Inspection on 14/06/06 for Pine Lodge

This inspection was carried out on 14th June 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pine Lodge 06/08/08

Pine Lodge 12/09/07

Pine Lodge 15/03/06

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Pine Lodge Blundell Avenue Freshfield Formby Merseyside L37 1PH Lead Inspector Ms Lorraine Farrar Unannounced Inspection 14th June 2006 12:50 Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 1 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 Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 2 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 Adults 18-65. 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 Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pine Lodge Address Blundell Avenue Freshfield Formby Merseyside L37 1PH 020 8788 8084 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Frances Taylor Foundation Mrs Jennifer McGibbon Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2006 Brief Description of the Service: Pinelodge provides accommodation and support with nursing for 12 adults who have a learning disability. Many of the people living there also have physical disabilites and the home provides aids and adaptations to meet their needs. There are care staff available 24 hours a day, during the day there is a registered nurse in the home whilst at night a registered nurse is based in the home but shared with two homes located nearby. Pinelodge is owned and operated by the Francis Taylor Foundation, a national organisation who provide services to people with a variety of support needs. The registered Manager of the home is Mrs Jenny McGibbon and the registered Responsible Individual for the organisation is Mr Terry Maguire. The home is located in the middle of Formby Pinewoods and shares the site with, two other registered homes, a day centre for 65 people and a convent. All the services support adults who have a learning disability. Services share transport, kitchen facilites, large grounds and some administrative support. Most of the bedrooms are single rooms, where two people share there are screens provided for privacy. All service users have their own toilet, which is either in or near to, their bedroom and is adapted to meet their needs. There is a dining room, several seating areas, adapted bathrooms, a small kitchen within the unit and a small, private, courtyard outside. The home has operated for many years as part of a larger care home registered as St Josephs Adult Services. In June 2005 the three units within this service were seperatly registered as part of the organisations aim to modernise the service. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for this inspection was gathered in a number of different ways. This included an unannounced site visit where time was spent reading records, looking around the building and observing everyday life in the home. A system called ‘case tracking’ was used as part of the visit. This involved looking at the support one person gets from the home including their care plans, medication, money and bedroom, time was spent meeting with the service user and with staff about how they meet the persons needs. Case tracking was used to look at life in the home for three of the people living there. Discussion also took place with the manager and deputy manager. Any information the Commission for Social Care Inspection (CSCI) has received since the last inspection about the home is also taken into account. This includes the results of comment cards sent out to service users, professionals involved with the people living in the home and relatives. The home are requested to contribute information to the inspection by completing a pre-inspection questionnaire, however this was not received from Pinelodge. Therefore information about fees in the home was not available for inclusion in this report. What the service does well: The organisation has a clear policy in place for making sure that any new service users receive a full assessment of their needs prior to them moving in. The manager has stated that she will also obtain copies of assessments completed by other professionals involved in the person life, before the person moves in. This helps the home to ensure they can meet the persons support needs and their choices. The home offers a good level of support to service users in maintaining their relationships with relatives. Visitors are welcomed to the home and staff inform relatives of important matters concerning the service user as well as providing some support for them to visit relatives. A number of on site opportunities are available for service users to engage in. This includes a resource centre, chapel, hydrotherapy pool and everyday activities such as watching TV and listening to music. Service users are supported to receive a good level of personal care based on their needs and choices and staff provide support to service users in accessing health care appointments. Some good practice was noted in the support staff provide to one service user in making their own decisions. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 6 There is sufficient space in the home to accommodate service users, visitors and staff. The majority of service users have their own bedroom, where there is a shared bedroom screens are provided for privacy. Key workers have worked with service users and their relatives to personalise bedrooms, with furniture, aids and adaptations and leisure equipment provided to suit the person’s individual choices and needs. There are adapted bathing facilities available and all service users have a designated toilet adapted to meet their individual needs. Some staff in the home have a good knowledge of service users individual needs and choices and take the time to communicate effectively with them. What has improved since the last inspection? What they could do better: The manager must ensure that up to date care plans and risk assessments are in place for all areas of a service users life. This includes providing a plan stating how they will meet the person’s individual choices and social needs and how to effectively communicate with them. She should also include a section on the decisions that each person is able to make, how they can be offered meaningful choices, the way they communicate this and how staff can support them. Mealtimes in the home are busy occasions with the support provided for service users varying from a good standard, with staff interacting with service users to a poor standard where service users have little or no interaction from staff. The manager must carry out a documented review of mealtimes, identify areas for improvement and take action to address these. