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Inspection on 04/05/05 for Pine Heath Nursing Home

Also see our care home review for Pine Heath Nursing Home for more information

This inspection was carried out on 4th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Care notes are kept in each resident`s room making them accessible to both the staff and residents so records can be easily read and updated. There are some good opportunities to participate in activities within the home and a different activity is available each weekday. This is helped by having a member of staff employed just to provide activities for the residents so that the care staff can get on with their jobs. The food was complimented by residents.

What has improved since the last inspection?

The number of staff on duty on each shift has improved, though this will continue to be monitored regularly by the Commission.

What the care home could do better:

Information about new staff must be properly recorded so that inspectors can see that proper checks are being made so that unsuitable people are not employed. Each member of staff must have regular individual meetings with a senior person so they can discuss what training they need to do their job better and discuss how the care in the home can be improved. Some of the furniture, (such as armchairs), must be replaced because it is worn out. Some areas of the building, (such as toilets), need decorating and making more homely as they are not nice facilities to use.Old equipment, such as rusty support frames and plastic chairs, needs to be disposed of before it becomes unsightly and/or a hazard. A safe enclosed area could be created in the garden for residents to sit and enjoy the well kept grounds in warm weather. The policy that sets out how staff and management deal with abuse needs updating so that the correct process is followed and residents are protected.

