CARE HOMES FOR OLDER PEOPLE
Pine Trees 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ Lead Inspector
Diana Penrose Announced Inspection 27th February 2006 09:30 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 Trees DS0000062885.V281335.R01.S.doc Version 5.1 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 Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Pine Trees Address 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ 01736 753249 01736 759261 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) Guardian Care Homes (uk) Ltd Mrs Frances Catherine Winsor Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th August 2005 Brief Description of the Service: Pine Trees Care Home is situated in the village of Connor Downs between the towns of Camborne and Hayle. There is car parking at the front of the home and a footpath that leads to the main entrance. Well-maintained grounds with colourful flowers surround the home. The building is a detached bungalow with a modern extension. There are 23 single rooms and one shared room. Accommodation and facilities are on one floor. All bedrooms have a door opening onto a walkway surrounding the building. These cannot be accessed from the outside when closed. Suitable ramps and grab rails are in situ. Meals are prepared in a well-equipped kitchen and served in the spacious dining room, or individual bedroom if preferred. There is a large smoke free lounge with an adjacent conservatory. There is a patio outside with garden seating and tables. The home provides residential care for up to twenty-five elderly people. The home also provides day care and respite facilities. The Registered Manager is a qualified nurse who, along with a team of suitably experienced care staff, provides personal care within a relaxed and friendly atmosphere. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Pine Trees on the 27 February 2006 and spent six and three-quarter hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 11.08.05. In addition the inspector focused on the following key areas of care: choice of home, assessment and care planning, health care, medicines, some of the environment, staffing and some management areas. On the day of inspection 23 residents were living in the home, this included one receiving respite care. The methods used to undertake the inspection were to meet with a number of residents, staff and the registered manager to gain their views on the services that Pine Trees offer. Pine Trees’ records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
The home offers a warm homely environment that is clean, free from offensive odours and well maintained. The grounds are accessible and kept tidy. Information is given to prospective residents and their family to assist them in choosing an appropriate place to live. The registered manager assesses prospective residents prior to their admission to the home to ensure the home can meet their needs. New care planning documentation is being implemented that provides much more information about the residents. Appropriate risk assessments are included. A life history is obtained for each resident and these are very informative and useful when providing care and activities. There is a suitable medicines policy and system in place. The medicines were administered professionally during the inspection. There are appropriate arrangements for respecting privacy and dignity and residents spoken with were very happy with the way they are treated. They have their own telephone lines in their rooms. Activities take place despite there being no co-ordinator at present and entertainers visit the home, residents said they are happy with what is on offer. Residents manage their own finances for as long as they are able and are encouraged to live independent lives. Routines are flexible and residents have personalised their rooms with their own possessions. There is an appropriate complaints procedure and method for recording. The home has had no complaints since the last inspection. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 6 Staffing levels are suited to the needs of the residents living in the home and residents said there are enough staff. They said the staff are all kind and caring and they are looked after well. 50 of care staff are qualified to at least NVQ level 2 in care, which meets the standard. Recruitment procedures are robust with appropriate checks made and documentation maintained. The regional manager visits the home unannounced each month and writes a report for the registered manager, a copy is sent to the Commission for Social Care Inspection. The home does not hold money for residents as a rule. Any money held is dealt with appropriately and records and receipts are kept. What has improved since the last inspection? What they could do better:
The service users guide must be reviewed and updated. The care documentation must be fully implemented and more detail recorded in the care plan section. This will inform and guide staff in the provision of care. The resident or their representative should be involved in the compilation of their care plan and any review.
Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 7 All staff must receive appropriate adult protection training. They have access to the home’s policy and the course information from the training undertaken by the registered manager but more training is required. Other training required urgently for staff is Health and Safety and moving and handling. A quality assurance system must be established and maintained to ensure a quality service is provided and monitored for improvement. The registered manager should keep a record of important conversations with staff as evidence that she has discussed issues with them. Cleaning schedules should be used in the kitchen indicating how items are to be cleaned. The cleaning rota should be initialled rather than ticked to show who actually did the cleaning. The home would benefit from the installation of a sluice with a washer disinfector. 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 Trees DS0000062885.V281335.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 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 the following standard(s): 1 and 3 Prospective residents are given information about the home enabling them to make a decision about the home; further detail would allow for a more informed decision. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care. EVIDENCE: The home has a statement of purpose that has been reviewed and a copy has been received by the Commission for Social Care Inspection. There are a few minor additions to be made and the registered manager said she would get this done promptly. The residents guide requires reviewing and updating and this was discussed with the registered manager. Generally prospective residents and their family visit the home to have a look around. This is when the registered manager tends to undertake her assessment of care needs. Sometimes she goes out to visit the prospective resident in his or her own home. The new format for recording the assessment is comprehensive and covers all of the areas listed in standard 3.3. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 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, 9 and 10 Individual care plans are generated for each resident but require more information to fully inform and direct the staff in the care provision. There are suitable systems and policies in place for dealing with residents medicines and assure residents safety. Systems are in place to ensure that residents are respected and their privacy is upheld at all times. EVIDENCE: The Company care planning documentation has been implemented for some residents. It is very informative with several risk assessments included. The actual care plan sections completed by the home are sparse and require expanding to include all of the areas listed in standard 3.3. The generic preprinted care plans are not being used by the home. There have been no reviews of the new documents as yet and there is no evidence that the care plans are compiled with the resident or their representative. The profiles of residents included in their files are very informative and give a good description of each resident and their life story. The daily records have improved. The home has a suitable medicines policy and staff are aware of this. Staff have undertaken training in the safe handling of medicines. There are no residents administering their own medicines at present but lockable storage
Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 11 space is provided in the bedrooms. The receipt, administration and disposal records are up to date. Any handwritten information on the MAR charts must be witnessed with two signatures recorded. The medicine round was observed and undertaken professionally. There are suitable arrangements for ensuring that resident’s privacy and dignity are respected. Residents have their own telephone line to their room and residents can receive calls on one of the home phones. All residents spoken with said their privacy was respected. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 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): 12 and 14 The home provides a range of activities and aims to offer a lifestyle that meets individual residents needs. Residents are helped to maintain control over their lives and staff respect their individual preferences and choice. EVIDENCE: The home does not employ an activities co-ordinator at present but is hoping that the post will be filled soon. Activities take place with the care staff and the registered manager arranges for entertainers to visit the home. Records are kept within the individual’s daily records. There is a plan of activities in the office but not distributed to the residents. Activities include reminiscence, manicures, a member of staff bringing her dog into the home, an organist who visits monthly and regular Holy Communion. Residents said they enjoy the singsongs and entertainers. One resident showed the inspector her painted fingernails and said she enjoys the pampering. Some residents said there is not a lot going on but they didn’t mind. Some were happy in their rooms. Staff encourage residents to be independent and the registered manager said they have every chance to choose how they live their lives. All residents bar one manage their own finances. They all have their own possessions around them. The daily routines are flexible and residents confirmed this. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 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 the following standard(s): 16 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon EVIDENCE: The home has an appropriate complaints procedure that is included in the statement of purpose. There is a method for recording complaints, there have been no complaints to the home since the last inspection but there has been one complaint to the Commission. Thank you cards and complimentary letters are kept. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. There is sufficient indoor and outdoor communal space for residents to be comfortable and choose where they would like to be. The home is clean and free from offensive odours making it a pleasant place to live in. EVIDENCE: The home is warm, homely and suitable for its’ purpose. The home has been totally re-decorated with new carpets fitted throughout. New furniture has arrived and is being installed in twenty rooms. Both staff and residents are happy with the new décor and furniture. The grounds are kept tidy, the swimming pool has been covered and a fence has been erected around it. A new non-slip dining room floor has been laid and new vertical blinds installed. The tables were laid with vases of flowers in the centre. A new widescreen television has been purchased for the lounge and residents commented that it was better. Furnishings throughout the home are good. The home runs a non-smoking policy.
Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 15 There were no unpleasant odours in the home and the home was clean on the day of inspection. There have been no domestic staff recently so the registered manager and the staff have undertaken the cleaning. The registered manager said that there had been an increase in dust due to the new carpets being laid but it has settled now. The laundry is suitable for the size of the home and suitable flooring has been fitted for infection control purposes. Hand-washing facilities for staff are good and alcohol gel is in use. It is recommended that there be a sluice with a washer disinfector in the home. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 29 and 30 Care staffing levels meet the needs of residents, however there are staffing vacancies to be filled. Residents are in safe hands and benefit from the 50 of care staff trained to at least NVQ level 2 in care. Recruitment procedures are robust and offer protection to the residents. The home is endeavouring to improve training for staff so they will be more competent in their roles. EVIDENCE: Staff are courteous and friendly and they interact well with the residents. Residents said the staff are kind and caring and they work very hard. In general residents feel there are enough staff and the duty rota showed sufficient staff for the number of residents. There are vacancies for night care staff, a deputy manager, an activities co-ordinator and a domestic. One domestic is due to commence work in a few days this will be of great benefit and relieve staff of this work. 50 of care staff are qualified to at least NVQ level 2 in care, which meets the standard. Agency staff are only employed when really necessary. Some staff work part time and tend to work extra hours to cover sickness and so on. A new recruitment system is in place with a checklist for documentation. Three staff files were inspected; some references had not been received for staff whose employment was imminent. The registered manager telephoned for verbal references during the inspection. All other documents and checks required by legislation are in place. The registered manager has the NHS study programme and staff can attend appropriate courses. A list of staff training is maintained, the information needs to be transferred to the individual staff files. The registered manager has
Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 17 undertaken infection control training and will train the staff in house. She has also undertaken the vulnerable adults alerter training and another staff member is booked to attend the course. The course information is available to all staff. A first aider is on duty at all times in the home. Fire training is up to date apart from two staff that were sick at the time of the last session. Two staff have achieved the Basic Food Hygiene Certificate, one night staff has the Intermediate Food Hygiene Certificate and so does the cook soon to be employed. No dates have been arranged yet for moving and handling training, this must be a priority. All staff apart from two require an update. Health and Safety training must also take place. The registered manager said there is a six-week induction programme for new employees. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 33 and 35 The home is run in the best interest of the residents but they would benefit if there were suitable Quality Assurance systems in place. There is a suitable system in the home for dealing with residents’ money with safeguards in place to protect the residents’ financial interests. EVIDENCE: There has been no quality assurance survey undertaken since Guardian Care purchased the home last year. It is hoped that a survey will be undertaken soon. No formal audits take place. There have been no residents meetings for some time either but the registered manager said she talks to the residents and informs them of any changes and so on. Sometimes written information is also given to residents. No formal staff meetings take place but the registered manager said she talks to staff all the time. It is recommended that the registered manager document when she has given information or discussed issues with staff. The regional manager undertakes monthly inspections and reports to the Commission in line with Regulation 26 of the care Homes
Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 19 Regulations 2001. A quality assurance system must be established and maintained. The registered manager said that all residents control their own money or their family take care of it for them. The home holds some money for one resident but only to pay for the hairdresser and chiropodist; her relatives deal with everything else. Suitable records and receipts are maintained. It is recommended that the registered manager keep a copy of power of attorney certificates. Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X X Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 21 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 2 Standard OP1 OP7 Regulation 6 15 Requirement The service users guide must be reviewed and updated The Registered Manager must continue to implement the new care documentation which must be written in more detail to fully inform and direct the care staff. Any handwritten information on the MAR charts must be witnessed with two signatures recorded All staff must receive appropriate adult protection training All staff must attend statutory Health and Safety training All staff must attend statutory moving and handling training A quality assurance system must be established and maintained Timescale for action 03/07/06 03/07/06 3 OP9 13(2) 27/02/06 4 5 6 7 OP18 OP38OP30 OP38OP30 OP33 13 12(1)(a)1 8(1)(a) 13(5) 24 03/07/06 03/07/06 03/07/06 03/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Pine Trees Refer to Good Practice Recommendations
DS0000062885.V281335.R01.S.doc Version 5.1 Page 22 Standard 1 2 3 4 5 6 OP7 OP26 OP33 OP35 OP38 OP38 There should be evidence that the resident or their representative is involved in the review of their care plan There needs to be a sluice with a washer disinfector in the home The registered manager should document relevant discussions with staff The registered manager should obtain a copy of power of attorney certificates The cleaning rota in the kitchen should be initialled when the work has been done rather than ticked There should be cleaning schedules for staff detailing how equipment should be cleaned and indicating the type of cleaning materials to be used Pine Trees DS0000062885.V281335.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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