The inspection took place on 14 November 2017. This inspection was unannounced.

At the last Care Quality Commission (CQC) comprehensive inspection on 09 and 10 August 2016, this service Required Improvement in the Effective and Responsive domains and had an overall rating of Requires Improvement. We returned to the service on 18 April 2017 to check that the provider had taken action in the Effective and Responsive domains. At the inspection on 18 April 2017, we changed the ratings in the Effective and Responsive domains to Good. We also changed the overall rating for the service to Good.

You can read the report from our last comprehensive inspection and subsequent focused inspection, by selecting the 'all reports' link for Copper Beeches on our website at www.cqc.org.uk

At this inspection, we found the registered manager and provider had consistently monitored the quality of their service to maintain a rating of Good.

Copper Beeches is a nursing home. The service provides accommodation, nursing and personal care for up to 36 older people, some of whom may be living with dementia. The nursing and care was provided in an environment that had been adapted to enhance people’s experience of the care. There were 35 people living at the service at the time of our inspection.

The improvements and changes implemented since our last comprehensive inspection in August 2016 had been embedded. Nurses and care staff demonstrated they shared the provider’s vision and values when delivering care. People were supported to maintain their purpose and pleasure in life and offered choice.

The registered manager was employed at the service. 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.

The provider and registered manager wanted to offer an inclusive service. They had comprehensive policies about Equality, Diversity and Human Rights. The provider was working with and learning from external organisations with expertise and experience of reaching out to the lesbian, gay, bi-sexual and transgender communities and people living with dementia.

The registered manager and provider were consistent in measuring the quality of people’s experiences and continued to work at putting people at the heart of the service.

The quality outcomes promoted in the providers policies and procedures were monitored by the registered manager and leaders in the service. There continued to be multiple audits undertaken based on cause and effect learning analysis, to improve quality. Staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice. The provider shared their learning with all the services in the group.

The registered manager consistently understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff protected people’s privacy and confidentiality whilst delivering care, but at other times, people could be observed in bed as their doors were open. It was not clear if people had consented to their doors being left open. We have made a recommendation about this.

People’s right to lead a fulfilling life and to a dignified death was understood and respected at all levels. People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face, by telephone, by using ‘on-line’ feedback forums or by using the comment box in the reception.

There continued to be enough nursing and care staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. People’s medicines w

The inspection was carried out on 18 April 2017 and was unannounced.

Our last inspection report about this service was published on 30 October 2016 and related to an inspection which had taken place on 9 and 10 August 2016. At the inspection in August 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 9, Person Centred Care. The design of activities provided for people did not ensure their needs and preferences were met. Regulation 18, Staffing. Staff were not receiving appropriate support, supervision and appraisal. We asked the provider to take action to meet Regulations 9 and 18.

The provider sent us a report of the actions they were taking to comply with the Regulations and they told us they would be meeting the Regulations by March 2017.

We also made a recommendation about the test and checks made on oxygen equipment people used, but that was not provided by the home. This could not be checked at this inspection because this equipment was no longer in use. However, the registered manager now had a system in place to ensure the recommendation would be met if required in the future.

We returned to carry out a focused inspection of two domains, Effective and Responsive, on 18 April 2017 to check the provider had taken action to meet the regulations. At this inspection we found that the provider had implemented new ways of working to address the breaches and recommendation made from the previous inspection which has resulted in an improvement in the ratings for this service.

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

Copper Beeches is a care home providing accommodation, personal care and nursing care for up to 36 older people who may be living with complex dementia and who may require nursing. At the time of this inspection there were 34 people living at the service. Accommodation was provided over two floors. A lift was available to take people between floors.

A registered manager was employed at the service. 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.

The registered manager had implemented a consistent system for staff supervisions and appraisals. Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills, maintaining their registration with the Nursing and Midwifery Council (NMC).

The resources and levels of commitment to activities and mental stimulation had improved by ensuring people living with dementia had access to activities based on their needs.

The staff team at Copper Beeches had accessed more specialised dementia training and the registered manager and nurses had started to attend the provider's ‘Nursing Academy.’

Nursing staff continued to assess people’s needs and plan people’s care. Nurses worked closely with other staff to ensure the assessed care was delivered. People had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the registered manager provided nurses with clinical training and development.

People’s care needs and health was monitored and care plans were regularly updated so that they reflected people’s most up to date needs.

People’s care was centred on them. People and/or their families had been consulted about how people may like their care delivered, their preferences, choices and the

The inspection was carried out on 9 and 10 August 2016 and was unannounced.

