Inspection on 15/06/09 for Pinehaven

This is the latest available inspection report for this service, carried out on 15th June 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pinehaven 31/07/07

Pinehaven 11/10/06

Pinehaven 27/02/06

Pinehaven 07/09/05

Pinehaven 08/03/05

Pinehaven 20/12/04

Pinehaven 17/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Pinehaven 23 Parkwood Road Boscombe Bournemouth Dorset BH5 2BS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Heidi Banks     Date: 0 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Pinehaven 23 Parkwood Road Boscombe Bournemouth Dorset BH5 2BS 01202427941 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): pinehaven@sfht.org.uk The Stable Family Home Trust Name of registered manager (if applicable) Mrs Carole Titley Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The service user to be accommodated in the second floor room must not be dependent on staff for means of their escape in the event of a fire. Date of last inspection Brief description of the care home Pinehaven is registered to provide accommodation and care for up to nine adults whose primary need is a learning disability. The registered provider is the Stable Family Home Trust (SFHT), a registered charity which also runs other residential and day services in the area. Pinehaven is a detached house located in a suburb of Bournemouth. It is within walking distance of the shopping areas and local amenities of Southbourne and Boscombe. There is good access to public transport including the railway station at Pokesdown. Accommodation is provided in single bedrooms with communal lounges, a dining room and a kitchen. There is a garden at the rear of the property and a tarmac area at the front which provides off-road parking. The home Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 9 Brief description of the care home has told us in their Annual Quality Assurance Assessment that basic fees for the service start at 441 pounds per week. Fees are charged according to assessment of individual needs. Further general information on care homes fees and fair terms of contracts can be obtained from the Office of Fair Trading whose website is at www.oft.gov.uk. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Pinehaven which was carried out over two separate days, 15th June 2009 and 2nd July 2009. The majority of the inspection was carried out by one inspector. However, on the second day the inspector was accompanied by an Expert by Experience, Mr Jeffery Osborne, from Bristol and South Gloucestershire People First and his supporter. Experts by Experience is a project that involves people who use services in the inspection of those services. Their role as part of the inspection team is to help us get a picture of the service from the viewpoint of the people who use it. Although most of the inspection was carried out by one person the term we is used throughout this report to indicate that the report is the view of the Care Quality Commission. As part of this inspection we requested that surveys were distributed to people who use and have contact with the service. We received a total of thirteen surveys in response, three from people who live in the home, four from relatives of people who Care Homes for Adults (18-65 years) Page 6 of 35 use the service, five from care workers employed by the home and one from a health care professional. We also made contact with another health care professional as part of our inspection. Peoples views about the home have been included throughout this report. During our inspection we looked around the premises and spent time talking to people who use the service about their experience of living there. We also spoke to some of the staff who support them and observed life in the home. We looked at a sample of records which included information about people who use the service, recruitment and training records for staff, health and safety records and medication records. We received the homes Annual Quality Assurance Assessment when we requested it. This gives us some written information and numerical data about the service. A total of 23 standards were assessed at this inspection. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection we have made four requirements. These are things the home must do to ensure peoples safety and comply with the law. At the time of the inspection the home was aware that they needed to respond to the changing needs of one individual and were liaising with appropriate professionals to identify a way forward. We identified a need for a comprehensive risk assessment to be drawn up to ensure that suitable measures are put in place to promote the persons safety in their home and community. Care Homes for Adults (18-65 years) Page 8 of 35 Improvements must be made in relation to medication practices. Although medication is checked on a regular basis by the home, the checks identified that people are not always given the medication they are prescribed and medication is not always signed for. This must be addressed to ensure that people get the medication they need and that record-keeping is robust. Although some work has been done towards making the home more accessible in order to meet the needs of one person with mobility difficulties we noted that more work needed be done in this area. This will help ensure that the individual can mobilise safely and be as independent as possible in their home. On our visit to the home we also found that the refrigerator was not working properly. The home must take action to address this to ensure that food is stored within safe temperatures and to ensure people are not put at risk. We have also made some recommendations as a result of this inspection. These are in relation to the home environment, infection control practices, health and safety procedures and staff training. Recommendations are based on good practice and should be given serious consideration by the provider to ensure best outcomes for people are achieved. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sound systems in place to ensure that admissions to the home are well planned and that prospective residents have their say in the process. Evidence: Since the last inspection of the service in July 2008 there has been one person admitted to Pinehaven. At the last inspection we saw that the admissions process was underway and the home had been provided with an assessment of the individuals needs from the local authority. The person had also been given opportunities to stay at the home before they were admitted. Residents at Pinehaven told us that they had been consulted about the individuals planned move to the home. Surveys we received indicated that people who live at Pinehaven had been asked if they wanted to move there and had received enough information about the home before they moved in so they could decide whether it was the right place for them. We also saw evidence on file of a review being carried out after approximately three months of a person being admitted to the home as a way of checking that all parties were satisfied with the arrangements in place. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a very person-centred approach to the delivery of care. People are given the support they require to lead full and meaningful lives which respects their individuality and right to make choices. Evidence: At the last inspection of the service we repeated a requirement in relation to care planning as the regulations had not been fully met. At this inspection, we looked at three care plans for people who use the service. We found that each plan contained useful information about the individuals personal, health and social needs including aspects of care where they need support from staff and where they can manage independently. Individuals preferences had also been documented so that care staff know how they would like to be supported with their personal care. We saw evidence of plans being updated where there were changes in peoples needs. Care plans had been signed by the service user, their key worker and the home manager and clearly dated. Although care plans have been signed by service users to indicate their agreement with the content we would suggest that the home looks at ways to make Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: the care plans more accessible to each individual so that they are in a format that can be fully understood by them. We looked to see how people who use the service are supported in making decisions about their lives. It was clear from observation of life in the home and discussion with people who use the service that people are given many opportunities to have control over their lives. We saw evidence of regular residents meetings being carried out, these demonstrating a high level of consultation with residents about life in the home. People who use the service also told us in surveys that they were able to make decisions about what they do. We also saw evidence of people being supported to manage their finances in different ways according to individual needs and capabilities. This included one person who is being supported to take control over their money with appropriate support as needed. The homes success in giving people opportunities to have their say was noted by a care professional who, following a review meeting, commented that their client clearly felt in control and empowered to put his views across which I thought was great to see and hear and a very different experience for him. Discussion with care workers and the manager of the home indicated that there is an emphasis on a person-centred approach to care. Care workers told us that things the home did well include; Promotes a level of independence for the residents, tries and succeeds in meeting each individuals needs; Ensure everyones individual needs are met and everyone is happy; The home works in a person-centred way and caters to the many diverse needs of the individuals extremely well. This was echoed by relatives of people who use the service who told us X is treated as an individual; The service provides X with all his needs and supports X 100 . Observation of life in the home and discussion with people who use the service indicated that they are supported to take positive risks in order to lead ordinary lives. It was evident that where people want to have more independence, for example with regards to the management of their money, this is responded to positively by the Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: home. Discussion with the manager indicated her awareness of there being a fine balance between promoting independence and ensuring people are given the support they need and she gave an example of a strategy in place to support a resident with maintaining a safe and clean bedroom environment. It was evident that the home had given careful consideration to how they could support the individual concerned without encroaching on his desire to be independent. The care plans we looked at identified where risks existed and the actions staff should take in order to minimise the risk of harm to the person concerned. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Pinehaven pursue fulfilling and meaningful activities that meet their lifestyle needs. Their rights to live an ordinary life are given a high priority and they are given opportunities to contribute to their home and participate in their community. Evidence: The majority of the residents we met at Pinehaven attend a day service which is run by the Stable Family Home Trust. People we spoke with told us they enjoyed this and it gave them the opportunity to make friends and meet other people. Two people who live at Pinehaven have individual support hours to provide them with home and community-based activities to meet their needs. It was evident from the records we looked at and our observation that a range of activities were planned with them including drama sessions at a local arts centre, trips to town for shopping, lunch and coffee, walks to the beach, trips to a firework display and arts and crafts. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: Discussion with the manager and people who use the service indicated that as well as attending day services individuals have been supported to identify college courses and work placements to pursue their interests. This has included work experience at a local football club for a person who is particularly passionate about football, voluntary work in a charity shop and a college course in animal welfare for a person who wants to work with animals. We noted that the home has computer facilities for use by the people who live there which includes a large screen and large, colourful keyboard for individuals who find this easier to use. The home has also recently purchased a Nintendo Wii at the request of residents for them to use in their leisure time and there is a large trampoline in the garden for residents use. Discussion with people who use the service, the manager and the staff team indicated an awareness of peoples rights and individuality. Observation showed that people have access to all communal areas of the home and can access their bedrooms as they wish. Emphasis is placed on individuals bedrooms being their own personal space although the manager gave us an example where an agreement had needed to be reached for staff to have access to a persons bedroom to promote their welfare and support them with their responsibilities. Discussion with people who use the service indicated that they have opportunities to make friends and form relationships which was clearly important to them. People spoke of having contact with their families and it was clear from discussion with the manager that the home works hard to respect individuals confidentiality while promoting the involvement of the family where this is the service users choice. At the time of the inspection a number of people were making arrangements to celebrate their birthdays at the home. It was clear from our discussion with them that they were able to choose how they were to celebrate their birthdays and the people they wanted to invite. People spoke excitedly about their party plans which they had taken the lead in organising. People we spoke with told us that they had input into the weekly menu and a person whose birthday it was on the day we visited had chosen that evenings meal. We saw a menu for the week on display in the kitchen with pictures to aid understanding. People we spoke with told us they liked the food they were offered but if they wanted to choose something different this would not be a problem. Residents told us they particularly enjoyed barbecues in the garden and it was clear from discussion and observation that this was something that they are given the opportunity to do on a regular basis. We observed one person helping staff prepare a salad during the inspection, the individual concerned telling us they had studied cookery at college and enjoyed doing this. Care Homes for Adults (18-65 years) Page 16 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that peoples personal and health care needs are met through liaison with appropriate professionals and effective communication. There are systems in place to promote the safe administration of medication but some aspects need review to ensure that there is consistent evidence of good practice. Evidence: We looked at the care plans for three people who use the service all of which gave us some information about how individuals want to be supported with their personal care routines. The people we met during the inspection told us that they were happy with the support they received from the home and this was echoed by their relatives, the majority of whom told us in surveys that the home always gave their family member the support that they would expect with one indicating that this was usually the case. The care plans we looked at also contained information on peoples health care needs including appointments attended by each individual. It was evident from reading the care plans that people are supported with visits to their doctor, dentist, chiropodist, optician and hospital. In addition it was apparent from discussion with the manager and review of peoples records including the homes diary that health care Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: professionals visit the home where individuals require specific input with occupational therapy, nursing and physiotherapy needs. We also saw that the home had been proactive in responding to a resident who they felt would benefit from counselling and assertiveness coaching and had referred this need to the psychology team who had provided this support. We received one survey from a health care professional who told us that they felt the home always respected peoples privacy and dignity in the delivery of care and that the home always sought advice and acted on it to meet peoples needs. Another health care professional who we had contact with during the inspection process told us; The home continues to provide good support to the individual we are involved with. They take on board all that we say and have been instrumental in supporting the client...with a very good result. We discussed with the manager current strategies in place to support one person who lives in the home who has a tendency to wander. This involves use of a wristband and alarm system at night to enable staff to know if the individual leaves the home. It was evident from our discussion that the home was making contact with appropriate professionals to ensure their awareness of the persons changing needs. We were told that a review was due to take place the following week for the person concerned which would be an opportunity to discuss risk management strategies including a review of staffing levels. We are making a requirement that a full risk assessment is put in place which takes account of the individuals needs, potential risks and management strategies to ensure their safety and welfare in the home and community in the least restrictive way possible. Medication in the home is stored in a lockable metal cabinet which is fixed to the wall of the laundry area. There is a separate storage facility in place for controlled drugs. We noted that as well as basic training for staff which is provided either in-house or by the local pharmacy there is also a competence assessment process which staff have to go through before they are deemed competent to administer medication. The manager told us that this process is reviewed annually. The manager told us that she had recently done some research into available training on medication and was looking to implement training that she felt would be most effective in meeting peoples needs. We saw that medication is provided by a local pharmacy who also provides the medication administration record (MAR) charts for staff to record when medication is administered. A book for the recording of controlled drugs was also seen to be in place. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Medication stored in the cabinet had been separated into individual boxes which were clearly named and labelled. The manager told us that this has made it easier for staff to identify peoples medication. A system is in place to ensure that a medication that is needed by a service user during the day when they are at day service is signed over to staff at the day service and we saw written records to evidence this. We noted that where creams had been opened the date of opening had been recorded. The manager told us that a system for auditing medication is in place. This takes place on a monthly basis and is undertaken by a senior support worker. We looked at a sample of audit records which indicated that there have been incidences where the amount of medication left in a box has not corresponded with the medication administration record. This suggests that staff may be signing for medication which they have not administered. We also identified gaps in the medication administration medication where staff have not signed for medication that has been given. In addition we noted handwritten instructions on medication administration records that were not double-signed. The manager told us that the outcome of audits is discussed with staff in team meetings. We are making a requirement for the home to ensure that people who use the service always receive the medication that is prescribed for them and that medication is always signed for at the time it is administered. The home must also ensure that any handwritten instructions on the medication administration record are double-signed by staff to confirm their accuracy. We saw an incident record where advice needed to be sought from a health care professional about a medication error. Appropriate action was taken by the home to respond to the error and ensure the well-being of the service user concerned. However, this was not reported to us at the time of the incident. We told the manager at the inspection that she must ensure that medication errors are reported to us under Regulation 37. Since our discussion with the manager on this issue she has ensured that we have been notified appropriately of incidents. Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has sound systems in place to respond to concerns, complaints and safeguarding issues. This means that people in the home are able to have their say about the care they receive and know that their concerns will be responded to appropriately. Evidence: A record of compliments, concerns and complaints is kept at the home. We saw that where issues had been raised with the manager these had been responded to and the outcome documented on file. All three people who use the service who responded to our survey told us they knew who to speak to if they were not happy. They also told us that they knew how to make a complaint and this was echoed by relatives who also indicated their awareness of this procedure. Relatives of people who use the service and a care professional who has contact with the home also told us that the home had responded appropriately to any concerns they had raised. All care workers responding to our survey told us that they knew what to do if someone using the service or their relative had concerns. Just prior to the inspection the manager notified us of an adult protection concern involving a person who uses the service. She also notified us of another safeguarding issue which occurred during the timeframe of the inspection. The incidents had been reported to the relevant local authority for investigation. We made contact with one local authority who told us that the home had responded appropriately to the issue Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: and had put a protection plan in place for the individual to promote their safety. We noted on care workers records that staff receive training on the protection of vulnerable adults so that they know what action to take to keep people safe. Care Homes for Adults (18-65 years) Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pinehaven provides a comfortable and homely environment for people to live in. There was evidence that people are consulted about changes in the home and involved in decision-making. However, improvements are needed to ensure the home is accessible to people with mobility difficulties. The home would also benefit from a more proactive approach to infection control, redecoration and maintenance so that people live in a smarter environment that minimises risks for them with regards to cross-infection. Evidence: At the last inspection of the service in 2008 we identified that the home had made a number of changes to the premises to improve the environment for people who live there. This included a new kitchen and dining area and appropriate wash hand basins instead of kitchen sinks in two peoples bedrooms. The manager has told us that gradual refurbishment of the premises has continued over the past twelve months with new carpets and new shower and toilet facilities being put in place to improve the home environment. We saw records to evidence that a system is in place by which the premises are checked by a member of staff on a regular basis and any issues reported. We also observed that the home has access to a maintenance worker who can carry out tasks around the home to ensure it remains in a state of satisfactory repair. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: We looked in a number of peoples bedrooms which showed us that the home enables individuals to personalise their space with pictures, posters and items of their choice. The manager told us that people who live in the home have a say in how their bedroom is decorated. The expert by experience told us that they thought this was positive as by having their rooms personalised it makes them feel like a home not like a hotel room. People we spoke with expressed satisfaction with their bedrooms. Between the first and second days of our inspection we noted that one communal room on the ground floor had been redecorated and adapted into space for people to use the Nintendo Wii game that had been purchased. It was evident that people who use the service had been involved in this decision. Our tour of the premises indicated some issues which need to be given consideration in the homes maintenance plan. We observed that some doorways, skirting boards and paintwork around the home were scuffed. We were aware that some of this damage is incurred by use of a wheelchair around the ground floor of the home as the doorways can be difficult to navigate. Accessibility within the home was an issue that was also raised by a health care professional we had contact with, a care worker and the expert by experience. The expert by experience commented that more work needed to be done in this area in order to promote the persons independence in and around the home. Other comments we received included; (What the home could do better) Better facilities for wheelchair access ie. pushing through doorways can be tough (care worker); From an environmental point of view the house is not particularly wheelchair friendly around the kitchen. The corners are quite tight but that is the nature of the building (care professional). We also observed a member of staff attempting to support the resident concerned with accessing the kitchen from the garden through the rear entrance to the home. This presented some difficulties which meant another entrance had to be used. The manager told us at the inspection that accessibility was being reviewed by the home with a view to enabling level access into and from the premises. We have made this a requirement to ensure that the persons needs continue to be met by the service. The home has a garden to the rear of the property which has a patio and seating area, Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: a brick barbecue facility, a trampoline and goal nets for residents who wish to play football. We observed residents choosing to sit in the garden when they came home from day services. The expert by experience observed that the lawn in the garden was very uneven in parts and it is recommended that this is looked at by the home to minimise the risk of falls. The expert by experience who also looked at the homes premises told us that in their view the home was clean and tidy. However, they thought that some of the bath and shower rooms they saw would benefit from redecoration. Feedback we received from people who live in the home was mixed in relation to the cleanliness of the home. One person told us that the home was always clean and fresh, two people told us this was only sometimes the case. One resident commented; Sometimes the home is a little bit dirty and untidy. We are making a recommendation that the home keeps this under review to ensure that residents live in a home that is clean and fresh. On our tour of the home we looked in two communal toilets. We saw that liquid soap was available in both. Both toilets had paper hand towels and also fabric hand towels. We advised the manager that fabric hand towels were not recommended in communal areas due to the risks presented by cross-infection. The manager told us that they like having fabric hand towels and that they are changed on a daily basis. We are making a recommendation that the home reviews this in line with best practice in infection control procedures. We also noted on our tour of the premises that the flooring of the laundry area had been damaged by the opening and closure of a door. This had led to the wearing way of the floor in this area. We advised the manager that this presents an infection control risk and the flooring should be repaired so that it provides an unbroken and impermeable surface. Again we are making a recommendation for the home to address this issue. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has sound recruitment procedures that ensures prospective care workers are safe to work with vulnerable adults. A framework for training and development is in place so that staff are able to access the training they need to understand and meet peoples needs. Evidence: We looked at the records for three care workers who had been recruited to work in the home since the last inspection. In each case the home had obtained sufficient information about the individual before they started work in the home including proof of identity, two written references and a check with the Criminal Records Bureau (CRB). In one case the evidence that a CRB check had been undertaken was not on the persons record in the home and had to be e-mailed across to the manager by the organisations Head Office. This was done at the time of the inspection. The manager is reminded to ensure that evidence regarding peoples recruitment checks is maintained in the home in line with the regulations. All care workers responding to our survey indicated that the home had undertaken relevant checks on them before they were allowed to start work. We saw evidence on file of care workers undertaking an induction programme that meets the Common Induction Standards. A care worker we spoke with confirmed that Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: they had received induction training when they started in post. Out of the five staff