall, people said there were enough staff to meet their or their family member’s needs. However, we noted that at times, people who used the service had to wait for periods of time for the support they needed such as assistance with meals.

There were systems in place to record accidents and incidents and monitor for any patterns or trends. However, we found on one unit two incident reports that had not been completed in full or followed up to show what action was taken in response to them.

The premises and equipment were well maintained to ensure people’s safety. However, improvements to the environment were needed to assist people who lived with dementia to promote their freedom and independence.

People told us they felt safe and well looked after at the home. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Staff were recruited appropriately in order to ensure they were suitable to work within the home. They were provided with training to develop their knowledge and skills. However, not all staff were able to demonstrate their knowledge and skills in how to support people living with dementia.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were, in the main, made in their best interests.

People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Overall, their choices and preferences were respected and they were supported to make their own decisions whenever they could do so.

People told us they enjoyed the food and got the support they needed with meals. However, some improvements were needed to ensure the meal time experience was positive for all people who used the service.

There were systems in place to ensure complaints and concerns were fully investigated. People had the opportunity to say what they thought about the service and the feedback gave the provider an opportunity for learning and improvement.

People were not put at risk because systems for monitoring quality were effective. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

The registered manager was supportive of people who lived in the home and the staff who worked there. They listened to what people had to say and took action to address any issues they had.

Copperhill comprises of six separate houses - The Laurels (intensive dementia and mental health); Murray Unit (dementia nursing); Kitson Unit (nursing care); Copley Unit ( dementia care, residential), Churchill Unit (residential and nursing care) and another unit which is currently closed. We spoke with eighteen people who used the service, eighteen relatives and twenty seven staff.

Is the service safe?

Most people said they were treated with respect and dignity by the staff. People were complimentary about the staff and told us they were well looked after. Comments included:

'All the staff are lovely.' 'It's excellent here.'

However, some people said they were not always treated with dignity and respect and their personal hygiene needs were not always met properly. We also saw that some people did not get the support they needed at meal times.

There was poor recording of people's mental capacity and it was not clear whether assessments had been made. We saw there were times when people were deprived of their liberty but no application for a deprivation of liberty safeguard (DoL's) had been considered or made. We found inconsistencies in the records in relation to the recording of consent and capacity.

An independent review had been carried out on the Laurels unit. A number of recommendations had been made; including the safety of staffing levels. The report also identified the risks associated with the current physical environment such as numerous ligature points throughout the unit.

People who used the service, staff and relatives told us there were not enough staff on this unit to meet their needs. One person told us that staff only had time to speak with them when providing personal care. We saw that staff appeared rushed and had to leave people unsupervised at times.

On Copley unit, people who used the service said the staff were polite and respectful, however, most commented on how busy the staff were. One person said 'They do what needs to be done'. Relatives raised concerns about staff being rushed, and told us they did not always feel confident staff were able to respond to the needs of their family member promptly.

On Murray unit we saw staff made every effort to attend to people. However, at busier times, such as lunch time, people had to wait for staff to assist them. We saw one person waited for more than ten minutes for staff to assist them to the toilet.

We saw safeguarding procedures were robust and gave staff information needed to help them understand how to safeguard people. Most staff had a sound understanding of the signs of abuse and what they would do to ensure people were kept safe. However, on the Laurels unit a number of staff said they had not been trained in managing behaviours that challenge which meant there were risks to the welfare of people who used the service. Records showed that all staff had received some training in behaviour that challenges; it was therefore unclear to us why some staff did not feel they had been trained to manage the complex behaviours people presented with.

Is the service effective?

We saw people were consulted and their verbal consent was obtained for most aspects of their care and daily routine. Records for important decisions or choices made in people's best interests were not always available. For example, one person was given their medicines mixed in with their food. However, there was no assessment to show whether the person could make a decision about taking their medicines.

Care records did not always show evidence of involvement of people who used the service or their representatives. The majority of people who used the service and relatives we spoke with said they had not been involved in the drawing up of their care plans and associated documentation.

We found care records were, in the main, difficult to navigate around. There was no evidence of cross referencing between care plans, such that needs or evaluation of care were often duplicated or not updated in accordance with the provider's policy. We saw evidence in the care records that people's health was monitored. There was evidence of professional visits, such as dieticians and GPs.

Is the service caring?

Overall people were supported by kind and attentive staff. Staff communicated with people in a positive manner. Comments we received included:

'We are well looked after.'

'It's very nice here.'

However, we observed people's experiences of lunchtime in each of the units and we found in some units the staff were extremely busy and this was a task-centred process, rather than a positive dining experience.

On the Laurels unit one person said they were very happy at the home. However, one person told us the frequently had to ask staff to support them in care tasks such as teeth cleaning and said they had gone to bed in their daywear one night as staff did not assist them to put their night wear on.

Is the service responsive?

People who used the service and their relatives had participated in an annual satisfaction survey. We saw where shortfalls had been identified there was an action plan in place. The action plan was still in progress with many of the actions still to be completed.

People told us they knew how to raise concerns and things had improved after doing so. The Registered Manager had systems in place to ensure people's concerns were responded to.

Some people said they enjoyed the activity on offer and this met their needs. However, particularly on The Laurels Unit, people said activity was sometimes unsuitable and described it as childish at times. We also saw on this unit that people who used the service were asleep for long periods of time with little stimulation or staff interaction. We saw activities were not always meaningful for the people in Murray unit. One relative said they felt the activities were not suitable for their family member and there was often nothing taking place to ensure people were occupied.

Is the service well led?

The provider had systems in place to identify and assess risks to the health, safety and welfare of people using the service but these were ineffective and not fully embedded in protecting people from the risk of unsafe or inappropriate care or treatment.

Senior managers from the organisation carried out a monthly audit to check standards and the quality of care being provided. We saw there were action plans developed when any shortfalls were identified.

Records did not show risks identified at unit level but overall for the service. It was not always clear from the records seen how learning from incidents/investigations took place and appropriate changes were implemented in each unit.

There was no clear or stable leadership in place for staff in Murray unit. The registered manager told us there had been difficulties in securing a consistent unit manager.

We spoke with the management team who said prompt action had been taken to scrutinise procedures throughout the entire home and not just in the Murray unit where we had identified concerns. We saw people were protected against the risks associated with medicines because the provider had made arrangements to ensure staff were trained, records were maintained and regular audits were made. We saw medicines were administered and recorded correctly.

We also observed people's care and welfare and spoke with people who lived in the Murray unit and the Churchill unit. We spoke with four people and two relatives. People said they were happy living in the home. One person said: 'they take good care of us, I like it here'. We saw care records had clear information and were up to date. We saw people were appropriately cared for, although some people's clothing had dirty marks, which managers told us they would look into without delay. Relatives said they were happy. One told us: 'staff work very hard and they do a good job. I have no complaints'.

We were satisfied with the standard of care for people overall, although in the Murray unit we observed that medication was not administered and recorded correctly.

We spoke with relatives who told us that they were happy with the care of their family members. We spoke with staff, who said they were happy working in the home and enjoyed the teamwork. We found staffing levels to be sufficient to meet the needs of the people living in the home.

We saw that people's care records were clearly detailed and maintained with sufficient information to present a personalised profile for each individual. We saw that complaints were documented clearly and responded to thoroughly.