Copper Beeches is a care home providing accommodation, personal care and nursing care for up to 36 older people who may be living with complex dementia. At the time of this inspection there were 34 people living at the service. Accommodation was provided over two floors. A lift was available to take people between floors.

A registered manager was not employed at the service. 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. However, the provider had appointed a manager who intended to apply to register with the Care Quality Commission.

The available resources and levels of commitment to activities and mental stimulation did not support best practice in ensuring people lived well with dementia and reduced social isolation.

The provider and manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the service had been tested and well maintained, but this did not always include equipment people provided for themselves.

We have made a recommendation about this.

There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely. However, there were issues with cleanliness and infection control in some areas of the clinical rooms.

Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council (NMC). The manager had not ensured that a consistent system was in place for staff supervisions and appraisals.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred. End of life care was delivered by consent and mutually agreed with people and their families.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. A robust agency back up system was in place. The provider had a system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the manager provided nurses with clinical training and development.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. This included checking nurse’s professional registration.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in

During this inspection, the inspector focused on answering five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Staff had been trained in safeguarding people from abuse and they understood their responsibilities to protect vulnerable people. New staff were trained in safeguarding procedures as part of their induction. The staff that we spoke with understood the safeguarding procedures and they described the processes they would follow to keep people safe.

The registered manager ensured that staff underwent checks before starting work at the home. For example they checked a person’s character by carrying out Disclosure and Barring Service checks. (DBS). This was formally known as a criminal records check.

During our inspection we saw that staff delivered the care outlined in people’s care plans. For example we observed that staff ensured people were safe when they were lifted because staff used specialist equipment. Also to ensure people’s safety, where two staff were required to carry out a task, we observed that two staff were available.

Procedures for dealing with foreseeable emergencies were in place and staff were able to describe these to us. The manager understood how care would be continued in the event of a foreseeable emergency occurring. Staff had access to support and advice at all times from a senior member of staff.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that people’s rights were protected because the manager understood how to support people to make decisions in their best interest.

There were systems in place for making regular checks on the risks of providing the service and safety of the premises. Incidents and accidents were monitored. The manager had made changes as a result of learning from incidents and these had been put into practice.

The manager ensured that there were enough staff to meet people’s needs. We found that that they had ensured that staff had the required skills and knowledge to care for people in a safe way.

Is the service effective?

People had an individual care plan which set out their care needs. We found that the manager used an assessment system that was appropriate for people living with dementia. People’s relatives had been fully involved in the assessment of people’s health and care needs. Relatives and other key people had been involved in supporting decisions that had been made in people’s best interest. For example, when people lacked capacity to make the decisions for themselves. People’s care plans were reviewed regularly to check they were still effective. During our inspection we saw staff delivering the care outlined in people’s plans. When people fed back about the service they talked positively about the care provided at the service.

Is the service caring?

We found that people were treated with respect and their dignity was maintained. People appeared relaxed and comfortable with the staff that supported them. We observed that people had a positive relationship with staff. Staff took time to chat with people about day to day matters. People told us that the staff were caring. One person said “X’s care has been really good, X is well cared for.” Other people said “We are very happy with the service, people are well looked after”. Other people had commented ‘I am very happy with the care, my relative is in safe hands’ and ‘I am satisfied with the care provided.’ Staff we talked with told us that people were well cared for. One new member of staff said, “People are well cared for, I have been able to settle in and get to know people’s needs”. Another said, “I think people are well cared for, I really enjoy my job.”

Is the service responsive?

The service reviewed people’s care plans regularly. There was a nominated person in charge of the service with the required training and authority to manage how the service was delivered. The manager or their deputies were available via telephone for further advice when needed.

We found that the manager asked people about what they experienced from the care and treatment they had received. The registered manager had consulted people who used the service, listened to their comments and acted on them.

Is the service well-led?

The provider continually monitored areas of risk in the service and made regular checks on quality. There was evidence that the provider learnt from incidents. Changes had been made to minimise the risks of incidents occurring again.

People’s care was assessed, planned and managed. Staff were aware of people’s care needs. The manager had ensured that the resources required to deliver the regulated activities were available.

Staff were trained and inducted. Team meetings enabled staff to express their views about service quality and they were able to raise issues that concerned them.

The manager ensured that daily checks of the quality and safety of the service were carried out. Regular reviews of people’s care plans took place which ensured their needs were being met.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had dementia which meant they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the service. The atmosphere in the home was calm and relaxed. All the interactions we saw between staff, management and people who lived in the home were positive. We saw people felt free to express their opinions and were listened to and provided with all the support they needed.