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 7 Service users opportunities to take part in leisure and occupational activities away from the site are limited. The home should look at ways of increasing opportunities for service users in this area. The medication stock check system in use in the home should be developed further to make sure service users medication is available at all times and stocks of unwanted medications are recorded and disposed of in a timely fashion. Some communal areas have a shabby and clinical appearance and would benefit from re-decorated and refurbishment to provide a more pleasant and homely environment for service users. Due to unforeseen circumstances the home are currently covering a number of shifts each week with agency and bank staff. The manager advised that wherever possible, they use staff familiar with the home and ensure there are at least two permanent members of staff on each shift. However this has impacted on service users daily lives and plans for improvements to the service. Relatives expressed some concern regarding the use of unfamiliar staff, but were complimentary about permanent staff working in the home. The manager is spending time providing and overseeing direct care for service users and is not able to implement planned improvements and ensure the home meets national standards. The organisation must provide additional support to the manager to ensure the home is progressing and meeting national standards. The manager needs to make sure the service is as safe as possible for service users. This includes ensuring staff have training related to service users health and welfare and that all fire checks are carried out within recommended times. 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 Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has appropriate policies in place for introducing and assessing new service users before they move in. This helps to make sure the home can meet the person’s needs and choices. EVIDENCE: No new service users have moved into the home since the previous inspection, therefore the assessment process for new service users could not be practically assessed. The organisation has a policy in place for introducing new service users. This states that a full assessment must be carried out by the home and a copy of the placing authority assessment obtained, before the person moves in. It was identified at the last inspection that the home did not always obtain a copy of the local authority assessment before a service user moved into the home. The Manager has since obtained this assessment. She has also confirmed in writing to the CSCI and further explained on the day of the site visit that she will ensure any new service users are not admitted without a full assessment of their needs, completed by their placing authority, being obtained. This will ensure that the home have identified and are aware of the persons individual support needs and choices and are confident they can meet these. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Care plans are in place for all service users, these need further development to ensure service users receive support in all areas of their lives, including with their social needs. Risks to service users are identified and guidelines provided to minimise these. Reviews of these do not always take place regularly which could impact on the person health and safety. Service users are provided with some support to make decisions, this needs to be further developed to support service users with their skills and choices. EVIDENCE: Individual care plans are available for all of the people living at Pinelodge, three of which were read during the site visit. These contained information about the person’s personal care and healthcare support needs and had been updated recently. Some information was available about the person’s choice of routines such as the times they like to get up and go to bed. Limited personal information is available about the persons choices and needs with regards to how they communicate, the things they like to do and how the home are working with them to meet their social care needs. At the previous inspection of the home in March 2006, the Manager and Deputy Manager were aware of Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 11 this and explained that they were working on a new format based upon person centred planning. At this inspection both explained that due to staffing difficulties they have been unable to complete these new plans although it is still their intention to introduce these for all service users. Two uncompleted plans written in this format were viewed and once completed and in place they will provide a good basis for supporting service users to meet their needs and choices in all areas of their lives. A lack of clear information in care plans regarding the persons personality, their social choices, the support they need and how they communicate may lead to the service user not receiving a service that meets all of their needs and choices. The manager must ensure all service users have a care plan in place which identifies their support needs and gives clear guidelines regarding how these are to be met, for all areas of their life. The home provides support to