who responded to our surveys, three indicated that they felt their induction covered what they needed to know very well with two people telling us this was mostly the case. We also saw evidence that new care workers undergo a three month probation period at which point their performance and suitability for the role is reviewed with them. Records showed that people are given supervision on a regular basis with the manager and this is an opportunity for training needs to be identified. We noted that one person who had started in post without previous experience of care work had attended a number of courses relevant to their role. On another persons record it was stated that they had been offered training in epilepsy but had declined this as they had done epilepsy training in their previous employment in 2007. We talked to the manager about the need to make sure that people are trained to a consistent standard and be updated on a regular basis. She told us that this individual had recently commenced working as a permanent member of staff and would be receiving training from the Stable Family Home Trust in the near future. We discussed with the manager that people who live in the home present with a range of different needs and therefore there is a need to ensure that training is provided to meet these needs. The manager told us that she uses team meetings as a forum for discussion on various topics and was making links with various organisations to come and talk to staff on subjects such as autism and dementia. The manager also told us that she had recently undertaken a train the trainer course in breakaway techniques which she would be responsible for rolling out across the home and organisation. We were also told that the majority of staff working at the home have received training in Makaton. The home has notified us of incidents where residents have encountered issues around their sexuality and relationships. We discussed with the manager that staff should receive training on this subject so that they are able to support people who use the service effectively and provide a consistent, informed approach. We are making a recommendation that the home continues to look at sourcing specialist training to meet the changing needs of people who use the service to include training in sexuality and relationships. The homes Annual Quality Assurance Assessment tells us that five out of the nine permanent staff working in the home have achieved a National Vocational Qualification (NVQ) in Care at Level 2 or above. All care workers responding to the survey indicated that they were being given training relevant to their role, that helps them understand and meet the individual needs of people who use the service and that keeps them upto-date. One out of four relatives responding to our survey told us that care workers Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: always have the right skills and experience to look after people properly with the remaining three relatives stating this was usually the case. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home demonstrates a real commitment to being run in the best interests of the people who live there. People who use the service are actively consulted about decisions that need to be made and are able to influence change. Some systems in relation to health and safety matters need to be made more robust to ensure potential risks have been given full consideration. Evidence: Since the last inspection of the service the manager, Mrs Carole Titley, has applied for registration with the Commission and has been deemed fit to manage the home. Mrs Titley has a National Vocational Qualification (NVQ) at Level 4 in Management and has told us that she is currently working towards her NVQ Level 4 in Care. Mrs Titley demonstrated awareness of the need to keep up-to-date with developments in care and has attended a range of training courses since starting in post as the manager of the home. She has also told us in the homes Annual Quality Assurance Assessment that she has made links with a local learning hub and workforce development group as a means of keeping herself up-to-date. We saw on record that the Responsible Individual of the home visits Pinehaven on a regular basis to carry out visits which Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: comply with Regulation 26. These help to monitor quality in the home. Mrs Titley told us that she feels she gets the support she needs from the wider organisation to manage the home effectively. We received many positive comments about how Mrs Titleys management approach had improved the service over the past twelve months; The manager will always listen to our concerns and requests and actions them immediately. She has made a noticeable difference to Pinehaven (relative); I feel that over the last year the way the home is run has improved immensely and our residents receive a very good quality of life in consequence (care worker); A lot of improvements have been made (care worker); The home is run well. I like living here (service user). Through observation and talking to people who use the service it was evident that they are consulted about the running of the home. We heard a number of examples of how people are involved in decision-making and having their say. These included contributing to a 360 degree appraisal of the managers performance and deciding how elements of the homes budget should be spent. Residents meetings are held on a monthly basis, the minutes of these showing how service users have been able to make choices and decisions about a wide range of issues that affect them as a group. The manager told us that the organisation is committed to involving people who use their services in assessing the quality of the services they provide and work is underway to achieve this. We saw that there is a system in place to monitor the quality of care provided by means of surveys which ask residents about their satisfaction with what happens in their home and the support they are given. The expert by experience told us that in their view The home has a person-centred ethos. Everything the staff do is person-centred. We looked at a sample of health and safety records in the home. We were told that a system is in place to monitor aspects of health and safety with checks being carried out every two or three months on the property to ensure it provides a safe place to live. We saw that a recording framework is in place to evidence this. We saw that water temperatures in the home were last checked on 05/06/2009. The health and safety checklist did not refer to window restrictors and we recommend that this is incorporated into the current system of checks to ensure that they are working effectively. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: We noted a number of gaps in temperature checks for the homes refrigerator and freezer for the previous month. In addition some of the refrigerator temperatures recorded were not within a safe range. There was no information on the temperature chart to inform staff of what constitutes a safe temperature. We discussed this with the manager who told us that there appeared to be a problem with the refrigerator not working effectively. We are making a requirement that this is addressed to ensure the safe storage of food in the home and to minimise risks to people who use the service. At the last inspection of the service we made a requirement that records of money held on behalf of people who use the service were maintained accurately so that they provide an auditable and clear record of the money being held. The manager showed us a framework in place for one resident which showed a clear record of money coming in and going out. The manager told us that this is audited to ensure there are no discrepancies. We saw evidence of people being supported to manage their money independently where this was practicable and heard from the manager that where individuals experience difficulty with budgeting safeguards are in place to ensure they are protected. We saw that there was a lockable cupboard in the home used to store cleaning products. However, there were some cleaning products also left out underneath the cupboard. In addition, laundry tablets are stored in an unlocked drawer next to the washing machine. We discussed with the manager that while we support the homes aim to promote peoples independence in their home environment with regards to cleaning and doing their laundry, a risk assessment should be done to ensure that all individuals who use the service are not put at risk by products not being locked away. We saw that the home has a system for reporting accidents and incidents, records of which are sent to the organisations Head Office for review. We discussed with the manager the type of incidents that must be reported to us under the current regulatory framework. The manager agreed to review the reporting of incidents in light of this information. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 You must ensure that a comprehensive risk assessment is drawn up which takes account of the changing needs of one resident who wanders. You must do this to ensure that appropriate measures are in place to promote their safety and welfare and manage identified risks in the least restrictive way. 14/08/2009 2 20 13 You must ensure that people 31/08/2009 receive their medication as prescribed. You must ensure that medication is signed for at the time of its administration. You must ensure that handwritten instructions on the medication administration record are Care Homes for Adults (18-65 years) Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action double-signed to confirm their accuracy. You must do this to ensure that systems in place to promote the safe adminstration of medication are followed consistently and protect people who use the service. 3 24 23 You must ensure that the accessibility of the premises is reviewed in light of the need for wheelchair access and any shortfalls addressed. You must do this to ensure that, as far as practicable, the home environment can meet the needs of individuals who live there and their independence with mobilising is promoted. 4 42 16 You must ensure that food is 14/08/2009 stored within appropriate temperatures in the refrigerator. You must do this to ensure that people are not put at risk of harm by the food they eat. 31/10/2009 Care Homes for Adults (18-65 years) Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 24 You should continue to ensure that there is a proactive approach to maintenance and decoration within the home so that it remains in good order and shortfalls are addressed promptly. You should ensure that any uneven areas of the lawn are risk assessed and addressed in order to minimise risks of falls. 2 30 You should ensure that the laundry floor in the home is repaired or replaced to ensure that it provides an unbroken and impermeable surface and so minimises risk of infection. You should ensure that the practice of having fabric handtowels in communal areas is reviewed to comply with best practice in infection control. You should ensure that the general cleanliness of the home is kept under review so that people who live in the home benefit from an environment that is always clean and fresh. 3 35 You should continue to source and provide specialist training for care workers that aims to meet the needs of people who use the service. This should include training for staff on supporting people with their relationships and sexuality. You should ensure that checks on window restrictors are incorporated into the homes risk assessment and health and safety checks. You should ensure that checks on the temperatures of refrigerator and freezer facilities in the home are undertaken consistently and prompt action is taken to address any concerns. You should ensure that a risk assessment is carried out regarding peoples access to chemical substances in the home and measures put in place to protect any person who is identified as being at risk of harm. 4 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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