The inspection was carried out on the 13 December 2018. The inspection was unannounced.

Copperfield’s residential home is ‘care home.' People in care home services receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation was provided over three floors. A lift was available to take people between floors. Residential accommodation and personal care were provided for up to 20 older people. There were 14 people living in the service when we inspected. Some people had memory loss or health issues associated with ageing or were living with dementia. There were four people with a learning disability.

We carried out our last comprehensive inspection of this service on 21 March 2018 and we gave the service an overall rating of ‘Requires Improvement.’ After this inspection we received information of concern relating to the safe management of medicines, the management of people’s finances, moving and handling practice, safeguarding employment checks on new staff and the management of incidents and accidents. Therefore, on 17 May 2018 we carried out a focused inspection. At that inspection we inspected the Safe and Well Led domains. After the focused inspection the Safe and Well Led domains were rated ‘Inadequate’. This changed the overall rating for the service to ‘Inadequate’. We asked the provider to tell us what actions they would take with time scales to meet the Regulations.

At our last comprehensive inspection of this service on 21 March 2018 we found three breaches of the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to Regulation 12, safe care and treatment - known risks were not always assessed and minimised. Regulation 17, good governance - quality monitoring systems were not fully effective. Regulation 18, Staffing - the provider had not ensured that staff had completed or had regular training to be effective in their role. At our focused inspection of this service on 17 May 2018 we found two breaches of the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014. The first breach related to Regulation 12, safe care and treatment - there was a failure to manage medicines and infection control risks safely. The second continued breach related to Regulation 17, good governance - the provider's audit systems were not operated effectively to assess and monitor the quality and safety of the service provided.

The provider sent us an improvement action plan telling us how they intended to meet the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014. They told us they would meet the regulations by 30 November 2018.

The service had been in breach of Regulations and rated as Inadequate or Requires Improvement for three inspections since 31 January 2017. At this comprehensive inspection we found improvements had been made. The provider was now meeting Regulations 12 and 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. However, the improvements we found had not fully bedded in at the time of this inspection to demonstrate to us that the provider and registered manager could sustain the improvements they had been making. Therefore, the overall service rating has moved from ‘Inadequate’ to ‘Requires Improvement.’

In November 2018, the provider and the registered manager had started to use a computerised quality audit management system. The provider and registered manager implemented plans to improve the service.

Since our last comprehensive and focused inspections, the registered manager and provider had worked with a consultant who specialised in mentoring social care services to improve their management oversight, auditing the risks systems.

Since our

The inspection was carried out on 17 May 2018. The inspection was unannounced.

Copperfield’s residential home 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. The service is registered to provide care and support for up to 20 people. There were 15 people using the service at the time of our inspection, who were living with a range of health and support needs. These included diabetes and dementia. Some people had mobility difficulties, sensory impairments and one person received their care in bed. The accommodation was provided over three floors. A lift was available to take people between floors.

There was a registered manager in post. 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. The provider and the registered manager assisted us during the inspection.

At the last comprehensive inspection on 21 March 2018, the service was rated requires improvement overall. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Copperfield’s residential home on our website at www.cqc.org.uk.

We undertook this focused inspection because we received allegations of concern about the service made by former staff. The allegations of concern related to the safe management of medicines, the management of people’s finances, moving and handling practice, safeguarding checks on new staff and the management of incidents and accidents. We checked to see if the service was Safe and Well led. This report only covers our findings in relation to those requirements.

At the time of this inspection, to safeguard people we were working in liaison with other agencies. The local authority had visited the service to check on people’s safety and care. The police had been investigating some of the allegations about the management of people’s finances. The police had also carried out an investigation into possible links between a fall a person had in the service and their subsequent death. We also used our powers under Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to look at this during this inspection.

At this inspection we found people were not at serious risk of harm. The registered manager and provider were still in the process of reviewing and acting upon the findings from our comprehensive inspection on 21 March 2018. At this focused inspection we could not corroborate all of the allegations we had received. However, we found medicines were not managed to minimise the risks of harm. Medicines were not audited by the registered manager or provider to check if people had received their medicines as prescribed. When people’s medicines had been changed, the changes were not appropriately recorded on medicine administration records (MAR’s). Medicine counts could not be audited back to the prescription amounts.

There was a lack of organisational oversight into auditing medicines.

Risks assessments had been updated and were in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. However, the information recorded for staff to follow in people’s risks assessments did not always match other information in peoples care plans. We could not be sure that people were not at risk of potential harm from staff using incorrect methods of care. Also, not all risks were mitigated by actions to reduce risks.

The premises and equipment in the service was clean, odour free and main

This unannounced comprehensive inspection took place on 21 March 2018.

Copperfield’s residential home 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. The service is registered to provide care and support for up to 20 people. There were 15 people using the service at the time of our inspection, who were living with a range of health and support needs. These included diabetes and dementia. Some people had mobility difficulties, sensory impairments and one person received their care in bed. The accommodation was provided over three floors. A lift was available to take people between floors.