some service users in making decisions about their everyday lives. Good practice was seen in that the home support one service user to use moving equipment that he prefers rather than using an easier option and a service user spoken with confirmed that he decides when to get up and go to bed, he can go choose what to do at home, staff don’t tell him what to do, he decides and they help him with this. Less evidence was available that the home supports service users who do not communicate easily, to make everyday decisions, such as choose between two offered items of food. The manager should include in care plans a section on the decisions that each person is able to make, how they can be offered meaningful choices, the way they communicate this and how staff can support them with this. Information about local advocacy services is displayed and the manager advised that she has supported one service user to obtain an independent advocate. Risk assessments are in place for all service users covering a variety of areas ranging from risks to health to risk of abuse. Good practice was noted in that the home have worked with one service user to support their choices to go out alone and to consume alcohol whilst minimising the risk from these activities. Some risk assessments had been written or reviewed recently. However it was identified at the previous inspection of the home in March 2006 that some risk assessments had not been reviewed since October 2004. At this inspection one service users plan contained assessments with regard to their risk of pressure areas breaking down and from eating and drinking, neither of which had been reviewed since October 2004. This could lead to staff not identifying changes to the persons needs and taking action to minimise any risks arising. The Manager must ensure that all service users have risk assessments in place, which are reviewed at least every six months and whenever their needs alter. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, 15 & 17 The quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Service users have access to on site leisure and occupational activities however opportunities to access these within the local community are limited. Support is provided to service users in maintaining relationships with their families. A healthy, varied diet is available, however mealtimes in the home are not well managed, with limited choices available and little opportunities for interaction. EVIDENCE: Pinelodge is part of the Francis Taylor Foundation, an organisation with a Christian ethos and any spiritual needs service users have are well catered for, with a chapel on site providing services for different Christian faiths, which service users are supported to attend. All of the people who live at Pinelodge can attend the on-site resource centre several days a week, this facility is attended by other people living on site and people who have a learning disability and live in the local community. None of the service users currently attend educational or leisure facilities off the site, which limits their opportunities to meet new people. As identified at the Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 13 previous inspection of the home in March 2006, the manager should look into facilities available in the local area and offer these opportunities to service users as part of their care planning. A service user explained that at times he gets bored and would like a voluntary job. He explained that the manager is aware of this and helping him to look into the options available. Service users support to get out and about in their local community and access off site leisure facilities is limited. One service users care plan stated that they should have more community activities, in the two weeks prior to the inspection, she had been out once for a walk and once to Southport for shopping and lunch. Another service user had a social development plan in place, she had been out twice for a walk and once for shopping and lunch. There are on site activities which service users are supported to attend, this includes, attending the resource centre, the chapel and hydrotherapy pool. Records evidenced that service users are supported with activities at home, this includes listening to music or watching TV or DVDs of their choice. A service user confirmed that staff always switch his TV or videos on when he asks and he is able to watch what he wants. Staff have supported service users to go on holiday within the past year. Service users cover the cost of the holiday and are required to pay the cost for a member of staff sleeping in overnight if needed. Relatives of six service users completed comment cards. All said that they are always able to visit their relative in private, are made welcome and informed of important matters affecting their relative, with one relative explaining, “we are always made very welcome when we visit”. Records in the home evidenced that staff support service users to remain in contact with their relatives through visits and phone calls. There is a small kitchen in the home, which can cater for drinks and snacks. A main kitchen on site is responsible for providing main meals. These are sent to the home on a heated trolley and served by staff from the smaller kitchen. Stocks of fresh juice, cereals and some snack meals were stored in the smaller kitchen. The main kitchen does not offer a routine alternative to the main meal, although this has been an inspection recommendation for some time, in order to provide service users with more choices and control in their lives. The manager advised alternatives are provided by the main kitchen if requested in advance and there are some alternatives available in the home. One service user was served a salad as identified in her care plan and another service users records, identified she had been offered a sandwich when she did not Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 14 want the main meal. Records of menus evidenced