About the service: Copper Beeches is a care home that provides personal care for up to 20 people in one adapted building. It is registered to provide a service to older people who may be living with dementia or physical disability. At the time of the inspection 15 people lived at the home.

People’s experience of using this service: Risks associated with people’s care and support were not always managed safely. Improvements were needed to ensure people received their medicines as required. There were not always enough staff to meet people’s needs. Improvements were required to ensure the home was clean and well maintained. People felt safe and there were systems and processes in place to minimise the risk of abuse. Accidents and incidents were reviewed and analysed to try to prevent future incidents. Safe recruitment practices were followed.

Further work was needed to ensure people’s rights under the Mental Capacity Act 2015 were protected. Staff required more training to enable them to provide safe and effective. Mealtimes were positive experiences and risks were managed. People had access to a range of health care professionals, but care plans required more information about people’s health to ensure consistent support. Overall, the home was adapted to meet people’s needs, but some areas were in a poor state of repair.

Although staff were kind and caring this was based upon the approach of individual staff and not promoted by the culture of the organisation. People were supported to be as independent as possible. People had access to advocacy services if they required this.

People did not consistently receive personalised care that met their needs. People were not always provided with opportunity for meaningful activity. There were systems in place to respond to complaints.

The service did not have a clear vision. Swift action had not always been taken to address risks to people’s safety. Records of care and support were not accurate or up to date. The new service manager had been proactive in identifying areas for improvements at the home. Improvements were underway to develop auditing systems and work had started to better involve people who used the service and staff in the running of the home.

The service met the characteristics of requires improvement in most areas we inspected. More information is in the detailed findings below.

Rating at last inspection: Inadequate (report published 20 November 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that work was underway to make improvements to the safety and quality of the service. However, further work was needed to ensure these improvements continued and were sustained.

Enforcement: We identified five breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safety, staffing, the environment, care and governance. Details of action we have asked the provider to take can be found at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: During our inspection we requested an action plan and evidence of improvements made in in relation to staffing and fire safety. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The overall rating for this service is ‘Requires improvement’. However, we are keeping the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under revie

We conducted an unannounced inspection at Copper Beeches on 2 and 3 October 2018. Copper Beeches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Copper Beeches accommodates up to 20 people in one building. On the day of our inspection, 16 people were living at the home; all of these were older people, some of whom were living with dementia.

We carried out an unannounced comprehensive inspection of this service in June 2018. Breaches of legal requirements were found in relation to; risk management, safeguarding, cleanliness and infection control, person centred care, dignity, consent and leadership and governance.

Since our June 2018 inspection we received concerns in relation to the safety, management and leadership of Copper Beeches. As a result, we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Copper Beeches on our website at www.cqc.org.uk.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the home in September 2017. 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.

During our inspection we found the service was not safe. People were subject to improper treatment that did not respect their rights. Restrictive practices were used to manage people’s behaviour. People were not always protected from risks associated with their care and support. People were placed at risk of falls as assistive technology was not used effectively. Risks associated with people’s health conditions were also not managed safely. This placed people at risk of harm. Risks associated with the environment, specifically legionella, were not safely managed. Furthermore, some areas of the home were unsafe, placing people at risk of harm. People were at risk of not receiving their medicines as prescribed, as there were not always medicines trained staff on shift. Medicines practices were not always hygienic. Infection control and prevention measures were not effective, this exposed people to the risk of infection. Staff were not always deployed effectively to meet people’s needs in a timely way. Safe recruitment practices were not always followed.

Copper Beeches was not well led. Quality assurance processes were not effective, this had led to a failure to identify and address areas of concern. Serious incidents were not investigated; this meant action had not been taken to reduce the risk of reoccurrence. The provider had not kept up to date with current guidance and legislation. Decisions about people’s care and support were not always based upon specialist advice or best practice. The culture of the home was not respectful or person centred. There were limited opportunities for people living at Copper Beeches to influence the running and development of the home. The provider was not compliant with their own policies. We received mixed feedback from the staff team about the leadership and management of the home.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significan

We conducted an unannounced inspection at Copper Beeches on 7 June 2018. Copper Beeches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Copper Beeches accommodates up to 20 people in one building. On the day of our inspection, 19 people were living at the home; all of these were older people, some of whom were living with dementia.

At the last comprehensive inspection in June 2017, we asked the provider to take action to make improvements across a number of areas including; risk management, safeguarding, recruitment, person centred care, consent and leadership and governance. We conducted a focused inspection of Copper Beeches in September 2017. That inspection only looked at whether the service was safe and well led. We found ongoing concerns in relation to the safety and leadership of the home.

During this inspection, we found continued concerns about the safety and quality of the service provided at Copper Beeches . We found eight breaches of the Health and Social Care Act 2008 regulations. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the home in September 2017. 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. There was a manager in post who told us they were planning to register. We will monitor this.

During our inspection we found the service was not safe. People were not always protected from risks associated with their care and support. People were placed at risk of choking as risks were not assessed and staff did not have adequate guidance to inform their care and support. People were not protected from the risk of pressure ulcers. Incidents were not analysed or investigated; this meant action had not been taken to reduce the risk of reoccurrence. Risks associated with the environment, specifically fire, were not safely managed and this exposed people to the risk of harm. Medicines were not stored or managed safely, poor record keeping meant people may not receive their medicines as prescribed.