CARE HOMES FOR OLDER PEOPLE Pine Heath Nursing Home Cromer Road High Kelling Holt NR25 6QD Lead Inspector Roger Andrews Announced 4 May 2005 9.30am 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Pine Heath Nursing Home Address Cromer Road High Kelling Holt Norfolk NR25 6QD 01263 711429 01263 711488 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Diamond Care (UK) Limited Diane Lynne Varrall Care Home 47 Category(ies) of Dementia (47) registration, with number Old Age (47) of places Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Forty-seven (47) Older People who may have dementia may be accommodated. Total number not to exceed 47. Date of last inspection 13 September 2004 Brief Description of the Service: Pine Heath Nursing Home provides accommodation for 47 service users in a large two storey building situated on the main road between Holt and Cromer. It accommodates older people who are in need of nursing care and who also may have a degree of mental frailty. Most of the rooms are single and of a good size and only five are double rooms. Communal space is short with the lounge accommodation half of what it should be for the number of service users. It is therefore common for many of the service users to remain in their rooms. However a large room just off the registered accommodation has been made into an activities room and is bright and airy. Activities take place in there every day. The grounds are attractive and extensive though would benefit from some concrete walkways so service users could enjoy them more. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced. A number of staff and residents were interviewed privately. A tour of the home was made and records were examined. Some feedback was also received via a questionnaire from relatives and this has been incorporated into the body of the report where appropriate. At the time of the inspection there were 34 residents living at Pine Heath Nursing Home. What the service does well: What has improved since the last inspection? What they could do better: Information about new staff must be properly recorded so that inspectors can see that proper checks are being made so that unsuitable people are not employed. Each member of staff must have regular individual meetings with a senior person so they can discuss what training they need to do their job better and discuss how the care in the home can be improved. Some of the furniture, (such as armchairs), must be replaced because it is worn out. Some areas of the building, (such as toilets), need decorating and making more homely as they are not nice facilities to use. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 6 Old equipment, such as rusty support frames and plastic chairs, needs to be disposed of before it becomes unsightly and/or a hazard. A safe enclosed area could be created in the garden for residents to sit and enjoy the well kept grounds in warm weather. The policy that sets out how staff and management deal with abuse needs updating so that the correct process is followed and residents are protected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x Not applicable. EVIDENCE: None of these standards were inspected on this occasion. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 & 10 Care plans contain relevant information and are clearly accessible and used on a frequent basis by staff during the day. The examples seen gave a reasonable picture of the care required and delivered. Medication is properly stored and dispensed. Privacy and dignity are respected, though small improvements can still be made. EVIDENCE: A ‘new resident admission form’ is in place on files. In the examples seen this included a pressure sore assessment, handling assessment, (e.g. number of carers required), and information on washing, dressing and mobility. This information is translated into a care plan, copies of which are available in each resident’s room. Staff record specific information in the care plans including frequency of turning and bathing. There is a formal handover between staff at the end of every shift. A member of nursing staff was observed handing out medication and signing the medication records. She was able to give a thorough explanation of the Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 10 medication dispensing process. Medication is stored in a secure cabinet. At present no resident handles their own medication, but some have done so in the past. One resident said he was happy for the staff to look after his medication. Comments in the care plans refer to treating residents with privacy and dignity. This coincided with observations made during the inspection when residents were being assisted by staff, e.g. staff were observed chatting to residents whilst assisting them. This was an improvement compared to an observation made on a previous visit to the home. Assisting residents with privacy and dignity, (e.g. when toileting or serving food), is included in the induction training schedule. One of the bedrooms on the ground floor has been converted into a meeting room where private conversations can take place. Residents wear their own clothes and one resident reported that clothes are laundered speedily and returned in good condition. Several residents prefer to spend time in their rooms which is respected. The public telephone provided for residents could be located in a more private place. See recommendation. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, & 15 The routine of the home is flexible and a variety of in-house activities are available and are being developed. Opportunities for outings could be explored. The standard and variety of food served in the home is good. EVIDENCE: Staff and residents reported flexible times for getting up and going to bed. Bath times are organised as and when requested or in accordance with health needs. Some residents occasionally refuse baths and this is respected. An in-house activity programme is displayed and a different activity is available every weekday afternoon including exercise sessions, crafts and signing. A group of residents were observed participating in a session in the activity room. A separate activity co-ordinator is employed. One resident reported that she prefers to stay in her room and watch television, especially sport. A summer fete was advertised on the main notice board along with a monthly communion and monthly music session. One resident did say it would be nice to get out more. Several residents were having their hair done by the hairdresser on the day of inspection. Visitors can call at any time and one relative spends a lot of time at the home on a daily basis. There is a suggestion box for visitors in the main entrance. It Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 12 was suggested to the manager that paper and pen be provided to make it more convenient for visitors to make impromptu comments. See recommendation. All of the residents spoken to made complementary comments about the food. One resident referred to “a marvellous lunch on a Sunday” and the food is “as good as you’ll get”. A choice is available and residents are asked the day before to select their choice for the following day. The menu, (which is displayed), is varied and the food observed during the inspection looked very nice. Residents can eat either in the dining area or in their own rooms. Special diets, (e.g. for residents with diabetes), are catered for. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The adult protection procedure requires updating and staff need to be made aware of up to date protocols. The complaints procedure is accessible to residents. EVIDENCE: There is a complaints procedure in place and a copy of this is in each resident’s care plan in their rooms. This also contains a communication page for relatives and visitors to write comments on for the staff. A complaint by a former member of staff is currently being investigated. This relates to several issues some of which it is not appropriate to comment on in this report. However, staffing levels are being monitored with the assistance of the manager and the provider who are being cooperative in following up these matters. Residents spoken with said they knew who to talk to if they had any worries or concerns. The manager reported that she and a senior nurse have attended a day on adult protection held by Age Concern. The adult protection procedure is not currently in line with local agreed protocols. Advice was given to the manager about who to contact to obtain up to date information. See requirement. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 25 & 26, Some of the furniture has seen better days and should be replaced. Several of the toilets are not inviting facilities to use and require attention. A plan of redecoration and refurbishment is required. The pleasant grounds could be made more accessible to residents and a secure garden made available. EVIDENCE: On the day of the inspection the home was clean and warm and free of unpleasant odours. There is a choice of lounges. However, some of the furniture, (e.g. armchairs), in these areas is worn and scratched. Bedrooms are personalised and one bedroom on the first floor was undergoing redecoration and has been re-carpeted. Corridors have pictures on the walls to improve the domestic feel of the home. Toilets around the building need redecoration and refurbishment. There were instances of toilet seats needing replacement or securing and toilet floors need attention. One toilet door did not have a lock. Some portable metal support Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 15 frames in toilets are rusty and should be disposed of and replaced with new equipment. See requirement. Bathrooms would benefit by the addition of pictures to make them feel more homely and less clinical. See recommendation. The home has extensive, well kept and attractive grounds. Residents would benefit from an enclosed area where they could sit outside and walk about without being able to wander off for those who may be confused. See recommendation. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The Commission for Social Care Inspection is currently monitoring staffing levels as it has not been satisfied with the numbers of staff provided, though this appears to be improving. Relevant ongoing training, both in-house and external is taking place. A training profile needs to be drawn up and maintained. EVIDENCE: Staffing levels are currently being monitored on a regular basis due to difficulties the home has experienced in recruiting sufficient staff. The manager reported progress in this area and a further new member of staff is starting work shortly. Staff files contain appropriate information on staff including evidence of identity, Criminal Records Bureau checks and application forms. Where telephone references are taken up, (whilst awaiting written references), the content of such telephone discussions is not being recorded on the member of staff’s file. See requirement. Not all staff have been provided with the Code of Conduct issued by the General Social Care Council. Copies of these are, however, now on order so this is not made a requirement in this report. As a care home providing nursing care a number of the staff hold nursing qualifications. The Continence Advisor recently did a talk to the staff group on use of continence equipment. Several staff, including the manager, are undertaking a distance learning course covering all areas of risk assessment. Two staff have completed NVQ 3. Four staff have completed NVQ 2. Three staff Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 17 are about to embark on NVQ 2 training. The manager is to undertake the management element of NVQ 4 and has applied to a college to undertake this. These examples of training are not exhaustive. However, a training profile showing training undertaken by all staff is not in place. See requirement. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 & 38 Not all of the ingredients of a thorough quality monitoring process are in place. Supervision and regulation 26 visits need to be implemented. The record of residents’ monies is well maintained. Equipment in the home is regularly serviced. EVIDENCE: Formal supervision that is properly documented and in accord with the timescales identified in the National Minimum Standards, (at least every two months), is not in place. See requirement. Staff meetings were reported to take place every two months or so. Visit reports under regulation 26 of the Care Homes Regulations 2001 are not being provided to the Commission. See requirement. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 19 The home’s administrator described how personal monies are looked after for those residents who are unable or choose not to manage their own. Copies of financial records are periodically shared with relatives. It was suggested that a copy be given to residents. A record was checked at random and coincided with the actual amount kept. Only small amounts of money are kept on behalf of residents. Policies and procedures are available to all staff and are located in the treatment room on the ground floor. The fire records were examined. They were up to date. The fire equipment was serviced in August 2004. Servicing certificates were seen in respect of the lift and hoists. The Environmental Health Officer undertook an inspection of the catering facilities on the same day as this inspection. No major issues were identified. No obvious safety hazards were identified during a tour of the home. Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 1 x x x 2 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x 2 3 1 x x Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 18 Regulation 13 Requirement The registered person must ensure that the procedure for dealing with allegations of abuse is up to date and that staff are fully aware of that procedure. A review of toilet facilities must be undertaken and redecoration and refurbishment carried out to improve these areas. A plan of action must be submitted to the Commission by the identified date. Old and rusty support frames must be disposed of and replaced. Any temporary references taken up on the telephone must be documented on the staff files pending a written reference arriving. A record must be kept of all training and qualiifications undertaken by each member of staff Staff must receive formal supervision with a senior person every two months. A monthly visit needs to be undertaken by the provider or a representative, a report compiled and a copy sent to the I55 S15672 Pine Heath V217576 040505 Stage 4.doc Timescale for action Immediate 2. 21 23 1st August 2005 3. 4. 21 29 23 19 Immediate Immediate 5. 30 17 1st September 2005 1st July 2005 1st August 2005 6. 7. 36 33 18 26 Pine Heath Nursing Home Version 1.30 Page 22 Commission in line with regulation 26 of the Care Home regulations 2001 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 10 13 19 21 Good Practice Recommendations The telephone should be located in a place that allows residents to make a call without being overheard. Paper and pen should be provided to encourage visitors and relatives to contribute suggestions to the manager./ Consideration should be given to creating an enclosed area in the garden to allow residents to enjoy this facility in safety. Bathrooms could be given a more homely feel by the use of pictures and other iornaments Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pine Heath Nursing Home I55 S15672 Pine Heath V217576 040505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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