service users are offered a healthy varied diet. Mealtimes in the home take a long time as the majority of people living there need 1-1 support. Time was spent during the visit observing the evening meal. Service users who do not need 1-1 support where given their meal but had little or no interaction or support from staff. Care staff were involved in some meal preparation and were in the small kitchen serving and blending food. None of the staff wore aprons or any protective clothing, as they had been involved in supporting service users with personal care during the day this could lead to a risk of infection and must be addressed. Some service users have their meals blended and it was noted that all the contents of their meal were blended together; this presents a visually unappetising meal with no variety of taste. The nurse in charge explained that this was unusual as the main kitchen usually send meals, with each item individually blended. During the visit the home was staffed with a permanent nurse and permanent carer, an agency carer and a bank carer, all of whom had worked there before. The nurse in charge did try to oversee the support offered to service users and was observed advising staff on their preferences. However as she was also involved in supporting service users and dealing with medication this was not always feasible. The support service users received was variable, with one member of staff observed sitting with a service user, talking to them and holding their hand whilst supporting them to eat their meal. Another member of staff sat with a service user and did not interact with him apart from to repeat his name, she offered him large spoonfuls of food despite him repeatedly clamping his month shut, turning away and accepting smaller portions when offered. No service user was informed of the contents of their meal or given a drink whilst eating. The manager must carry out a documented review of mealtimes in the home to identify areas for improvement and the action that need to be taken to address these. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home provides support to service users with their healthy and personal care, however assessments of healthcare needs are not always up to date which could lead to service users needs not being identified and met. Medication is stored and administered safely, however the current stock check system needs developing further to ensure service users always have access to their medication. EVIDENCE: All relatives who completed comment cards said that they are happy with the overall care provided. Their comments included, “in the main, we are very happy with the care (my relative) receives and would like to thank all the staff for the love, care and support they give, sometimes in difficult circumstances” “My (relative) always looks clean and well dressed. Permanent staff are tuned into (my relatives) needs.” “ There was a transitional period when staffing was poor and the care standards appeared to drop, however there has been a return to previously good standards since”. Information about the support a person needs with their personal care is available in their care plan and includes the persons choices and likes and dislikes as well as their support needs. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 16 Care plans contain assessments and information about the person’s health and personal care needs and include, assessments of their pressure areas, moving and handling needs and nutrition, most but not all of which had been reviewed regularly. Records showed that the home works with other health care professionals and obtains appointments and advice for the service user when needed. Some service users have not seen an optician for three years, however the manager advised that she is actively looking for a local optician who can accommodate service users needs. Good practice was noted in that a member of staff discussed with a service user his fluid intake and possible consequences regarding this and reached a mutual decision. The home has a separate room to store medication, which was clean and tidy with medication stored appropriately. All medication given had been recorded on medication administration sheets (MAR sheets), however where entries are handwritten these had only been signed by one member of staff. The manager must ensure that two staff sign to witness handwritten entries, this will help to lessen the risk of mistakes being made. Regular stock checks of medication received are carried out however one service user had not received one of their medications for 16 days and this was recorded as out of stock. No stock check system is in place for medication that is to be returned. Currently these are stored in a cupboard in the medication room and not counted or entered as stored until they are ready to be returned. A cupboard in the medication room contained a variety of dressings. This included, loose packets and boxes with no name on. No service users should have a dressing applied that is not prescribed and stored in a box in their name, therefore these should be disposed of. The manager must review the stock check system for medication to ensure all medication held is recorded, service users always have sufficient supplies available and stores of unnamed or unused dressings are not held. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has satisfactory polices and procedures in place which they follow in the event of a complaint or allegation, however this informationi is not easily available to service users representatives. EVIDENCE: Two of the relatives who completed comment cards stated that they aware of how to make a formal complaint however the other four relatives stated that they are unaware of how to do this. The manager should ensure all relatives are provided with up to date information on the organisations complaints procedure. One relative explained, “ I have never made a formal complaint, when I have been unhappy about a certain aspect of (my relatives) care I have voiced it and generally speaking it is dealt with. There are copies of the organisations complaints and adult protection policies available in the home along with copies of the local authorities procedures for dealing with allegations of abuse. The manager advised training has been booked for staff in the protection of vulnerable adults. The manager and organisation have recently listed to and acted upon concerns raised by a service user and have co-operated with agencies involved in investigating this. Amounts and receipts of service users monies held by the home were checked and tallied. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29 & 30 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home provides sufficient shared and private space for residents, staff and visitors. Bedrooms and toilets are personal and well adapted to meet the person’s needs and choices. Communal rooms are not as well furnished or decorated and appear clinical and uninviting. The home is clean and hygienically maintained. EVIDENCE: The home is in the middle of Formby pinewoods and although in scenic surroundings it is quite isolated from the nearby community. As a purpose built home Pinelodge does not fit in with other properties in the local area and is recognisable as a care facility. Communal areas in the home include, a large dining room, two lounges, a seating area, bathrooms a kitchen and small courtyard. The home shares extensive grounds and parking with other services on the site. All areas of the home are accessible to people with mobility difficulties and the home provides a variety of equipment to meet peoples needs in this area. This includes, adapted toilets, baths, moving and handling equipment and an electric door to the main building. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 19 Bedrooms are furnished and decorated to a high standard and personalised by the service user or their representative. The communal areas are not as homely or well decorated and furnished. The dining room has a clinical and uninviting look and lounge areas have mis-matched furniture and would benefit from re-decoration. Each resident has a designated toilet, which is decorated and furnished with aids and adaptations to suit their needs. In addition the home provides bathrooms with adapted baths and moving and handling equipment. There is a separate laundry room with industrial washing and drying machines, clear systems are in place for minimising the risk of cross infection with laundry and the home was observed to be clean and pleasantly smelling throughout. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There are sufficient staff working in the home however not all staff are familiar with or have the skills and training to meet service users needs effectively. Clear recruitment polices are in place and staff receive some but not all of the training required to keep service users safe. EVIDENCE: Of the eight permanent care staff employed by the home six have obtained a care qualification (NVQ), the home are therefore exceeding the national standards of having over 50 of staff holding a care qualification. A service user spoken with said that they liked the staff working in the home. Some positive interaction between staff and service users was observed, with one member of staff taking time to communicate effectively with a service user and establish their views. As detailed elsewhere in this report staff interaction with service users at mealtimes was not always positive. For some time the home have been operating with a high number of agency or bank staff. The Manager advised that approximately 13 shifts per week have a bank or agency member of staff. She explained that the rota is now arranged so that there are at least two permanent members of staff working at any one time and that most bank or agency staff used are familiar with service users. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 21 Relatives who completed comment cards felt that there is sufficient staffing in the home but expressed concerns regarding the use of unfamiliar staff. One relative commented, “Staffing is sufficient. Concerns relate to number of agency staff employed at times. Residents’ benefit from having a key person who knows them well and has a trusting relationship. Staff we see regularly are caring and supportive”. Two relatives commented that they did not know who their relative’s keyworker was, with one explaining they would find this information useful. The manager should ensure this information is made available to relatives. The rota evidenced that there is usually a registered nurse and three carers working during the day with a registered nurse and one carer at night. In addition the home employs a part time domestic and has in put from the onsite kitchen and maintenance staff. Records showed that the home operates a good recruitment procedure with a clear format for interview, with some checks carried out to ensure staff are suitable to work with service users, This includes obtaining Criminal Records Bureau checks (CRB) and two written references. As identified at the previous inspection of the home in March 2006 not all forms of staff identification required are held by the home, this includes, a photograph, and copies of birth certificate and passport, the home should also obtain and keep on record a health declaration from the member of staff. Staff have copies of their terms and conditions of employment and code of conduct and the organisation operates a six month probation period for new staff. Most staff have completed training in moving and handling and fire, emergency aid and the ethos of the organisation. New staff have a good introduction to the home based on the Learning Disability Award framework (LADAF). Some care staff are responsible for giving fluids to a service user through a tube in their stomach. Although the manager explained that nursing staff have showed them how to do this no formal training or assessment of their competence has been carried out. The manager must ensure that no carer carries out this practice until they have received training and an assessment of their skills in this area, this will help to prevent any mistakes being made. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home manager is aware of her role and responsibilites and is motivated to improve the service offered. Support must be developed for the manager to achieve service aims and continual improvements of the service. Quality assurance systems are in place but not always completed. Health and safety, with the exception of fire checks, is well managed within the home. EVIDENCE: Mrs Jenny McGibbon is the registered manager of Pinelodge. She holds a registered nurse qualification for working with people with learning disabilities and has worked in a management capacity for some time. She does not currently hold a management qualification but is working towards obtaining this. The manager is enthusiastic and committed to improving the service offered and has plans in place for achieving this. She explained that at present a lot of Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 23 her time is spent providing or observing staff delivering, direct care to service users. She explained that due to staffing difficulties and in order to ensure service users are receiving a good service, she has to prioritise this area of her role at present. However not all last inspection requirements have been met by the home and plans in place at the last inspection for improving the service have not been implemented. The organisation must provide additional support to the registered manager to ensure the home is progressing and meeting national standards. The home has a system in place for carrying out quality assurance audits of their service. This is based on national care standards. The audit was not completed and did not include obtaining service users or their relatives views about the home. Satisfactory records and certificates were available for small electric appliances, fire, emergency lights, electrics, gas, water and the hoist. The fire book evidenced that regular tests of the system are carried out. However the record of staff participation in fire drills was not up to date and the record for visual checks had not been completed. The manager must ensure all staff participate in fire drills at regular intervals and all fire checks including escape routes are carried out regularly. Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 X 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 2 2 X X 2 2 Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 YA34 Regulation 17(2) 19 (1)(b) Requirement The home must obtain all identification documents for staff, this includes, a photograph, copies of birth certificate and passport and a health declaration from the member of staff. This is a previous inspection requirement. The manager must ensure all service users have a care plan in place which identifies their support needs and gives clear guidelines regarding how these are to be met, for all areas of their life. The Manager must ensure that all service users have risk assessments in place, which are reviewed at least every six months and whenever their needs alter. The manager must carry out a documented review of mealtimes in the home to identify areas for improvement and the action that need to be taken to address these. DS0000063016.V295024.R01.S.doc Timescale for action 17/08/06 2 YA6 15(1) 14/09/06 3 YA9 13(4)(c) 17/08/06 4 YA17 12(1) 14/09/06 Pine Lodge Version 5.2 Page 26 5 YA17 13(3) The manager must ensure good infection control practices are followed when staff are preparing and serving meals. 03/08/06 6 YA20 13(2) The manager must ensure that 03/08/06 two staff sign to witness handwritten entries, this will help to lessen the risk of mistakes being made. The manager must review the stock check system for medication to ensure all medication held is recorded, service users always have sufficient supplies available and stores of unnamed or unused dressings are not held. The manager must ensure that no carer supports a service user with the use of their stomach tube until they have received training and an assessment of their skills in this area The organisation must provide additional support to the registered manager to ensure the home is progressing and meeting national standards. The manager must ensure all staff participate in fire drills at regular intervals and all fire checks including escape routes are carried out regularly. 17/08/06 7 YA20 13(2) 8 YA35 18(1)(c) 03/08/06 9 YA38 10(1) 17/08/06 10 YA42 23(4) 17/08/06 Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 27 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 Refer to Standard YA7 Good Practice Recommendations The manager should include in care plans a section on the decisions that each person is able to make, how they can be offered meaningful choices, the way they communicate this and how staff can support them. The home should look into facilities available in the local area and offer these opportunities to service users as part of their care planning. This is a previous inspection recommendation The home should offer service users a choice at mealtimes. This is a previous inspection recommendation The home should give some consideration to decorating and furnishing the lounge to provide a more homely and inviting room. This is a previous inspection recommendation The manager should ensure all relatives are provided with up to date information on the organisations complaints procedure. The manager should ensure all relatives are provided with up to date information about service users keyworkers. 2 YA12 3 4 YA17 YA24 5 YA22 6 YA33 Pine Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Lodge DS0000063016.V295024.R01.S.doc Version 5.2 Page 29 - 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. 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