The inspection took place on 5 and 7 June 2017 and the first day was unannounced.

The last inspection took place 9 and 10 April 2015.

Coppermill Care Centre provides accommodation for up to 52 older people. The service supports people with a range of needs including supporting older people living with dementia. There were 50 people using the service at the time of this inspection.

The registered provider also owned two other care services.

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.

The registered manager had been in post for approximately two months and was in the process of assessing what areas worked well and if there were parts of the service that could be improved for the benefit of people using the service.

Feedback from people using the service, relatives, staff we spoke with and professionals was positive about the service.

People’s care records included people's needs and preferences, although some of the information was generic and would benefit from being reviewed and amended to include more person centred details on how to support a person.

We made a recommendation for the provider to seek national guidance on writing person centred care plans and information relevant to the person.

Staff continued to receive support through one to one and group meetings. Although we saw no evidence that an annual appraisal had taken place in 2016, staff confirmed they had received an appraisal of their work. Training on various topics and refresher training had been arranged that were relevant to staff member's roles and responsibilities.

We saw information about people’s needs had been reviewed on a regular basis.

People had access to the health care services they needed and their nutritional needs were being met.

People received the medicines they needed safely and the registered manager had introduced a daily record for staff to record that they had counted and checked people’s medicines and associated records.

There were checks and systems in place to check the fire procedures and that equipment protected people in the event of a fire.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. There had been no safeguarding incidents since the last inspection.

There were checks on a range of areas in the service to ensure people received good care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

There was a complaints procedure available and people or their relatives felt able to raise any complaints with the registered manager.

Following our inspection that was carried out 13 July 2013, we issued a compliance action to the provider because they were not compliant with Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because we found that people's care records did not contain personalised information. They were written in a general way and did not record people's individual needs and and preferences. In addition, risk assessments did not inform staff how to minimise some of the identified risks. The provider told us that care records would be reviewed and updated and action would be taken to ensure compliance with this Regulation by the 7 November 2013.

We met with the director, the head senior and four members of staff. We also spoke with seven people who use the service and two relatives. We found improvements at this inspection visit. We viewed eight care records and they contained an assessment for the individual and where possible had been completed prior to their admission to ensure the service was able to meet their needs. The provider had introduced a new care plan format and we found these care plans contained more detailed information about people’s individual needs including their likes, dislikes and preferences. The care plans also promoted people’s independence by detailing what people were able to do for themselves so that staff encouraged people to maintain these skills. Care records had been reviewed each month and where possible people or their representatives had signed to agree their contents.

We saw that identified risks were assessed and action taken to minimise these. For example, we saw risk assessments relating to falls, nutrition, behaviour, wheelchair use, non-compliance with medication and the risk of developing pressure ulcers.

Feedback from people using the service was positive and we observed positive interactions between staff and people using the service. The two relatives were also happy with the service and told us, “they [staff] are very caring, well-meaning and helpful.” Another relative told us, “I am very satisfied.”

This scheduled inspection was brought forward as a result of concerns that were raised with the Care Quality Commission about the quality of the care provided for people using the service. Concerns were raised about poor treatment of people using the service, the quality of the food, the cleanliness of the home and the lack of activities available for people to participate in. In addition to this, concerns were raised about staffing levels, staff not responding to people's needs appropriately and staff not having the skills and experience to meet people's needs.

We spoke with nine members of staff, 10 people who were using the service and six relatives who were visiting the home. We were unable to speak with many of the people using the service as they had complex needs that meant they were unable to share their experiences with us. However, we observed care practices, reviewed records and spoke with family members in order to gain some insight into their experiences of living at the home.

We found that people using the service and their relatives were asked for their views about the service. One person said, "I made suggestions to the food committee" and another said "If I don't like something I tell the manager and he does something"

People told us about the activities they participated in. One person said, "I do bingo, we spend time in the garden and do singing activities." Another person told us, "four of us went out to the bunny park."

