We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Copper Beeches 5 Sylewood Close, Borstal, Rochester, ME1 3LL Tel: Date of Inspection: 22 May 2014 Date of Publication: July 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Safeguarding people who use services from abuse Staffing Assessing and monitoring the quality of service provision Met this standard Met this standard Met this standard Met this standard Met this standard Inspection Report Copper Beeches July

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Four Seasons 2000 Limited Ms Susan Ann Oates Copper Beeches is a care home providing accommodation, personal care and nursing care for up to 36 older people who are experiencing cognitive impairment due to dementia. Care home service with nursing Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Copper Beeches July

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 6 Our judgements for each standard inspected: Respecting and involving people who use services 7 Care and welfare of people who use services 9 Safeguarding people who use services from abuse 12 Staffing 14 Assessing and monitoring the quality of service provision 16 About CQC Inspections 18 How we define our judgements 19 Glossary of terms we use in this report 21 Contact us 23 Inspection Report Copper Beeches July

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 22 May 2014, talked with carers and / or family members and talked with staff. We reviewed information given to us by the provider. 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 with us. What people told us and what we found 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 Inspection Report Copper Beeches July

5 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? Inspection Report Copper Beeches July

6 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. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Copper Beeches July

7 Our judgements for each standard inspected Respecting and involving people who use services Met this standard People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement People expressed their views and were involved in making decisions about their care and treatment. We found that the manager used the PEARL dementia care programme approach which was developed on the foundation of engaging with people who have dementia. The PEARL approach ensured that people themselves, their family, friends and associated social workers built a person's life story and recognised what was important to them. We saw that PEARL assessments had been completed by the manager of the service and the provider's dementia care specialist. We found that relatives had been fully involved in informing the development of people's care plans. Their views were recorded in people's files. One relative told us that their views had been taken into account in relation to their relative's care plan. Recorded discussions covered all aspects of the person's life; for example a personal life history and their likes and dislikes. This meant that people's views were taken into account in relation to their care. We looked at five care files for people living with dementia. We saw that mental capacity assessments had been carried out as required under the Mental Capacity act 2005 (MCA). The MCA assessments ensured that people's rights were protected because they had led to decisions being made in people's best interest. We found that best interest meetings had been held about key decisions. For example when people required medical interventions or agreement about the care and treatments they required. For example, we saw that a best interest meeting had been held for one person because for their safety they required bed rails. This meant that people's rights were protected and that decisions about the person's care had taken account of their best interest. We observed that people were being supported to undertake activities and that these were planned and well organised. For example during our inspection some people had visited Inspection Report Copper Beeches July

8 the hair dresser and others were having their hands manicured. There was a list of planned events and people had individual activity planners; these were called "My Journal". We noted that in X's activity planner it said that they were due to visit the hair dresser and have a manicure. We observed that X had visited the hair dresser on the day of our inspection. Also, a member of staff told us that X had received a manicure. We saw that when people participated in activities that this was recorded in their activity planner. We found that other activities had been advertised within the service. For example a ladies day out and other social events. People we talked with told us that activities had taken place. One relative said "Activities are offered like gardening, connect four and jigsaws". This meant that people who used the service could choose to participate in planned activities. We observed that staff treated people with respect and were careful not to rush people when moving around the service or when making decisions. We observed that staff considered people's dementia when they offered choices. For example we observed that staff showed people the food available before they were asked to choose what they would like. We saw that staff used people's preferred name when they addressed them. We noted that staff lowered themselves so that they had eye level contact with people when they needed to talk to them. We observed a person being hoisted from their wheelchair into an arm chair in the lounge. Staff gained the person's verbal consent before they used the hoist and they explained what was happening throughout the process. For example they asked X if they could put the hoist sling onto them and asked X if it was okay to start lifting them. We observed that staff knocked on people's doors before entering their bedrooms and that people's bedroom doors were closed when they received personal care. This meant that staff respected people's dignity and privacy. We noted that people's wishes were respected. For example one person asked staff if they could stay in bed until 11am. We saw that staff respected the person's request. We noted that before leaving the person that staff made sure the person was comfortable. We observed that staff were aware of people's preferences when they offered them drinks. For example some people had china cups and other people had double handed lidded beakers. We talked with three relatives during our inspection and looked at comments made about the service by others. People we talked with said "Staff are very friendly". Another person said "The staff are very kind". During our inspection 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 with us. We found that people had a relaxed and positive relationship with the staff supporting them. We observed that staff were caring. We saw that staff spent time chatting to people if they appeared upset or unhappy. For example, we observed that a person with dementia became upset and agitated because they could not operate the door security key pad. They wanted to get to the ground floor of the service. We saw that a member of staff accompanied the person to the ground floor and they sat with them and had a cup of tea. We saw that the person was no longer agitated and upset. This meant that staff had respected the person's dignity and independence. Inspection Report Copper Beeches July

