CARE HOMES FOR OLDER PEOPLE
Pine Lodge 13 Hazeldene Road Weston Super Mare North Somerset BS23 2XL Lead Inspector
Melanie Edwards Key Unannounced Inspection 09:30 30 August and 17 September 2007 X10015.doc Version 1.40 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 DS0000069525.V344199.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 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 Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Pine Lodge Address 13 Hazeldene Road Weston Super Mare North Somerset BS23 2XL 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) 01934 622539 Orchard Care (South West) Ltd Miss Rebecca Louise Kingston Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 21. 2. Date of last inspection Brief Description of the Service:
Pine Lodge is a large detached property with well kept gardens and visitor car parking situated in a quiet position near to Ashcombe Park. It is a Home registered for residential care of residents aged 65 years or older. All rooms are single with shared accommodation offered upon request. It is a non-smoking home. Eleven of the 20 rooms have en-suite facilities and the remainder have wash hand basins. The communal areas include a lounge area on the first floor, a TV lounge and another quiet lounge area on the ground floor with a large separate dining room. It is in close proximity to local shops, places of worship and a main bus route. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted seven hours and was carried out over two separate days. On the first day of the inspection the Home was officially closed to outside visitors. This was due to an outbreak of diarrhoea and vomiting among residents and staff. The Inspector met an Environmental Health who advised visitors not to come to the Home for at least forty-eight hours. The inspector met twelve of the sixteen residents at the Home. A number of visitors were also spoken to. A senior care assistant, two care staff, and the cook were consulted about their roles and responsibilities, their training needs, and how they assist and support residents. Residents were observed being assisted with their needs by staff. A number of records relating to the day-to-day running and management of the Home were inspected. A range of residents’ records and care plans were also inspected. The environment was seen throughout, both inside and out. Sue Fuller the Commission Pharmacist Inspector for the South West region carried out an inspection of medication standards in the Home. A copy of the report following her visit is available on request to the Commission. The Home was operating within the required conditions of registration set down by The Commission. The conditions of registration set out the type of care and the needs of residents. The conditions also set out the numbers of residents who may stay at the Home. What the service does well:
Caring staff support the residents, and their needs are well met. Residents feel very satisfied with the care and the service that they are provided with. One resident said of the service, `I find it very good, the staff are very caring’, another resident said, `the staff are all lovely’. These comments were reflective of the comments made by all the residents who were consulted. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 6 Residents are provided with a varied and well balanced diet, and a range of low-key social activities. The Home is very clean and it is satisfactorily maintained. Residents say they like living in an environment that is very ‘homely’ and welcoming. What has improved since the last inspection? What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4. Quality in this outcome area is adequate. Residents and their representatives have the information they need to make an informed choice about living at the Home. Residents ’ needs are being assessed. However assessment records are not all up to date. Assessment information fails to reflect what residents’ current needs are. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the service users guide is kept in the entrance hall, and this is a wellfrequented area of the Home. There is also a copy of the last inspection report kept there. This helps residents and visitors to be able to find out the necessary information about the Home. The service users guide and statement of purpose were looked at to find out what information is available for residents and representatives. Both documents were detailed and informative.
Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 9 There were photographs of the Home included as well as the aims and objectives of the Home and the type of care to be provided. The name and contact details of the owners, along with experience of staff and the manager of the Home are also included. Three assessment records were looked at in detail. The assessments include information about each resident’s needs, and evidence that that the type of care they need is being assessed. There was a basic nutritional needs assessment for each resident to show what the person dietary and nutritional needs are. There was some information about residents skin vulnerability and the risks the person may develop pressure sores. There was also assessment information about each residents mobility needs, and the risks they face of falling. However the assessment records were over two years old, and the information did not reflect all of the information written in the resident’s care plans. The three care staff on duty were providing sensitive, and discrete support to residents. They were seen to be meeting personal care needs in a kind and very patient way. Residents expressed very positive views about the care and service they received. The residents and relatives survey forms that were sent back to us also included very positive views about the care provided. Examples of comments made by residents about the staff and the Home included, ‘I think the service is very good,’ `the staff are extremely helpful’, `I’m well looked after’, and, ‘I find it very very good’. These comments demonstrate residents feel satisfied and happy that the Home is meeting their needs. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10. Quality in this outcome area is good. Residents’ needs are met by extremely kind and sensitive staff who treat residents with the up most respect. Care plans adequately demonstrate how needs are being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were read to find out how residents are supported to meet their needs. The care plans seen set out how to meet the needs of residents. Care plans contained an adequate level of information and basic guidance for staff to follow to support residents with physical, psychological, social and communication needs. The care plans had been reviewed, and up dated on a monthly basis by Miss Kingston. To monitor the physical health of residents, the Home keeps a health check record for each person. This is a record of when the resident had seen the doctor, the optician, the dentist, and what treatment may be required.
Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 11 The records showed the GP sees residents on a regular basis to attend to their health care needs. Residents also see the optician for regular eye tests. These records help to demonstrate how the Home is ensuring residents’ physical needs are met. Residents are registered with local GP surgeries. During the inspection a GP visited the Home to attend to one residents health needs. This is good evidence that residents’ health needs are monitored. Care staff assisted residents in a very polite and very respectful manner. All of the residents the inspector met commented in a very positive way about the care and the attitude of the staff. Examples of comments made by residents included, ‘I get on well with all of them they are all lovely’ and, `you wont find a better home’, ‘it’s wonderful here my G.P recommended it,’ `the staff are all very nice’, and, `yes I’m well looked after’. The staff refer to residents as Mr, Mrs, or Miss. This respectful tone was clearly appreciated by all of the residents who were consulted. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15. Quality in this outcome area is good. Residents are provided with a variety of low-key social and therapeutic activities. They are supported to receive visits from family and friends, and to be a part of the local community if they so wish. Residents are provided with a well-cooked varied and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was information on display in the entrance hall to ensure residents are aware of planned activities in the Home. Residents take part in a range of lowkey social activities, including, making jigsaw puzzles, scrabble sessions, and whist drives. There are outside musical entertainers who visit the Home, and several residents said that they enjoyed these events. Residents go out for regular trips often on their own or with family and friends into the local community. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 13 There is a hairdresser who attends to residents in the Home Residents were observed having their hair attended to during the inspection, and looking as if they were having an enjoyable time. Comments made by residents confirmed that they felt able to choose if they wished to what time that they get up, and go to bed. This was also observed during the inspection, with residents rising at differing times during the morning. This also helps demonstrate residents can exercise choices in their daily lives. Residents were observed receiving visitors and the Home operate a relaxed and flexible visiting policy. This should help to ensure residents keep in close contact with their families and friends. To check the quality of food provided a portion of a lunchtime meal was sampled in the company of a group of residents. This consisted of roast pork creamed potatoes, gravy, brussel sprouts, cauliflower, and carrots. There was homemade coconut sponge or fresh fruit for desert. The meal was tasty and well cooked. The Home operates a very flexible menu of traditional cooked meals. The menu choices were well balanced, and varied and special diets are also catered for. All of the residents commented very positively about the quality of meals provided. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ complaints about the service are listened to and acted upon wherever possible. The residents are cared for by very kind understanding staff. However they would be even better protected if all staff had up to date knowledge of how to protect residents from harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home employ a `liaison officer’ to address residents concerns and complaints. They meet all residents on a one to one basis every week .The `liaison officer’ has the job of making sure if residents have complaints they are promptly and properly dealt with. A number of residents said how useful this person’s role is. They said they always speak to the member of staff if they had any concerns. The complaints record was not looked at on this occasion, as it could not be located, this will be requested at the next inspection. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 15 There is a copy of the complaints procedure in the reception area, which includes the name of the Commission for Social Care Inspection. This helps anyone who wishes to contact us to make a complaint. The contact details of the owners are included in the service users guide and with residents’ contracts, if residents or representatives wish to contact the owners directly to make a complaint. Many residents also said that they felt able to speak to the manager, or the senior care assistant if they have any concerns and wished to complain. Staff were observed assisting residents and talking to them in a polite and respectful manner, which helps to suggest that staff are suitable to work with vulnerable residents in their care. However, the staff have not attended any training on the subject of protection of vulnerable adults from abuse. This training is beneficial for residents and staff as it helps them know how to ensure residents are protected from abuse. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26. Quality in this outcome area is good. The Home is suitable for residents to live in and has the necessary adaptations and equipment in place to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pine Lodge Care Home is situated close to Weston Super Mare town centre. It is also near to local shops, a church and a park. The Home is a large older house built over two floors. There are stairs or a stair lift to reach the second floor. The majority of bedrooms and all the communal areas were viewed. All of the bedrooms are for single occupancy. Eleven of the bedrooms have en-suite facilities in them. There are also shared toilets and bathrooms nearby for those rooms that do not have en-suite facilities.
Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 17 Rooms were satisfactorily decorated and maintained. The environment was very clean and tidy throughout. Residents said that a high standard of cleanliness is maintained. Bedrooms are personalised to reflect the tastes of residents with photographs, mementos and small items of furniture. All of the residents asked said they liked the environment and setting of the Home. There is a dining room, a television lounge, and a small staff lounge located next to the kitchen. Residents were observed sitting in communal areas looking very relaxed and comfortable in the surroundings. To assist residents with reduced mobility there is specialist equipment and adaptations are in place throughout the Home. Accessible toilets are located close to the dining rooms and lounges. Communal bathrooms were clean and well maintained and were free of any unpleasant odours. The building was ventilated and warm with plenty of natural light. Radiators were fitted with guards throughout the Home. This helps reduce the risk of residents burning themselves. As stated in the summary of the report, the Home was officially closed to outside visitors on the first day of the inspection. This was due to an outbreak of diarrhoea and vomiting among some of the residents and the staff. The environmental health officer had left a report that confirmed that the Home had followed the correct practises and procedures to minimise further risks. The outbreak passed after forty-eight hours. There was soap and hand-towels available in the toilets and bathrooms. This should minimise the risks of cross infection in the Home. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30. Quality in this outcome area is good. Residents are cared for by a sufficient number of very caring competent staff. The recruitment procedures are safe and robust and protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff duty record for two weeks of September 2007 was checked to find out how many staff are on duty to support residents with their needs. There had been no sickness recorded during this time. There are at least three staff on duty during the early shift to provide residents with the support they need during the day. There are three staff on duty in the afternoon. There are two members of staff work a night shift one of who does a `sleeping in’ shift and can be called upon if needed. The manager works full time largely supernumerary hours during the week to support staff and residents. There are also full time catering staff, with a cook and part time cook, as well as domestic staff working during the week. The comments made in the survey forms, and from the residents the Inspector met were very positive about the staff. Residents all said how kind, caring, and very helpful of the staff are. Based on the evidence seen during the inspection, the number of staff on duty is sufficient to meet residents’ needs. The training records of staff could not be located at the inspection. These will be requested at the next inspection of the service. However there was
Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 19 information seen that showed staff have attend training sessions in health and safety, fire safety, and food hygiene. The staff on duty said that the manager is in the process of trying to book staff onto National Vocational Qualifications in care. The progress of this training will reviewed at the next inspection. Staff were very polite and very courteous in manner when helping residents with their care needs. Staff were also asked about how they help residents with their needs. The staff consulted demonstrated a good understanding of how they need to support residents with their needs. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36, 37,38. Quality in this outcome area is good. Residents’ benefit from the management in the Home. The health and safety of residents and staff is protected in the Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ms. Kingston has been the registered manager of the Home since March 2007. She also has three years experience working as a manager of another Care Home in Bristol. This experience makes Mrs Kingston suitable to fulfil the requirements of the role of registered manager. A full time senior care assistant supports Mrs Kingston in her role. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 21 Residents said that Mrs. Kingston was friendly and kind and would do `anything to help’. The residents also spoke equally positively about the senior care assistant, who they said was always very helpful. Residents individual records and the Homes general records were kept secure in the Home.Care records were satisfactorily maintained, and in order. Records were kept in the office that could be locked when not in use. Generally the records seen were satisfactorily maintained and up to date, legible and in order and helped to demonstrate organised management and day-to-day running of the Home. Other records have been referenced elsewhere in the report. Miss Kingston has commenced providing supervision to all staff in the Home. The supervision records of one member of staff were looked at on this occasion. These records demonstrated that the staff feel supported by Miss Kingston. One of the care staff on duty also said that they had found having one to one supervision sessions with Miss Kingston very helpful and beneficial to them. A number of residents said that Mrs. Kingston was approachable and listens to concerns and problems. Many residents also spoke very positively about the senior care assistant who they also said was, ‘very approachable’, and. ‘very kind’. This helps demonstrate resident’s views are listened to and acted on by the Home where possible. One of the owners carry’s out the required Regulation 26 monthly monitoring visit of the Home to check on the overall quality of service provided. The reports of these visits could not be located. However the staff on duty said that residents are consulted every time the Regulation 26 visits take place. The environment looked to be safe and satisfactorily maintained throughout. A maintenance worker is employed to carry out routine repairs. There are regular health and safety checks of the Home carried out .A record of these checks as well as any action that is needed is kept to ensure residents health and safety is maintained. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 3 3 Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 23 N/A 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 OP3 Regulation 14.2 Requirement Residents assessments of their needs must be updated on are regular basis: This requirement relates to assessment records being over two years ago and not updated. Timescale for action 17/10/07 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 OP18 Good Practice Recommendations Staff should undertake some form of training about the protection of vulnerable adults from abuse: This is so that staff have a good understanding of how to protect residents from the risks of abuse. Pine Lodge DS0000069525.V344199.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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