CARE HOMES FOR OLDER PEOPLE
Pine Lodge Retirement Home 32 Key Street Sittingbourne Kent ME10 1YU Lead Inspector
Andrea Leverett Unannounced 26 July 2005 7.00am 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 Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Pine Lodge Retirement Home Address 32 Key Street Sittingbourne Kent ME10 1YU 01795 423052 01795 423052 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) Mr Stephen Paul George Thompson Mrs Gail Edey Care Home 57 Category(ies) of OP Old Age (57) registration, with number of places Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5 December 2004 Brief Description of the Service: Pine Lodge Residential Home occupies detached premises, with accommodation for residents on two floors. The premises have been substantially extended and refurbished and is now registered for 57 service users. The Home has two shaft lifts and other mobility aids that enable it to accommodate wheelchair users. There is allocated car parking to the front and rear of the building and two enclosed garden areas. The Home is situated close to Sittingbourne town centre, with local shops, public transport and other community facilities within the vicinity. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 07.30am until 13.00pm. The home currently has 48 residents and is running with 9 vacancies. The visit was spent talking directly with residents privately and collectively, care staff, kitchen staff, the owner and the registered manager. Some judgements about quality of life and choices were taken from direct conversation with residents and observation followed by discussion with support staff and evidencing records held at the home. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
The Home has now purchased a second hoist, which can be used to lift service users from the floor if necessary and a range of moving and handling equipment was evident around the Home, which when used will enable staff to support service users to move safely and comfortably. Service users safety has been enhanced by the provision of call bells in en suite facilities.
Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 6 Safety has also been improved by the provision of thermostatically controlled valves fitted to water outlets used by service users. Safety of service users has been further enhanced by improvements in medication storage. The Home has recently purchased two medication trolleys and now has a lockable drug fridge for storing medication at the appropriate temperature. The risk of financial abuse to service users has been reduced by the introduction of a formal system to allow staff to undertake personal shopping on behalf of service users whose relatives are unable to carry out this role. Service users have benefited from an occupational therapy assessment of the premises and facilities and subsequent action taken by the Home to meet recommendations made by the therapist. Feedback from service users spoken to and observation on the day of the inspection evidenced that service users benefit from fruit being made available as a snack. What they could do better:
The Home could improve the safety and quality of care of service users by increasing staffing levels in line with the Residential Forum Staffing Guidelines. The quality of life and safety of service users could be enhanced by the redecoration and refurbishment of parts of the original premises; including the refurbishment of the first floor bathroom, the installation of radiator covers or guaranteed low temperature surfaces and restricted window openings fitted to above ground level accommodation. The protection of service users from abuse could be enhanced by ensuring that all staff have undertaken training in Adult Protection. Safety of service users accommodated in double rooms could be improved by ensuring that call bells are more accessible. Ensuring that service users have access to hot drinks and snacks in the evenings could be improved by introducing a supper menu, which all service users are informed about and is properly recorded and monitored. The safety of service users could be improved by ensuring that all staff involved in food preparation undergo certificated food hygiene training. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 7 The risk of infection to service users could be reduced by ensuring that all bins used in areas were personal care and food preparation are undertaken have lids that can be lifted hygienically. 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 Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 8 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 Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 9 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) None of these standards were assessed on this occasion. EVIDENCE: Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9 Safety of service users has been further enhanced by improvements in medication storage. EVIDENCE: Medication administration and storage was not fully inspected on this occasion but it was noted that the Home has recently purchased two medication trolleys and now has a lockable drug fridge for storing medication at the appropriate temperature. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 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, 15 Service users benefit from being offered the opportunity to undertake activities but these are not always consistent and does not always include the opportunity for physical exercise. Service users are happy with the range and choice of foods available at breakfast, lunch and tea but the Home could do more to ensure that all service users are given the option of a hot drink and light supper later in the evening. EVIDENCE: Service user feedback regarding activities was mixed. Some service users talked about a recent day trip that was organised by the Home and others said they were sometimes offered the chance to take part in quizzes and games with the support of care staff. One lady confirmed that she is able to take part in a church service held regularly in the Home and is visited by a nun every Friday. Service users in the Pines side of the home were observed taking part in a game of scrabble on the day of this unannounced inspection. No activities were observed on the Firs side of the Home and several service users told the inspector that they are not given the opportunity to undertake activities that include regular exercise. Most service users spoke positively about the food provided at breakfast, lunch and tea. Comments such as “ if we don’t like what’s on the menu we can
Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 12 choose something else” “ There is always fruit in the lounge we can have what we like” “The food has got a lot better here recently” Feedback regarding access to hot drinks and snacks in the evenings was mixed. Several service users said they could not have a hot drink after nine o’ clock. Another service user said “ you only get a drink and snack if you ask and you have to ask every time.” It was noted that since the last inspection the Home has started recording when service users have had snacks in the evenings although records were not being consistently filled in. The last entry in the Firs supper record book was the 7th July and June for the Pines side of the Home. Taking into consideration that some service users are very frail and have short term memory loss or mild dementia the Home must be able to evidence that service users are offered hot drinks and snacks at reasonable times. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 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) 18 Poor staffing levels and lack of training in Adult Protection are undermining the homes ability to safeguard service users from the risk of neglect and abuse. EVIDENCE: The home’s staffing levels are well below minimum staffing levels recommended by the Department of Health and the Residential Forum Staffing Guidelines.(see standard 27 for more details.) Also on the day of this unannounced inspection the Home had only had two staff on night duty to care for 48 service users including very sick and frail or service users who are suffering from short term memory lose and dementia. Staff spoken to said this does happen sometimes and the staff rota indicated that this serious staffing shortfall was going to be repeated during the coming week. One staff member said “ It can be very busy with call bells going all night” another is quoted as saying “ If we tell service users we are busy they are very good and don’t ring their call bells so much.” A service user stated that after falling to the floor “ It seemed like a long time before staff came to help” These sorts of comments and observations have consistently been expressed at previous inspections and requirements that the Home improve staffing levels sufficient to meet service users needs remain outstanding. Training records were not inspected on this occasion but the manager informed the inspectors that approximately 40 of staff have still not received training in Adult Protection.
Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 14 The Home is currently the subject of Two Adult Protection investigations and although it is acknowledged that the Home has co operated fully with the investigations and taken subsequent action to reduce the risk of harm or abuse, lack of staff training in this area is seen as a major shortfall. The commission is minded to take enforcement action if the Home does not comply with outstanding requirements regarding Adult Protection Training for staff. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 15 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) 21,22,24,25,26 Although Parts of the Home are decorated and maintained to a good standard quality of live and safety of service users is being undermined by poorly maintained environments in other parts of the Home. EVIDENCE: The environment on the Pines side of the Home is decorated and maintained to a good standard and service users expressed satisfaction with the decoration and furnishings. The Home has now purchased a second hoist, which can be used to lift service users from the floor if necessary and a range of moving and handling equipment was evident around the Home, which when used will enable staff to support service users to move safely and comfortably. Service users safety has been enhanced by the provision of call bells in en suite facilities. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 16 Safety has also been improved by the provision of thermostatically controlled valves fitted to water outlets used by service users. Service users have benefited from an occupational therapy assessment of the premises and facilities and subsequent action taken by the Home to meet recommendations made by the therapist. The quality of life and safety of service users could be enhanced by the redecoration and refurbishment of parts of the original premises; including the refurbishment of the first floor bathroom, the installation of radiator covers or guaranteed low temperature surfaces and restricted window openings fitted to all above ground level accommodation used by service users. The Commission is minded to take enforcement action against the Home if outstanding requirements regarding protection from unguarded radiators, access to call bells in double rooms and safe window openings are not met. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 17 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 Poor and inconsistent staffing levels are undermining the homes ability to meet the assessed needs of service users. EVIDENCE: The homes staffing levels are well below minimum staffing levels recommended by the Department of Health and the Residential Forum Staffing Guidelines. Evidence seen at this and other unannounced inspections indicate that this is seriously undermining the homes ability to keep service user safe and meet assessed needs. ( see standard 18 for more details and service user comments.) The following conclusions have been reached using information provided by the registered manager regarding numbers of service users and their level of needs and the staffing formula recommended by the Department of Health. The total number of weekly hours required of 861.21 is based upon guidance from the Residential Forum and includes allowances made for personal care, social, recreational and cultural activities. The total hours of 699.00 are those declared by the manager to be hours spent by care staff working directly with the service users and does not include time spent on administration, paperwork, or time spent with relatives, meetings etc. The total hours provided are 161.21 below those required. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 18 The Commission is minded to take enforcement action if the outstanding requirement to provide adequate staff at all times is not met. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 19 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) 36 Staff and service users benefit from formal and informal support and supervision from the manager. EVIDENCE: Staff spoken to at this inspection and service users spoken to at previous inspections evidence that the manager is approachable and supportive to service users and staff. Comments from staff such as “ Gayle sometimes comes in early to see if we are working properly and we can always go into the office and speak with her if we have any concerns.” And service users have been quoted as saying “ If you tell Gayle she will sort it out for you.” Staff also confirmed that a yearly staff appraisal system is in place. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 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 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION x x 2 2 x 2 3 2 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x x x x x x x 2 Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 21 No 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 OP18 Regulation 13(6) Timescale for action The registered person must Action plan ensure that all care staff receives by 25th Adult Protection Training. August 2005 The Registered Person must Action plan ensure that all radiators are by 25th guarded or have guaranteed low August temperature surfaces. 2005 The Registered Person must Action plan ensure that the homes call by 25th system is accessible to all August service users. 2005 The Registered Person must Action plan ensure that the strip lighting in by 25th the laundry area has secondary August covers. 2005 The Registered Person must Action plan ensure that the Home provides, by 25th in adequate quantities, suitable, August wholesome and nutritious food, 2005 which is varied and available in that: the can evidence that service users are offered a hot drink and light supper at such times as may be reasonably be required. The Registered Person must Action plan ensure that staff employed to by 25th undertake food preparation do August not do so without appropriate 2005 training.
Version 1.40 Page 22 Requirement 2. OP25 13(4)(c ) 3. OP24 23.2(a) 4. OP25 13.4(a) 5. OP15 16.2(i) 6. OP15 18.1(a) Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc 7. OP26 13.3 8. OP38 13.4(a) The Registered Person must ensure that for the purposes of hygiene and infection control, bins provided in areas were personal care and food preperation are undertaken are covered and can be opened hygienically. The registered Person must ensure that first floor windows are fitted with restrictors. The registered Person must ensure that adequate staff are provided in the home at all times. The registered person must ensure that the upstaires bathroom on the Firs side is refurbished and decorated to a resonable standard. Action plan by 25th August 2005 9. OP27 18.1(a) 10. OP 21 23.2 (d) Action plan by 25th August 2005 Action plan by 25th August 2005 Action plan by the 25th August. 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 OP12 Good Practice Recommendations It is recommended that a planned programme of activiites that includes opportunities for regular excersice is introduced and the home employs an activities co ordinator. Pine Lodge Retirement Home H56-H06 S23989 Pine Lodge V241691 260705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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