9 Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People's needs were assessed, and their care and treatment was planned and delivered in line with their individual care plan. We looked at five care plan file records. We found that they contained an initial assessment of a person's needs. The assessment process included a dependency assessment. This meant that people's individual care requirements had been recorded. The care a person had received was recorded in their care files; these records were all up to date. For example we saw that one person who was bedbound had been assessed as requiring re-positioning or turning every two hours. We saw that a turning chart was kept and that this had been completed by staff. This meant that people's care was planned and recorded. The provider may find it useful to note that the layout of the care plans used was complex and disjointed. For example staff were required to complete different sections within the care plan for the same care process. We talked with the manager about this and they showed us a new, more effective and less complicated care plan system that was being introduced. The new system enabled staff to record the care provided in one place. We saw that separate records were used to record visits or contacts with health care professionals such as the person's GP and community nursing teams. We found that the outcome of the visits had been recorded. For example we found that a health professional had recommended that a person's legs were raised when they were in a seated position. We observed that this person was sitting in a reclining arm chair and that their legs had been raised. We noted that staff had recorded this in the person's care notes. This meant that staff protected people's health and welfare because they followed health professional guidance. We saw that people's care plan files and risk assessments contained enough information to ensure that staff delivered care safely. For example we saw that each person's care file contained a Malnutrition Universal Screening Tool Assessment and Waterlow Assessment. These assessments had taken account of the risk to individuals from dehydration, malnutrition and the risk from pressure ulcers. We saw that when a risk had Inspection Report Copper Beeches July

10 been identified; that this was acted upon by staff. In one person's care file we saw that it had been recorded that they were at risk of malnutrition and dehydration. Because of this the care file stated that the person required a soft diet and that drinks must be left within the person's reach. We talked with staff about this. They confirmed that they provided a soft diet and that they understood the person's needs in relation to access to drink. We observed that this person had access to a drink within their reach. Also, we saw that the person was provided with a soft food meal at lunch time. This meant that people's care and treatment was planned and that staff followed people's assessed needs. We talked with a senior member of the staff team about how they ensured that people's care plans were kept up to date. They told us that care plans files and risk assessments were reviewed monthly or more frequently if the person' needs changed. Any changes were recorded during the staff hand over meetings. We noted that the care plan files we looked at evidenced that people's care plans had been reviewed. We found that where risks had been identified that the manager sought specialist help. For example, we saw that the risk of a person falling had been identified. The manager had made a referral to the local community falls team. They had visited the service and made recommendations about how to reduce the risk of falls. One of the recommendations was that the person should take no more than two steps to their wheelchair. We observed that when staff supported this person to transfer from their wheelchair that they did not need to take more than two steps. This meant that people's needs were kept under review and that staff cared for people safely because they understood their most up to date needs. There were a range of general and person specific risk assessments in place. For example where people required additional staff to carry out moving and handling tasks. We saw that it was recorded in one person's care plan that they required two staff when they were lifted using a hoist. We observed this person being lifted using a hoist and saw that two staff were carrying out this task. We talked with staff about this. They confirmed that they had received manual handling training and that they were following the person's risk assessment to keep them safe. This meant that staff had ensured they protected people's health and wellbeing because they were following safe manual handling practices. Most people we talked with made positive comments about the service. During our inspection we talked with three people's relatives and four staff. All of the people we talked with during our inspection were happy with the care their relatives had received. 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." This meant that people's experience of the service was generally positive and that a range of people believed that people were well cared for. We saw that the service had a procedure in place to deal with emergencies that could reasonably be expected to arise. For example, the manager had identified other places where care and support could continue if the home had to be evacuated. We saw a range of emergency numbers for emergency contractors, such as for gas leaks were easily accessible to staff. There was fire risk assessment in place. The manager of the home explained how the service would be evacuated by stages in the event of a fire. Each person had a personal emergency evacuation plan in place (PEEP). This plan took account of their needs in the event of an evacuation being required. Staff confirmed that Inspection Report Copper Beeches July

