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Inspection on 29/11/05 for Pine Lodge Retirement Home

Also see our care home review for Pine Lodge Retirement Home for more information

This inspection was carried out on 29th November 2005.

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

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

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

What the care home does well

The new manager has begun to re-write care plans. The new care plans are very detailed, and indicate closer assessment of service users and increased knowledge of individuals. The home owner and manager also acknowledge that Pine Lodge has been through a difficult period, and were enthusiastic about learning from that and moving on in a positive frame of mind.

What has improved since the last inspection?

The home is undergoing refurbishment. The environment for service users has improved, although this is still on going, and service users in the Firs unit have not yet benefited from the redecoration.

What the care home could do better:

The home needs to have a more proactive approach to dealing with falls. This needs to include developing formal protocols regarding medical attention, and informing (Regulation 37) relevant parties of incidents.

CARE HOMES FOR OLDER PEOPLE Pine Lodge Retirement Home 32 Key Street Sittingbourne Kent ME10 1YU Lead Inspector Sarah Montgomery Unannounced Inspection 29th November 2005 10:00 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 Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Pine Lodge Retirement Home Address 32 Key Street Sittingbourne Kent ME10 1YU 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) 01795 423052 01795 423052 Mr Stephen Paul George Thompson Mrs Gillian Lesley Thompson Vacant Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (57) of places Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2005 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 DS0000023989.V270727.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sarah Montgomery and Andrea Leverett conducted this unannounced inspection on November 29th 2005. The majority of the inspection was spent talking to service users. This included reading through care plans with individuals and reading through the service user guide. Discussions were also held with the manager, home-owner, and care staff. A tour of the building was undertaken and environment standards were inspected. The duration of the inspection was five and a half hours. What the service does well: What has improved since the last inspection? The home is undergoing refurbishment. The environment for service users has improved, although this is still on going, and service users in the Firs unit have not yet benefited from the redecoration. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 6 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. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. The service users can be confident that the home’s Statement of Purpose and Service User guide provide all the information required by service users and their representatives to make an informed choice about where they live. Service users benefit from having their needs assessed prior to moving in. EVIDENCE: During the inspection service users were asked about facilities and services in the home, and about staff roles. Service users were able to tell the inspector about the home and the staff. This evidenced that the statement of purpose and service user guide were documents that accurately reflected day-to-day life at Pine Lodge. Service users spoke of being visited by the manager prior to moving in. They indicated that a long time was spent with them, their relatives, and any other persons involved in their care. The manager asked a lot of questions about their lifestyle and needs, and the service user and their representatives also had opportunity to ask questions about the home. When possible, service Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 9 users are encouraged to visit the home and meet staff and residents, look at the communal facilities, and view the bedroom. Service users informed the inspectors that they all had a contract with the home, and that this contract stated a ‘settling in period’. Care plans viewed indicated assessment prior to moving in. All assessments viewed contained detailed information about the needs and wishes of the service user. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 10. Service users cannot be sure that their care plans currently outline all their health, personal and social care needs. Some service users cannot be confident that they are treated with respect. EVIDENCE: A high number of service users are experiencing regular falls. Care plans of these service users were inspected. The care plans do not evidence re assessment of the service users following a fall. The manager, who intends to reassess all service users, prioritising those with a current history of falls, noted this shortfall. The manager also intends to introduce a quick reference ‘falls log’ in each individual care plan. At present, the home’s protocol in response to a fall is for a carer to ‘check the person over’, record the fall in the accident book and on an incident sheet, and request that the community nurse looks at the service user the next time she is in. (The community nurse visits Monday – Friday). Staff have not received training in assessing service users following a fall. Most carers recorded in the accident book ‘no action taken’. Some falls appeared Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 11 quite serious, and at the very least, the service user should have been seen by a qualified practitioner to check for injuries and/or fractures. One service user spoken with told the inspectors of a ‘very nasty bang on his head’. He said he ‘supposed he should have gone to casualty’. However, no action was taken. The home’s current accident policy is insufficient and does not offer enough guidance to staff on what to do following an accident, ie: ‘decide whether the accident can be dealt with by following the usual course of action’. The policy does not allude to what the ‘usual course of action’ is. Review notes and daily notes were viewed. Some recorded comments were inappropriate and did not indicate that service users are treated with respect. Some examples of this are ‘he wet himself’, ‘she has been a pain again’ and ‘buzzed for silly reasons’. The manager is aware of this and has begun to address this with staff. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14. Service users can be assured that staff will support and encourage them to maintain contact with family and friends. Some service users cannot be confident that they will be helped to exercise choice and control over their lives. EVIDENCE: Service users spoke of their families and friends, and informed the inspectors that the home supports them to keep in contact with their friends and family by assisting them to arrange visits, write letters, and use the telephone. During the inspection the inspectors noted that many visits from relatives and friends were taking place. The home’s staff were observed to be friendly and welcoming towards guests, with every effort made to be helpful. Some service users talked about negative interactions with staff. Service users said they were made to feel ‘a nuisance’ and were sometimes ‘told off’ for needing help. Records viewed supported this, and staff had written inappropriate comments, which suggested that assisting service users to exercise choice and control over their lives was inconvenient. The manager is appalled by this, and vows to end this practice/working culture immediately. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 13 Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users cannot be sure that their complaints are listened to and acted upon. Service users cannot be confident that they are protected from abuse. EVIDENCE: Several service users spoken to expressed satisfaction with the home, and complimented many staff that worked there. However, the same service users spoke of a feeling of resignation regarding complaints, with most feeling that they were not taken seriously, and that any concern or complaint they had raised had not, to their knowledge, been addressed. One service user was told by a staff member that ‘If I fall once more, they will leave me there all night’. When told of this the manager and owner had no knowledge of this incident, or that the service user had complained. The home must ensure that all service users are aware of the complaints procedure, and feel confident and able to use it. Trust needs to be built with service users, and this will need to involve all staff. Management must ensure that service users are kept informed of any actions or outcomes relating to complaints. The home was required to ensure all staff received training in Adult Protection. Only one staff member completed this training, and they have left. This outstanding training is critical for the entire staff team, and without it service users and stakeholders cannot be sure that the service users living at the home are protected from abuse, or even that abusive practices are recognised by carers. The manager informed inspectors that she is working hard to identify a training course for all staff in the near future. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 15 Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. Service users in the new unit can be confident that they live in a safe, wellmaintained environment, with sufficient toilets and bathrooms to meet their needs. Service users living in the Firs cannot be sure that they live in a safe and wellmaintained environment. EVIDENCE: The home is split into two units: the Pines (newer unit) and the Firs. A comprehensive refurbishment is occurring in the home, and the service users expressed satisfaction at the positive changes taking place. The refurbishment programme is concentrating on the newer unit, which is decorated and furnished to a high standard. The inspector was informed that the Firs was due to be decorated in the next couple of weeks. Inspection of the Firs revealed shortfalls, not only in décor, but also in furnishings and carpeting in communal areas. Chairs and carpets were shabby and worn, and replacements are necessary. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 17 A bathroom on the first floor is unsafe as the floor covering is ripped and considered to be hazardous, both in terms of infection control and a risk to service users falling. This must be addressed urgently. Both units presented as clean and hygienic. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, and 30. The care of service users may be compromised due to a recent high turnover in staff. Service users cannot be confident that they are in safe hands at all times as staff training needs in key areas are yet to be addressed. EVIDENCE: The home has recently experienced a high turnover of staff; the manager, deputy manager and a number of care staff resigned, most without any notice. Prior to this, rotas were adequate, and staffing was sufficient. The rota for the last two weeks indicated a fall in staffing numbers, both during the day and at night. While the inspectors recognise that the home is actively seeking to recruit staff, the rota at present is insufficient to meet the needs of service users, and therefore the home is required to ensure that the home is staffed sufficiently at all times, with the numbers of staff not falling below what is considered safe. Staff training is insufficient. New staff are not given a formal induction due to the post of deputy being vacant. No staff have received training in adult protection. The manager has identified that the staff team are unsure about their role as key worker, and require training in this area. Care notes indicate a lack of sufficient knowledge of recording significant events, and, more worryingly, staff are recording comments, which are derogatory, and disrespectful. It is clear that all staff require training in report writing. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 19 The manager is aware of a training gap in the staff team, and assured inspectors that this will be addressed as a matter of urgency. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 33. Service users can be confident that they live in a home which is managed by a competent and experienced manager, and whose policies and practices reflect the best interests of service users. EVIDENCE: The manager has been in post six weeks. She is experienced in managing residential care for older people, and presents as competent leader, willing to tackle issues, and to promote excellent care for the people living at the home. The manager recognises previous difficulties at the home, and has compiled an action plan linked to timescales. She has audited the medication and has initiated some changes in recording. Care plans are being re-written and will provide more information for care staff to work with. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 21 Rotas viewed indicated a home run with the needs of the service users paramount. Policies and procedures all demonstrate a service that is responsive to service users, and run in their best interests. Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X X Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Timescale for action Unless it is impracticable to carry 30/04/06 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall make 30/11/05 arrangements for service users – (b) to receive where necessary, treatment, advice and other services from any health care professional. The registered person shall ensure that – (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person shall make 30/11/05 suitable arrangements to ensure that the care home is conducted – (a) in a manner which respects the privacy and dignity of service users. The registered provider and 30/11/05 registered manager shall, in DS0000023989.V270727.R01.S.doc Version 5.0 Page 24 Requirement 2. OP8 13(1)(b) 13(4)(c) 3. OP10 12(4)(a) 4. OP14 12(5)(a) 12(5)(b) Pine Lodge Retirement Home 5. OP16 22(3) 6. OP18 13(6) 7. OP28OP27 18(1)(a) 8. OP30 18(1)(c)(i ) 9. OP19 16(2)(c) relation to the conduct of the care home – (a) maintain good personal and professional relationships with each other and with service users and staff; and (b) (b) encourage and assist staff to maintain good personal and professional relationships with service users. The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (c) ensure that persons employed by the registered person to work at the care home receive – (i) training appropriate to the work they are to perfom. The registered person shall DS0000023989.V270727.R01.S.doc 30/11/05 28/02/06 30/11/05 31/03/06 28/02/06 Page 25 Pine Lodge Retirement Home Version 5.0 having regard to the size of the care home and the number and the needs of service users – (c) provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Pine Lodge Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Retirement Home DS0000023989.V270727.R01.S.doc Version 5.0 Page 27 - 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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