People were not protected from abuse and improper treatment. We found evidence of an allegation of abuse that had not been referred to the local authority safeguarding adults team for investigation. The cause of unexplained marks to people’s skin were not investigated. Infection control and prevention measures were not effective, this exposed people to the risk of infection spreading. People could not be assured that good hygiene practices were followed, effective cleaning procedures were not in place for some items of equipment and some areas of the home.

Staff levels were not based upon an assessment of people’s need and consequently, there were not enough staff to meet people’s needs and ensure their safety. Staff were not always deployed effectively and this placed people at risk of harm. Safe recruitment practices were in place to reduce the risk of people being supported by unsuitable staff.

People were supported by staff who did not always have appropriate training or support. Staff lacked training in key areas, such as people’s health conditions and we found this had a negative impact on people living at

We inspected Copper Beeches on 9 October 2017. The inspection was unannounced. The home is a situated in Collingham in Nottinghamshire and is operated by Copper Beeches Limited. The service is registered to provide accommodation for a maximum of 20 older people. There were 18 people living at the home on the day of our inspection visit.

We carried out an unannounced comprehensive inspection of this service on 14 and 16 June 2017. Breaches of legal requirements were found. After the comprehensive inspection we took action against the provider and issued two Warning Notices to ensure that improvements were made in relation to the safety and governance of the home. The provider was required to be compliant with the notices by 4 September 2017 (safety) and 9 October 2017 (governance). We undertook this focused inspection to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Copper Beeches on our website at www.cqc.org.uk.

At this inspection we found that the provider had not made the all of the required improvements and remained in breach of these legal regulations. We also found a breach of the Care Quality Commission (Registration) Regulations) 2009. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place at the time of our 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.

During this inspection we found that the service was still not safe. People were exposed to the risk of harm and action had not been taken to protect them from risks associated with their care and support. Risks associated with falls, moving and handling and pressure ulcers were not effectively assessed or managed.

Equipment was not always used safety. We found a number of unsafe practices in relation to the use of bedrails. Risks resulting from environmental hazards, such as windows and portable heaters, were not safely managed, consequently we found that people were exposed to the risk of harm.

Improvements had been made to ensure that people received their medicines as prescribed. However, where people were prescribed creams; these were not always applied as required. Improvements had been made to the cleanliness of the environment and effective food hygiene practices were now followed.

Since our last inspection action had been taken by the provider to ensure that the risk of people experiencing improper treatment or abuse were minimised. There were enough staff to provide care and support to people when they needed it. Safe recruitment practices were followed.

The service was still not well led. Auditing systems were not effective in identifying or addressing risks to people who used the service and this placed people at risk of harm. There were concerns with the competency of the management of the home.

Opportunities for people living at the home to provide feedback on the service were still limited and people told us that communication required improvement. In contrast, staff felt supported and were able to express their views in relation to how the service was run. The provider was not conspicuously displaying their rating in line with our requirements and CQC was not notified of significant events as required.

The provider was responsive to our feedback and took swift action to respond to our concerns and address the risks to people who used the service.

The overall rating for this service is ‘Requires improvement’. However, the service remains in ‘special measures'. This is because t

We inspected Copper Beeches on 14 and 16 June 2017. The inspection was unannounced. The home is a situated in Collingham in Nottinghamshire and is operated by Copper Beeches Limited. The service is registered to provide accommodation for a maximum of 20 older people. There were 19 people living at the home on the days of our inspection visit. This was the services first inspection since they registered with us.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place at the time of our 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.

People’s medicines were not always given as prescribed or managed in a safe way. Risks to people’s health and safety were not always managed appropriately or safely. Risks associated with the environment were not always assessed, the environment was not always clean and hygienic, and basic food hygiene practices were not always followed. Although people told us they felt safe, people were not always protected from abuse and improper treatment. People were not supported by staff that had been safely recruited.

There were enough staff available to meet people’s needs and ensure their safety. Staff received an induction to their role and had access to ongoing training to meet people’s needs.

The principles and application of the Mental Capacity Act were not always understood or followed where people lacked capacity to make decisions for themselves.

People had enough to eat and drink and were provided with assistance as required, however people’s feedback about the quality of the food was varied and action had not been taken to address this when issues were raised. People’s day to day health care needs were met, but there was a risk that action may not be taken in response to changes in people’s health, as staff did not always have access to information about their health conditions and how to support them with these.

People’s views about their care and support were not consistently acted upon which meant people’s preferences were sometimes not met. There was a risk that people may not have access to advocacy services if they required this to help them express their views.

Staff understood how people communicated and they were supported to maintain their independence. Staff understood the importance of treating people with kindness, dignity and respect and we observed this in practice. Staff also respected people’s right to privacy.

People told us they received inconsistent support from staff, care plans did not always contain adequate detail of the support people required and staff were not always aware of people’s specific needs. People could not always be assured that they would receive support that was based on their individual needs, as some routines were in place to suit the needs of the staff at the service rather than the people living at the home.

People had the opportunity to get involved in social activities. People knew how to complain and complaints were documented, investigated and action was taken to address concerns raised.

The service was not well led and we identified a number of shortfalls in the way the service was managed. There were not sufficiently robust or comprehensive systems in place to ensure people were provided with safe and effective care that met their needs. Appropriate action was not taken by the provider to investigate incidents which posed a risk to the health and wellbeing of people who used the service. Swift action was not taken in response to known issues an