11 fire evacuation practices had taken place. This meant that the manager had a plan in place that ensured people's care could continue during and after a foreseeable emergency occurring. Inspection Report Copper Beeches July

12 Safeguarding people who use services from abuse Met this standard People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement People who used the service were protected from the risk of abuse. The service had policies and procedures in place on abuse awareness and the protection of vulnerable adults known as safeguarding. We found that the Kent and Medway Safeguarding Protocols were available in the office. These protocols provided the most up to date procedures for staff and managers to follow in the event that they needed to report abuse. The manager of the service was able to describe how they would report abuse to the local authority. We saw that the manager maintained a local authority contact list related to safeguarding. These contacts enabled the manager to seek safeguarding advice. We talked with a new member of staff about their induction. They told us that they had received training in the safeguarding of vulnerable adults when they started at the service. This member of staff told us how they would raise concerns about people's safety if they suspected or witnessed abuse. We found that other staff who worked for the service were aware of their personal responsibility for reporting concerns. We talked with two other members of staff. They told us about their understanding of the provider's policy and procedure in respect of the protection of vulnerable adults. They were able to explain to us what they would do if they suspected abuse was happening. For example they said they would tell the manager of the service or go to external agencies, such as social services. We noted that the manager and staff had used the organisations safeguarding policy in the 12 months to report suspected abuse and informed the local authority. This meant that the manager and staff had a good understanding of how they should respond to suspected or actual abuse. We saw from staff records that we looked at that staff had received training in the safeguarding of vulnerable adults. We looked at seven staff records and could see that their attendance of safeguarding training had been recorded and certificated. We also talked with several staff and they could recall their safeguarding training. They described how abuse may occur and what actions they would take. This meant that staff delivering the service understood what safeguarding was and how to recognise and report concerns. Inspection Report Copper Beeches July

13 Staff told us that they were aware of the provider's whistle blowing policy and when it could be used. For example, in situations where they had reported abuse and the provider had not responded appropriately. This meant that staff understood that they had a responsibility to escalate their concerns if they needed to. We found records that showed that staff had been checked against the Disclosure and Barring Service Records (DBS). (This was formally known as Criminal Records Bureau or CRB.) The manager told us that staff could not work with vulnerable people until they could confirm that they were suitable to work with the client group. We spoke with a new member of staff about this and they confirmed that their DBS status was checked before they started their employment. This meant that the provider had made checks on staff that ensured the people they employed were suitable to work with vulnerable people. Inspection Report Copper Beeches July