We found that people or their representatives had been involved in decision making and giving their consent for care and treatment.

People were provided with appropriate care and support that met their needs.

People received the medication they needed at the time they needed it.

There was an effective system to regularly assess and monitor the quality of service that people received.

Complaints were taken seriously and action was taken to resolve complaints to people's satisfaction.

Overall we found this home had achieved compliance. We have made some comments that the provider may find useful to note.

During our inspection on 18 September 2012 we found areas of non compliance. During this visit we found that improvements had been made in upholding people’s privacy, dignity and rights and meeting their nursing, care and welfare needs. We found that there were effective systems in place to monitor the quality of the service and there were enough staff on duty to provide the nursing, care and support people needed. We have highlighted some areas within the report that the provider may find it useful to note.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences. We were accompanied by an Expert by Experience who spent time talking with people, their visitors and care and nursing staff who were working in the home.

People told us they were satisfied with the service they received. They said, “Things are improving here all the time and I cannot now fault the staff or the care they give.” “The Staff here carry out their duties cheerfully.” “I have no concerns when I leave the Home as I know I will be kept informed if there are any problems.” “I cannot speak too highly of the care here”.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed how people interacted with care and nursing staff. We saw people’s privacy and dignity was not always promoted and their rights were not always upheld. We found evidence that people’s privacy and dignity was not always protected, their safety and care and welfare needs were not always met and people were being unlawfully restrained. We spoke with two relatives of people who use the service. They described a number of concerns about the quality of service people were receiving. The provider had already identified shortfalls in the quality of the service and had begun to implement a programme of improvement.

The inspection was carried out on 16 and 21 July 2015. Our inspection was unannounced. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received.

At our previous inspection on 12 and 16 December 2014, we found breaches of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, and two breaches of the Health and Social Care Act 2008 (Registration) Regulations 2009. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. We took enforcement action and required the provider to make improvements. We issued three warning notices in relation to people’s health and welfare, assessing and monitoring the quality of the service and staffing numbers. We found a further seven breaches of regulations. We asked the provider to take action in relation to safeguarding people from abuse, infection control, availability and suitability of equipment, complaints, supporting staff, notifications of deaths and notifications of other incidents.

The provider sent us an updated action plan on 26 May 2015 with timescales showing how and when the regulations would be met.

At this inspection, we found that improvements had been made but the provider had not completed all the actions they needed to take to meet the regulations. In particular, they had not fully met the requirements of the warning notice we issued at out last inspection in relation to staffing numbers. As a result, they continued breaching regulations relating to fundamental standards of care.

Copper Beeches is a care home providing accommodation, personal care and nursing care for up to 36 older people who may be living with dementia. At the time of this inspection there were 31 people living at the Home. Accommodation is provided over two floors. A lift was available to take people between floors.

Copper Beeches did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. However, the provider had appointed a peripatetic manager to cover the home. Peripatetic managers are experienced managers with the skills and experience to step in to manage homes for short periods.

At this inspection we found that the manager and provider had taken action to address the breaches from the previous inspection, although there were still some areas needing improvement.

The manager had not ensured that they employed enough care staff to meet people’s assessed needs. The provider had a dedicated system in place to assess people’s needs and the required staffing levels. However, our findings at this inspection indicted that the system in use was not always effective. Staff were not always available in the right numbers to meet people’s needs.

People were not always effectively supported to eat and drink enough to maintain their health and wellbeing. Quality audits were not always effective in picking up staffing issues or the gaps in records.

People felt safe. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. The manager responded quickly to safeguarding concerns and learnt from these to prevent them happening again.

The manager and care staff assessed people’s needs and planned people’s care. General and individual risks were assessed, recorded and reviewed.

Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff.

Managers ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. The premises and equipment in the home had been well maintained.

People had access to qualified nursing staff who monitored their general health, for example by testing blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the home.

There were policies and a procedure in place for the safe administration of medicines. Nursing staff followed these policies and had been trained to administer medicines safely.

Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the NMC.

People and their relatives described staff that were welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

If people complained they were listened to and the manager made changes or suggested solutions that people were happy with.

People felt that the home had improved. They told us that managers were approachable and listened to their views. The manager of the home, nurses and other senior managers were experienced and provided good leadership. They ensured that they followed their action plans to improve the quality of the home. This was reflected in the changes they had already made within the home.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.