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Inspection on 05/08/09 for Pinewood Lodge

Also see our care home review for Pinewood Lodge for more information

This is the latest available inspection report for this service, carried out on 5th August 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents live in a homely and clean environment. They appeared well dressed and well cared for. In the residential unit, some residents were observed chatting among themselves in the lounge. Those spoken to gave positive feedback about the service and the care provided. In the dementia units, some of the residents participated in a group activity (Bingo) organised by the activity co-ordinator. The residents appeared happy and engrossed in the game. There was a selection of prizes to be won. Two members of staff were assisting another group activity in Oxhey Unit for those who preferred a game of Four in a Row. Members of staff interacted well with the residents and have knowledge of their wishes and preferences and delivered care accordingly. Team working was evident. The people who use the service and some of the visitors made the following comments about the service and the staff: "I am very pleased with the service and the care." "The staff are very nice. I have no complaints." "The food is very good. We have Sunday Roast which tastes very nice. I can`t complain." "I visit twice a week. It`s a smashing place. The staff are all very nice and helpful." "The staff are very good. Any concern raised is actioned by the manager immediately." "My (relative) has dementia and sometimes refuses to swallow the medicines. The staff are very patient with (my relative). I am very pleased with the care given." There have been no response to the survey questionnaires sent by us at the time of this report.

What has improved since the last inspection?

Since the last inspection, the interior of the premises have been refurbished and redecorated and the premises appear more homely and brighter. New furniture has been purchased and new kitchen units installed. All medicines are now stored in one storage room which is much easier for staff to manage and audit. The service has recruited an additional activity co-ordinator to assist with activities which are more organised and have improved with residents` input and preferences taken into account. The home has recruited more permanent staff and therefore agency workers are no longer deployed to make up the staff numbers. This ensures residents have continuity of care.

What the care home could do better:

In general, residents are well cared for by a team of dedicated staff. The ratio of staff to residents in each unit has been 3 to 15 residents. However, it was noted that in the dementia unit (Oxhey) where some of the current group of people have behavioural issues and changing care needs that are demanding, the three members of staff have to relieve each other for breaks thus leaving only two staff in the unit during break times. It would be safer for these residents if additional staff are deployed to relieve unit staff during their breaks to ensure that these residents are appropriately supervised at all times.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pinewood Lodge Oxhey Drive Watford Hertfordshire WD19 7HR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson     Date: 0 5 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Older People 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Pinewood Lodge Oxhey Drive Watford Hertfordshire WD19 7HR 02084217900 02084217961 pinewood@quantumcare.co.uk www.quantumcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Quantum Care Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Pinewood Lodge, provided by Quantum Care Limited, is a residential care home registered for 60 residents in the Old Age and Dementia category. The building is a purpose-built home that was completed in 1997. It comprises of a two-storey building with a main entrance to the first floor at upper ground level and a lower ground floor. There are parking facilities to the front of the building. Accommodation is offered in four 15 bedded units. Each unit has a separate lounge and dining area, a fully fitted kitchenette and a staff workstation. There is a medication 0 0 0 Over 65 60 60 60 Care Homes for Older People Page 4 of 24 Brief description of the care home storage room in the residential unit. All bedrooms are in excess of 12 sq. metres in area and have en suite toilets and sinks. The assisted bathroom and assisted shower room are nearby. The home has an administrative section on the ground floor, a fully fitted stainless steel equipped kitchen with appropriate storage rooms and cold storage equipment and a well equipped laundry. Other facilities available to residents include a ground floor conservatory and a first floor hairdressing salon. The gardens extend around the home, which is screened from the road and neighbouring buildings by mature hedges and trees. There are pleasant patio areas with seating for residents and visitors. The garden is accessible to wheelchair users. The home charges £550 - £650 per week. Further information can be obtained from the homes Statement of Purpose and the Service User Guide. A copy of the CQC inspection report should be available in the home. Care Homes for Older People Page 5 of 24 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This service had a key inspection in August 2007 and an annual service review in July 2008. The annual service review is a review of information received about the service without a site visit since the last key inspection. This unannounced key inspection was carried out on 05/08/2009. The home manager was present. There are 59 people in residence. The inspection included a tour of the premises, general observation and lunchtime observation of how the staff interacted with the residents. All 4 units were inspected. Extra time was spent observing the morning routine in the dementia units. Both staff and residents were spoken to and key documents were examined. The inspection ended with a thorough discussion with the home manager. To gain the views of people who use the service, survey questionnaires were sent to Care Homes for Older People Page 6 of 24 the residents and relatives and their responses and other information received by us were reviewed. What the care home does well: What has improved since the last inspection? Since the last inspection, the interior of the premises have been refurbished and redecorated and the premises appear more homely and brighter. New furniture has been purchased and new kitchen units installed. All medicines are now stored in one storage room which is much easier for staff to manage and audit. The service has recruited an additional activity co-ordinator to assist with activities which are more organised and have improved with residents input and preferences taken into account. The home has recruited more permanent staff and therefore agency workers are no longer deployed to make up the staff numbers. This ensures residents have continuity of care. Care Homes for Older People Page 8 of 24 What they could do better: 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 set out 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 Older People Page 9 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 24 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Prospective clients can be assured that a thorough pre-admission assessment will be carried out before they are admitted to ensure that the home can meet all their care needs. Evidence: The pre-admission documents were seen in the care plan files examined. The home manager confirmed that the service will only admit a prospective client whose care needs can be fully met. Care Homes for Older People Page 11 of 24 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People who use the service can be assured that their health and personal care needs will be positively met. They can be assured that their rights to privacy will be respected and that they will be protected by the homes Medication Policy and Procedure. Evidence: Each resident has a person-centred written care plan, which identified the care needs of the individual so that care can be delivered in a manner that upholds the persons individuality whilst meeting their care needs. It was noted that in the care plans examined, the review section had the signature of the author but not the date of the review. Since the inspection, the home manager had confirmed that the error has been rectified. Residents are able to choose their own doctor and they all have access to specialist medical treatment and other healthcare services when required. The district nurse assists with nursing tasks such as wound care and dressings. On the day of the inspection, one resident was waiting for admission to the hospital for surgery. The Care Homes for Older People Page 12 of 24 Evidence: assistant manager ensured that the resident was comfortable and at one stage the general practitioner was called to ensure the resident had adequate pain relief. Since the last inspection, there have been a number of residents with repeated falls with some requiring hospital admission. The home manager has since made arrangements for staff to have further training on Falls Awareness and Falls Prevention Strategy in order to minimise the incidence of falls or injury to individuals who are prone to falls. The administration of medicines is by a trained member of staff. Since the last inspection one of the rooms on the ground floor has been converted into a medication storage room for all medicines. There are four medication trolleys, one for each unit and these are stored in the storage room when not in use. The storage room temperature is closely monitored. Within the storage room there is a controlled drug cupboard and all controlled drugs in use are correctly recorded. The Medication Administration Record Charts examined were correctly filled in. The staff have regular refresher course on medication. The home manager confirmed that there have been no medication errors since the last inspection. Care Homes for Older People Page 13 of 24 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People who use the service can be assured that they will be supported to pursue personal interests, engage in communal activities and have close links with their friends and family. They can be assured that a healthy diet will be promoted which meets their nutritional needs and expectations. Evidence: Residents wishes and preferences are respected and they are given choices in the daily living routine in the home. They are encouraged to have close links with their friends and family. We met one visitor in one of the dementia units and two visitors in the residential units (known as the High Needs units, Blue Fern and Windsor) and they gave positive feedback about the care and service provided. Since the last inspection, the activities in the home have improved. There are two care co-coordinators, one for the residential unit and one for the dementia unit. They organise group activities, outings and day trips for residents as well as assisting the individual. The members of the care team interviewed said that they often assist as well and give one-to-one therapeutic stimulation as part of the daily activity programme whenever they can. Activities include bingo, hand massage, quizzes and games, a film afternoon on a Sunday and a tea dance on a Saturday every other Care Homes for Older People Page 14 of 24 Evidence: week. On the day of the inspection, the activity co-ordinator held a bingo session in the activity lounge in the dementia units. At least 9 residents joined in and they seemed to enjoy themselves. Prizes were on display for the winners. Additional activities were observed in the individual units. Two care workers were assisting seven residents in the Oxhey unit with a game called Four in a Row