14 Staffing Met this standard There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement We found that there were enough qualified, skilled and experienced staff to meet people's needs. Prior to our inspection we had received information of concern about staffing levels within this service. A relative had told us that they had concerns because sometimes they could not find a member of staff when their relative required support. During our inspection we carried two periods of observation, one on the ground floor and the other on the first floor. These observations took place during the lunch service and at other times during the day. We also spoke to staff and people's relatives about staffing levels. We found that there were enough staff to meet people's needs safely. We observed that when people required support that this was provided promptly. For example, if people needed support to the toilet or when they had pressed the nurse call bell in their bedrooms. Also, we noted that when lunch was served that there were enough staff to ensure that people received their food and support to eat promptly. We found that there were enough staff to meet people's assessed needs. For example, where two staff were required to carry out a task safely, two staff were available. People we talked with told us that they felt that there was enough staff to meet people's needs. One member of staff said, "In my experience there are always additional staff available when we carry out manual handling task". Other staff told us that they thought that there were enough staff. Relatives said "There are usually enough staff around." This meant that staff employed to deliver the regulated activities were available to meet people's care needs. We saw that the provider had a process in place to assess the dependency levels of people who used the service. This demonstrated that the provider understood the staffing levels required to meet people's needs. For example, there were additional staff available on the first floor because people had higher dependency levels and many were cared for in bed. This meant that staffing levels across the service were consistent with meeting people's needs. We viewed five staff records. These demonstrated that the manager took account of people's skills and experience when they applied for advertised jobs. We saw that the service had used agency and bank staff or existing staff were asked to work extra hours Inspection Report Copper Beeches July

15 when additional staffing was required. For example, on occasions of staff sickness or annual leave. This meant that the manager of the service had a back-up system that ensured people's needs were met when existing staffing arrangements were not sufficient. Inspection Report Copper Beeches July

16 Assessing and monitoring the quality of service provision Met this standard The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Reasons for our judgement People who used the service, their representatives and staff were asked for their views about their care and treatment. We found that the manager used a range of methods to collect feedback from people who used the service, their representative or relatives. We saw that annual questionnaires had been sent to people who used the service and their relatives. We found that the results of the surveys were analysed. We looked at the analysed survey results and people were very complimentary about the service. For example some people had made comments such as "The care home is good". We talked with a relative and they told us that the manager was responsive to their views. For example they had asked if their relative's bedroom furniture could be moved. They said, "I can bring up issues with the manager, we asked for the bedroom furniture to be moved around, they did this for us". We found that the manager had responded appropriately to complaints people had made. For example, we followed the path of a complaint that had been made about a person having dirty finger nails. We found that the manager had recorded the complaint and discussed this with the family making the complaint to try and resolve the issue. We noted that although the manager expressed the reasons why this may have happened to the family, they also acknowledged that it was not acceptable. We noted that on the same day the complaint had been made that staff had cleaned the person's finger nails. We saw that this had been recorded in the person's care records. It stated that 'X's finger nails had been cleaned and X's nails had been manicured.' We saw that the manager had learnt from the complaint and changed the persons care plan to reflect people's comments. This meant that people could be confident that their comments about the service were listened to and that the manager responded to them positively. Inspection Report Copper Beeches July

17 We found that the manager facilitated quality residents meetings. These enabled relatives to express their views about the service. We saw that the staff team had participated in team meetings. We viewed the minutes of the meeting held in March We talked with staff about this. They told us that they attended team meetings. One said "I have attended team meetings and can put my views about the service across at these meetings". Another said, "The manager is very approachable, they listen to us." This meant that the manager provided a range of opportunities to collect people's feedback. We found that incidents and accidents were recorded and monitored. The manager of the service had made changes as a result of lessons learnt from their analysis of events. For example, they had tracked a number of behavioural incidents for one person. As a result they had increased the levels of staff input and reviewed the persons activity plans. This meant that the manager had systems in place to identify and manage risks to people's safety and welfare. Quality audits had been completed by senior staff and entered onto a computerised tracking system within the service. These audits were tracked by regional managers using a corporate tracking tool. Health and safety audits were completed monthly by a regional manager. Also, monthly health and safety meetings had facilitated changes to equipment. For example, we noted that the supplier of beds to the service had been changed. This was because the manager had highlighted issues with the current beds in the March 14 health and safety meeting. We saw that care plans and risk assessments were audited. We saw that audits covered risk assessments, incidents and accidents and complaints. For example we viewed a recent medication audit dated May 14. This meant that the provider had systems in place to assess, identify and manage risk. Inspection Report Copper Beeches July

18 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Copper Beeches July

19 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Copper Beeches July

20 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Copper Beeches July

21 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Copper Beeches July

22 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Copper Beeches July

23 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Copper Beeches July

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