At our last inspection on 31 January 2017, the service was rated ‘Good’ in the Effective, Caring and Responsive domains and ‘Requires improvement’ in the Safe and Well Led domains. The overall judgement rating for the service was ‘Requires Improvement’ and we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 12 Safe care and treatment. This was because we found that the risks from fire were not adequately mitigated by the procedures and control measures in place within the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question, safe, to at least good. We received an action plan dated 14 April 2017, which stated that the provider has met the regulation on 13 April 2017. At this inspection we found improvement had been made to this area. However, we identified other issues which needed to be addressed to protect people's health, safety and well-being.

At this inspection, we found the service remained ‘Requires Improvement’.

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 2008 and associated Regulations about how the service is run.

People's safety had been taken into account regarding fire safety. The service had been inspected by the Fire services and there was a fire risk assessment carried out. Fire fighting equipment was in place and regularly maintained.

There were no assessments about choking for people who were known to be at risk, and no guidance for staff about actions to take in the event of a choking incident. Assessments about other types of risk however, were detailed and offered staff advice about reducing the likelihood of them happening.

Recruitment procedures were not always followed in line with the provider's policy. This meant effective checks were not completed before new staff began their employment.

People were not always supported by staff who had consistently received the necessary training to fulfil the role of the work they were employed to do.

Quality assurance processes had not picked up and addressed the issues we found during this inspection. The shortfalls identified during the inspection were not known to the registered provider as they had not identified them as part of their own monitoring systems.

Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

People told us they received their medicines as prescribed and staff ensured that medicines were recorded as given at the time of administration.

There were enough staff to keep people safe. The registered manager had appropriate arrangements in place to ensure there were always enough staff on shift.

The Care Quality Commission is required by law to moni

The inspection was carried out on 31 January 2016 and was unannounced.

The home provides accommodation and personal care for older people, some of whom may be living with dementia. People’s needs varied, but people had predominantly low to medium needs. Only one person required the use of a hoist due to their physical mobility needs. The accommodation was provided over two floors. A lift was available to take people between floors. There were 14 people living in the service when we inspected.

At the previous inspection on 15 December 2015, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in relation to people’s care not always taking account of the recommendations made by health and social care professionals. The provider sent us an action plan telling us what steps they would be taking to remedy the breaches in Regulations we had identified. At this inspection we checked they had implemented the changes and we found improvements.

There had not been a registered manager employed at this home since 25 August 2016. 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 had appointed a manager who had been in post since July 2016, but they had not registered with CQC at this inspection. Not registering a manager with CQC limited the providers rating or this home to requires improvement. We have made a recommendation about this.

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 an application had been made to the appropriate supervisory body as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made.

People’s care was delivered safely and staff understood their responsibilities to protect people living with dementia from potential abuse. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The premises and equipment in the home was clean, odour free and maintained to protect people. Safety systems in the home, like fire alarms, were serviced by an engineer and tested to ensure people’s safety. Risk within the home had been assessed and maintenance issues were reported and dealt with in a planned and timely manner. However, the fire procedure in place advocated a ‘stay put’ policy. Staff were aware of the procedure, but did not know how to use the evacuation chair that had been placed on the first floor. Also, the most recent fire risk assessment completed by a qualified consultancy company did not identify any additional protections needed for people who may not be able to evacuate the premises quickly. We have referred this to the fire service.

The manager involved people in planning their care by assessing their needs prior to and after they moved into the service. People were asked if they were happy with the care they received on a regular basis.

The structure of the staff team had changed since our last inspection. Care staff were now supported by other staff who did the cleaning and laundry. There was a new cook and most of the care staff team had been recruited since our last inspection. When new staff started working at the home, they received a five day induction and followed a recognised pathway of basic training to gain the skills required to meet people’s needs. We observed that staff knew people well, staff displayed a kind and caring attitude and people had been asked about who they were an

The inspection was carried out on 15 December 2015 and was unannounced.

The service provided accommodation and personal care for older people, some of whom may be living with dementia. People’s needs varied, but tended to be low to medium. The accommodation was provided over two floors. A lift was available to take people between floors. There were 16 people living in the service when we inspected.

There was registered manager, but at the time of this inspection, they were 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, a new manager had been appointed and they had submitted an application to register with CQC on 14 December 2015.

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 involved people in planning their care by assessing their needs prior to and after they moved into the service. People were asked if they were happy with the care they received on a regular basis. However, people were not always receiving the care recommended by health and social care professionals who had the skills, knowledge and experience for assessing particular task to ensure people’s needs were met.

Staff knew people well and people had been asked about who they were and about their life experiences. This helped staff deliver care to people as individuals.

People were safe and staff understood their responsibilities to protect people living with dementia. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The provider, manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed and management plans implemented by staff to protect people from harm.

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

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

We observed and people’s relatives described a service that was 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.

Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. The risk in the service 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 they happen people’s care needs would continue to be met. The premises and equipment in the service were well maintained.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The manager ensured that they employed enough staff to meet people’s assessed needs. Staffing levels were kept under review as people’s needs changed.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink.

If people complained they were listened to and the manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

The service was well led. The provider consistently monitored the quality of the service and made changes to improve the service, taking account of people’s needs and views. The manager of the service and other senior managers provided good leadership. The provider and manager developed business plans to improve the service. This was reflected in the positive feedback given about staff by the people who experienced care from them.

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.

At the scheduled inspection on 17 April 2013 we found that various records were not being completed or updated appropriately. At a follow up inspection on 25 November 2013 we found that the home was still not compliant and therefore people remained at risk of not receiving appropriate care and welfare. We issued a warning notice following that inspection and undertook a further follow up inspection on the 4 March 2014.

During this inspection we found that documents were now up to date, they were being completed accurately and contained more detail. In respect of people’s individual care and support we found that people’s care was provided as agreed and reviewed at least monthly. Records showed that any health issues were followed up with health professionals and their recommendations were followed by staff.

This meant that people's personal records were now accurate, fit for purpose and any risk regarding poor record keeping had been reduced.

People’s personal records were not accurate and fit for purpose.

At the last inspection on the 17 April 2013 we looked at a variety of records which included care plans, daily records, medication charts, staff records, and policies and procedures. We saw that records were not always kept up to date, or completed in enough detail. This meant peoples care and support could be compromised.

The provider sent us an action plan in response to our visit, within the agreed timescale. This set out how the provider would ensure on-going compliance and the timescales for completion.

During this inspection we found that not all the plans of care had been dated or signed by staff and the person who used the service to show they had been agreed with. We also saw risk assessments that had been undertaken but the management strategy to minimise the risk was not documented. Some risk assessments were not available on file, for example we saw no detailed mobility and skin integrity risk assessments and no management strategy for one person who was prone to pressure sores. This meant that both people who lived in the home, and staff could have been put at risk of harm.

We found that the daily records contained information such as people’s personal hygiene care, their general health. However, the details within the daily reports were not consistent. For example, we saw some staff recorded if one person sat in her chair in the afternoon as had been requested by the district nurse while others didn’t. There was no reason given why the person had not sat out in the chair if that was the case. Often there was little detail recorded so it was difficult to see if the support given by care workers cross referenced with the care plans. This meant people may not have received the care that had been agreed with them or requested by health professionals.

We saw fluid charts for one person, which had not all been completed fully. for example with the person’s name and date. The amount recorded had not been added up daily and it was not clear if staff recorded all the fluids the person had drunk. On one sheet it showed the person drank only 100mls, another day it added up to 700mls. We also noted that the amount recorded were 100 or 200mls in most cases, we queried if this was the amount given rather than the amount drunk. The amount showed that the person was not drinking sufficient fluid to stay hydrated. No action had been taken or recorded to show this had been addressed. The lack of accurate records meant that people could become dehydrated.

We saw that policies and procedures were available, these had been reviewed in January to ensure they remained up to date and in line with any new regulations or guidance changes.

The inspection visit was carried out by one Inspector and lasted for five hours. During this time we viewed most areas of the home, and spoke with the provider, the manager, and three other staff. We met and talked with six people living in the home, and looked at a variety of records.

We found that the home had a relaxed and friendly atmosphere, and people said that they liked living there. People said they were comfortable living at Copperfield. They told us they had been involved in discussions about the help they needed and their preferred day to day routines. They said that the staff supported them as needed and looked after them well.

We found that the home had reliable staff recruitment processes in place.

People said that the home was always kept clean and smelled fresh.

People said they knew who to speak to should they have any concerns, but said that they had no complaints.

Comments from people that used the service included “I can get up and go to bed when I want”, “The staff are very good, they are always there to help and I have meals in my room when I don’t feel like going down stairs”

We found that not all the records kept by the home were signed and dated and some information could have been more detailed. Peoples’ personal information was kept securely.

The planned review included a visit to the service, together with following up on the findings from our previous visit in December 2011. Therefore, part of the purpose of the visit was to assess if action had been taken to carry out improvements that had been highlighted at our last visit.

People said they liked living at Copperfields Residential Home. People said there were different activities to do and that they could join in with activities if they wanted to. They said they were happy with the support they received, that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. They said that the home was always kept clean and smelled fresh. People said they knew who to speak to should they have any concerns, but said they had no complaints.

People said they liked living at Copperfields Residential Home. People said there were different activities to do and that they could join in with activities if they wanted to. They said they were happy with the support they received, that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. They said that the home was always kept clean and smelled fresh. People said they knew who to speak to should they have any concerns, but said they had no complaints.

People living in the home said that staff were kind and caring and there was enough of them. They said that recently agency staff were being used and one person said ‘the staff keep changing, don’t get to know them much, lots of different faces’. People said they were attended to promptly if they needed assistance and that they received their medicines at the right time.