before the morning tea and coffee time. The residents participated and seemed involved in the game. Due to popular demand the residents are served a three course hot meal in the evening and are offered hot soup and a variety of sandwiches during lunchtime. The meals provided are wholesome and nutritious and there is a choice of menu. During lunchtime it was noted that members of staff assisted those residents who needed help and mealtime was unhurried. Care Homes for Older People Page 15 of 24 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. People who use the service can be assured that they will be listened to and that any concern raised will be investigated and appropriate action will be taken. Evidence: The service has a robust Complaints Policy and Procedure, a copy of which is given to each resident on admission. The home manager said that written complaints are minimal as any concerns raised are promptly dealt with before they escalate into a written complaint. Residents meetings are held regularly and residents views are listened to and the management make appropriate changes as requested to the benefit of the residents. Staff interviewed confirmed that they have had training on safeguarding issues and the Whistle-Blowing Policy. The home follows the Hertfordshire County Council Adult Care Services Safeguarding Procedure. Since the last inspection there have been three cases that were investigated under the joint Safeguarding Procedure and remedial actions were taken by the provider to improve the service, namely, dealing with staff communication and recording issues, falls management and care practice issues. Currently there is a safeguarding referral that is still being investigated by Hertfordshire County Council Adult Care Services under the joint safeguarding procedure. Care Homes for Older People Page 16 of 24 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, 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. 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. People who use the service can be assured that they will live in a clean, safe and comfortable environment and that the premises will be well maintained to meet their needs. Evidence: Residents have access to all communal areas. Since one of the residents with dementia wandered off the premises, the bolts on the gates in the garden have been changed to ensure the environment is safe and secure for residents with dementia. The service has a rolling maintenance programme. Since the last inspection, the premises have been refurbished and redecorated. The lighting in all the main communal areas and corridors has been improved with new lighting equipment installed. There are new carpets in the corridor and new kitchen units with new dishwashers have been installed. New furniture has been purchased and this includes garden furniture. On the day of the inspection, the garden and the interior of the home appeared clean and tidy. The bedrooms examined appeared clean and have personal items on display and reflected individual tastes and lifestyles. Residents spoken to seemed content with their bedrooms. Care Homes for Older People Page 17 of 24 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. People who use the service can be assured that they will be supported and protected by the homes Recruitment Policy and Procedures. They can be assured that the service has an effective staff team who will support them. Evidence: All the four units were inspected and some time was spent observing the morning routine in the dementia units. It was noted that at one stage only one care worker was present in Oxhey Unit as a member of staff had to leave the unit for a few minutes to collect the medication trolley while a third member of staff was on their 15 minutes break. It was further noted that there were no additional staff deployed to relieve the staff in the unit when they have their breaks. The duty manager who can be called upon for help was not available to assist as she was busy attending to a visiting family doctor and sorting out hospital admission for a resident. The remaining care worker was seen preparing the morning tea trolley whilst trying to supervise several residents, some in the lounge, one in their bedroom and several walking about in the in the corridors. Two of these residents have challenging behaviour. One has the tendency to pick and move furniture and lift up the fire extinguisher. Members of staff interviewed felt that they could do with an additional care staff to help out in the dementia units for the current group of residents whose changing care needs have been quite demanding. However, on the day of the site visit these residents seemed reasonably calm. The activity co-ordinator for the dementia units was busy with a Care Homes for Older People Page 18 of 24 Evidence: group activity for 9 residents in the activity room. She reassured us that she was conscious of the two residents in the garden and glanced towards them now and again to make sure that they were safe. A member of staff from Dove also confirmed that now and again she would glanced towards the garden to make sure the residents were alright. In general members of staff were observed to work hard and team effort was evident. However, it was clear from observation that staff time was taken up with daily tasks and relieving each other for breaks thus leaving only two staff in the unit at break times. Staff members confirmed that each medication round may take up to one and a half hours due to the fact that some residents with dementia may refuse medication while a couple of residents may take up to ten minutes to swallow the medicines. Staff said that there are times when a resident may refuse two to three times and the care worker has to complete the task of administering the medicines to these individuals which meant leaving the unit to fetch the medication trolley more than once per medication round. One of the residents was observed spitting out the tablets repeatedly and the staff assisting them was patiently helping the resident who has dementia. Members of staff interviewed confirmed that they have induction training. There is also a mandatory training programme for all staff. All care staff are expected to complete their NVQ2. The home has trainers and assessors among the senior staff. The unit managers have unit days so that they can work alongside the care workers and assess the care practice. The management has arranged for all staff to have training on Falls Awareness. All staff have had training on what to do in the event of a fall (Falls Management). Since the last inspection, the home has been busy recruiting permanent staff. Also the retention of staff has improved and therefore the deployment of agency workers is almost nil. The staff files examined were kept up to date. All new recruits are checked against the Protection of Vulnerable Adults (POVA) list and they have Criminal Record Bureau (CRB) checks and clearance before commencing work in the home Care Homes for Older People Page 19 of 24 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. People who use the service can be assured that the home is run in their best interests and they can be assured that their health, safety and welfare are promoted and protected. Evidence: The home manager has been managing the service short of a deputy manager who has been seconded to assist in a sister home two days a week. In general the standard of administration and management of the home has been well maintained. The recent fall incident has highlighted the need for a more detailed audit which the home manager had started to do since July 2009. A falls audit that indicates the type of falls, the time of falls and the frequency of falls for an individual may also lead the management to review and adjust its staffing level to ensure residents who are prone to falls have adequate supervision. The management has arranged for all staff to have training on Falls Awareness. All staff have had training on what to do in the event of a fall (Falls Management). Staff have also been reminded to be extra vigilant in the care Care Homes for Older People Page 20 of 24 Evidence: of residents who are prone to falls. The service has an annual quality assurance and monitoring survey that involves sending out questionnaires to residents, relatives and other stakeholders. All new residents receive written questionnaires a few weeks after admission to provide feedback. A report is concluded at the end of the year and shared with residents, relatives and any other interested parties. The service is not involved with the residents finances except for personal allowances with proper accounting records kept. The registration certificate and the homes public liability insurance certificate are on display on the wall in the reception area. All servicing and financial records are maintained and kept in accordance with the Data Protection Act 1998. Care Homes for Older People Page 21 of 24 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 Older People Page 22 of 24 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 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 27 It is recommended that additional staff be deployed to relieve unit staff during their breaks in the dementia units to ensure that residents are appropriately supervised at all times. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!