People spoke positively about the food provided at the home. One person said, "the food is excellent" and we received other comments such as "they give you a choice of food" and "some of it is marvellous."

Staff were able to demonstrate that they would take appropriate action if they had concerns about a person’s safety and the people we spoke with told us they felt safe. One person said, "I feel safe here, it is a smashing place, they are kind."

We found that the home had effective systems in place for managing medicines and infection control.

Staff received training and support to enable them to care for people and there were quality monitoring systems in place to ensure the home was operating effectively.

We found that care plans did not sufficiently inform staff about the action they should take to meet people’s needs. In addition to this they were not person centred and therefore were not individual to the person.

We found that there was inadequate monitoring of people’s physical condition and any injuries people sustained. Appropriate records were not maintained and people’s care plans were not updated to reflect their changing needs.

Although staffing levels were sufficient to meet people’s needs, we found that people were not supported to engage in meaningful activities during the weekend.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practicing professional.

The inspection team was led by a Care Quality Commission (CQC) inspector

joined by an Expert by Experience who has personal experience of using or

caring for someone who uses this type of service and a practising professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

At the time of inspection there were 52 people using the service. We spoke with 8 staff, 3 people using the service and 3 visitors.

This inspection took place on 9 and 10 April 2015. The visit was unannounced. At the last inspection, which we carried out on 2 January 2014, we found the service was meeting the regulations we had looked at.

Coppermill Care Centre provides accommodation for up to 52 older people. The service supports people with a range of needs including supporting older people living with dementia. There were 40 people using the service at the time of the inspection.

There was a registered manager in post who had worked in the home for approximately 11 years.

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 were able to see their friends and families when they wanted. Visitors were seen to be welcomed by staff throughout the inspection. Comments from people using the service were positive and included, “It’s very good here. Better than in hospital. I’m looked after extremely well, couldn’t be better.” Another person told us, “It’s absolutely lovely here.” The views of the relatives and visitors that we met were also favourable and they spoke highly about the staff and care in the service. One visitor said, “My mother was treated very well here. She loved it here. I want the place recognised for what it is.” Staff also gave their feedback about the service and confirmed that they felt they could go to the registered manager if they had a query or wanted to give feedback about the service. One staff member said, “the training is good”, whilst another told us the people using the service do get choices about their daily lives.

People were encouraged to take part in both group and one to one activities. Trips out of the service were offered as well as a holiday. There were four activity co-ordinators employed and they ensured the activities were pitched at people’s understanding and interests.

There were enough staff to meet the needs of people using the service. Staff received appropriate training and support and the registered manager ensured their skills and knowledge were kept up to date. People told us, and we saw that staff had built up good working relationships with people and were familiar with their individual needs and preferences.

There were recruitment procedures and checks in place to ensure staff were suitably vetted before working with people. The staff we spoke with were able to tell us the action they would take to ensure that people were protected from abuse. Staff had received training about safeguarding and records were kept of any concerns or complaints along with the outcome.

The care records we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. People were registered with a local GP and records showed that people saw a GP, dentist, optician, and chiropodist as needed.

Medicines were well managed. Safe and robust systems for medicines were in place, so that people consistently received their medicines safely and as prescribed.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). DoLS are in place to ensure that people’s freedom is not unduly restricted. Where people were at risk and unable to make decisions in their own best interest, they had been appropriately referred for assessment under DoLS. People’s capacity had also been considered and assessed to ensure staff supported people where possible to make daily choices and decisions.

People had a choice of meals and staff were available to provide support and assistance with meals. Where food and fluid intakes were being recorded for some people, the results were being effectively monitored. Staff referred people for input from healthcare professionals when required.

There were systems in place to monitor the quality of the service being provided and staff met regularly as a team to look at what was working well and where improvements could be made to ensure people received a good caring service.

The expert by experience commented that they had “witnessed a very friendly relationship between staff and relatives/visitors with some banter between staff and relatives/visitors, which was evidence of a warm, friendly and relaxed atmosphere.”