CARE HOMES FOR OLDER PEOPLE
Pinebeach 53 Southcliffe Road Friars Cliff Christchurch Dorset BH23 4EW Lead Inspector
Chris Gould Unannounced Inspection 7th November 2006 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 Pinebeach DS0000020485.V315682.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. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Pinebeach Address 53 Southcliffe Road Friars Cliff Christchurch Dorset BH23 4EW 01425 273122 01425 272876 pinebeach@totalise.co.uk 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) Lifecaring Holdings Limited Mrs Mary Ann Price Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th May 2006 Brief Description of the Service: Pinebeach is located opposite the sea and beach at Friars Cliff near Mudeford. The lounge, library and some of the rooms have sea views. The building has a lower ground floor. The laundry, kitchen, boiler room, registered persons office and staff facilities are located on this floor. The ground floor comprises of dining area and annexe, lounge, library, manager’s office, service user bedrooms, sluice room, communal bathrooms and toilets. The first floor comprises of service user bedrooms, a sluice room and communal toilets and bathrooms/shower rooms. There is level access throughout the floors and access by passenger lift to all floors. The outside area has two large wooden benches facing the sea. In the summer month’s additional garden furniture is put out that includes tables, chairs and parasol. The garden attracts wildlife, particularly birds. There is off road parking for staff and visitors. The fees for the home as provided to CSCI at the time of inspection range from £440 to £645. Additional charges include hairdressing, chiropody, toiletries and newspapers. See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over six hours on one day in November 2006. This was the second key inspection to be undertaken this year. Requirements and recommendations made as a result of the last inspection visit were reviewed. The commitment and hard work of the staff has continued and the progress identified in the previous inspection has been maintained. A tour of the premises took place and one staff file, three residents care records and relevant documentation and policies and procedures relating to the running of the home were inspected. Eleven residents, one visitor to the home and the staff on duty were spoken with. Since the last inspection four residents surveys and six relatives/visitors completed comments cards have been returned to CSCI. Mary Price the registered manager and Mr Dedman the responsible Individual was available throughout the inspection. What the service does well:
Residents confirmed that they are provided with a clean, well decorated and comfortable home where their privacy and dignity are respected and visitors are welcome to visit at any time. One relative commented ‘Very homely I am always welcome whatever time I visit’. The staff encourage residents to pursue their own lifestyle, where feasible, and to make choices about their daily lives. Those residents who were able to articulate a view confirmed that they were able to make choices about such matters as what they ate and when they got up in the mornings and went to bed at night. People living at Pinebeach can be confident that their complaints will be listened and responded to and that the home works to protect them from abuse and safeguard their financial interests. There is a varied activities programme for those residents who want to participate and they are offered a menu that provides a varied and well balanced diet. All comments received from the residents on the food were very positive including it was ‘good’, ‘excellent’ and ‘suits me’. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
As at the last two inspections the admissions process does not allow for the home to establish a person’s needs prior to moving into the home. A pre admission assessment is undertaken but is very limited in the information provided. This is a key area of practice, which carried out properly ensures that the home can meet prospective residents’ needs. Continued failure to meet this requirement will result in enforcement action. Both the responsible individual and the manager expressed their commitment to addressing this outstanding requirement for improvement. The home must develop and implement a risk assessment for the use of bed rails. Bed rails are considered to be a form of restraint and should only be used as a last resort following a risk assessment. There are administration of medication practices that need to be implemented to ensure that the residents receive their medication safely. The requirement to ensure that individual medicines are moved from blister packs on the day corresponding to the date prescribed must be carried out to ensure the safe administration of medicines could not be assessed at this inspection as it fell on the last day of the blister pack cycle. The home must accesses dementia training for staff members to meet the needs of people living in the home, who have needs in relation to dementia care.
Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 7 The home must continue to consult people about the service, collate results from consultations and produce responsive action plans to ensure that the home is run in the best interests of residents. 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. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 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 Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The written assessment does not contain sufficient detail to ensure that Pinebeach has the appropriate equipment, resources and environment to meet the individual needs. EVIDENCE: The care file of a recently admitted resident contained an assessment that had been undertaken before admission to the home. The home had confirmed by letter that they were able to meet the resident’s needs. The written information available was very limited. There was no clear indication of how their personal care needs are met including how much they were able to achieve for themselves or the level of assistance required with mobility. The assessment begins by stating that the resident needs help with
Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 10 all tasks but this is not demonstrated in the content of the assessment as it identifies minimal care needs. Staff spoken to said that they are usually aware of what the residents need when they are admitted. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 11 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, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the home has effective and supportive systems in place, which promote and meet residents’ health, personal and social care needs. The introduction of bed rails risk assessments will ensure the safety of residents who require a form of restraint. Adequate systems are in place to ensure that residents’ safely receive prescribed medication People living at the home are treated with great care and respect, and their right to privacy is upheld. EVIDENCE: The care records of three residents contained detailed care plans based on the process of assessing people’s individual needs.
Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 12 Assessments included pressure sore risk assessments, nutritional and manual handling assessments. One care plan assessed the resident as at risk from developing pressure ulcers and the prevention action plan detailed the care required including the pressure relieving equipment required including an air mattress and pressure-relieving cushion. The resident had both of these in place when they were visited in their own room. One resident’s care records identified a wound on admission and the assessment action plan and continuous evaluation demonstrated how with the appropriate treatment the wound has almost healed. Two of the care records had been reviewed at least monthly but this had not consistently taken place in the third file. One resident’s care plan identified the use of bed rails although this had not been as the result of a written risk assessment. Bed rails are considered to be a form of restraint and should only be used as a last resort following a risk assessment. The individual and/or representatives and relatives have been consulted and the outcome of the assessment and action plan required is documented in the resident’s care records. One assessment and action plan identified a risk of dehydration and the need for a fluid chart to record their fluid intake. A chart that had been appropriately completed was seen when visiting the resident in their own room. The home operates a monitored dosage system for the safe administration of medicines. A number of additions had been handwritten onto the Medication Administration Record (MAR) charts but these had not been signed. Eye drops did not consistently state if they were to be administered to both eyes or just one eye. The requirement to ensure that individual medicines are moved from blister packs on the day corresponding to the date prescribed must be carried out to ensure the safe administration of medicines could not be assessed at this inspection as it fell on the last day of the blister pack cycle. A number of residents require medication as required but there is no indication of the circumstances in which the medication would be given. A care plan for the administration of medication would not only assist with their safe administration but would also inform the care staff of any potential side effects that they need to be aware of when providing care. Throughout the visit staff members were observed treating residents with care and respect. Preferred names are stated and used both within documentation and interaction. Gentle and sensitive support was provided to people needing help to move about the home. Residents’ right to privacy was respected. During the day some people spent time in their own room, and others, according to their preferences dined in privacy. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 13 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, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a programme of activities, thus providing a stimulating environment for residents. The flexibility of the home enables residents to retain control over their lives where feasible. Residents are able to maintain contact with their family and friends and to go out into the community if they wish and are able. A varied, appealing and balanced diet is enjoyed by people living at the service at times, which are convenient to them. EVIDENCE: Residents’ social and recreational needs are assessed and outlined in their care plans. Since the last inspection a record has been maintained of the individuals involvement in the activities provided. The activities regularly provided include reminiscence, sherry lunches, music and movement, mini bus trips and bingo. The mobile library visits every three weeks. The individual
Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 14 care records identify that a number of residents go out regularly with relatives and friends. Talking to residents and comments included in the residents survey confirmed that activities are provided but it is the resident’s choice to decide if they wish to participate. Residents receive visitors whenever they wish. A record is maintained of all visitors to the home. The home encourages friends and relatives to keep in contact. A visitor spoken with confirmed that they are always made welcome by the staff. One relative that completed a comment card stated ‘Very homely I am always welcome whatever time I visit’. Those residents who were able to articulate a view confirmed that they were able to make choices about such matters as what they ate and when they got up in the mornings and went to bed at night. Residents are able to “personalise” their bedroom with additional items of their choice. This was confirmed when visiting residents’ bedrooms. All comments received from the residents on the food were very positive including it was ‘good’, ‘excellent’ and ‘suits me’. As well as the main menu there is always a choice of an alternative. The menus were viewed and found to be varied and well balanced offering at least five pieces of fruit and vegetables a day. Meals are served in the ground floor dining room but can be served in the resident’s bedroom if that is their choice. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 15 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Pinebeach can be confident that their complaints will be listened and responded to. Evidence from this visit to the home demonstrates that people living at the home are protected from abuse. EVIDENCE: The home has a complaints procedure, which is provided to people moving into the home and is displayed in the home’s reception area. There is a log for the recording of complaints received. No complaints had been detailed since the last inspection. The residents agreed that they knew who to speak to if they were unhappy and how to make a complaint. The home has details of the local adult protection protocol. Training in adult protection is part of the home’s regular programme of mandatory training as demonstrated when viewing training records and talking to staff. Pinebeach DS0000020485.V315682.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents at Pinebeach live in a home that is generally well maintained safe and clean. EVIDENCE: The home is comfortably furnished and well maintained. Residents spoken with agreed that it was a very homely, friendly place to live where the staff are cheerful and approachable. There is routine renewal as part of an ongoing programme of maintenance and refurbishment in the home. Since the last inspection as required some grouting and the plughole in the ground floor bathroom has been replaced. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 17 There are no outstanding recommendations resulting from the last fire officer’s inspection in February 2006 and the Environmental Health Officers visit in March 2006. All areas of the home that were seen during the tour of the home were in a clean condition and free from unpleasant odours, residents and visitors confirmed that this is always the case. Residents confirmed that their bedroom was regularly cleaned. Infection control training is provided for all staff, this was confirmed by viewing training records and in discussion with staff. Since the last inspection the wooden steps and shelving in the laundry have been covered with a washable surface Pinebeach DS0000020485.V315682.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, 28 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff on duty satisfactorily meets service users’ needs. The home has an ongoing programme of mandatory training, which works towards ensuring that staff members have the skills required to meet the residents needs; this must be extended to meet the specialist needs of the residents. Staff members are making progress in achieving National Vocational Qualifications in Care. People living at the home are supported and protected by the home’s recruitment practices. EVIDENCE: Rosters seen reflected required staffing levels, in accordance with Department of Health guidelines. Feedback from residents also concurred that there were sufficient members of staff on duty to meet people’s needs. The manager has a minimum of thirty hours supernumerary each week in order to carry out her management duties. Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 19 Of the thirteen care staff listed on the home’s training matrix, six staff members have a National Vocational Qualification in Care and five members of staff are undertaking their training. Two members of staff confirmed that they had undertaken an induction programme when they had started work at the home. The provider has obtained the required information and documentation to implement the ‘Skills for Care’ induction programme with the next member of staff to commence working at the home. The home maintains a training matrix, which details a summary of recent training undertaken by staff. The home’s training programme ensures that staff receive mandatory training and updating including manual handling, health and safety, infection control and elder abuse. It was identified during the last inspection and again at this inspection that a number of residents were noted to have needs in relation to dementia care. It is now required in this report that the home accesses dementia training for staff members. The staff recruitment file of a recently employed care worker identified that the home continues to ensure all relevant information and checks are in place before the member of staff commences at the home. Pinebeach DS0000020485.V315682.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, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements in the home ensure that the residents live in a home that is well managed. The lack of a fully implemented formal quality assurance system limits the extent to which the home is able to demonstrate that it meets the expectations of service users and achieves its stated aims and objectives. Residents manage their own finances or have a representative acting on their behalf to ensure their financial interests are met. Arrangements are in place to ensure that the welfare of residents is promoted and protected.
Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mr Dedman the responsible individual and general manager supports Mary Price the registered manager in the day-to-day management of Pinebeach. There is an ‘open door’ management style operated at Pinebeach and this was evident during the inspection. Staff and residents agreed that the manager is very approachable and will listen. As required since the last inspection the home has continued to produce Regulation 26 reports. Work continues to develop quality assurance and quality monitoring systems. A number of surveys from residents have been returned but these still require collating. At the present time three or four questionnaires are given to residents at different times making them very difficult to collate and to establish how the home is meeting its goals. The need to develop a structured programme was discussed to ensure that the views of the residents, relatives, friends and other people involved in the care of the residents and the day to day running of the home are obtained. Three monthly staff meetings take place and the minutes of past meetings were viewed. The manager stated that the home does not hold any monies on behalf of service users, nor does she, or the responsible individual act as appointee for any service user. Family, friends or professional advisors assist all residents to manage their financial affairs. The home has a training programme in place covering all areas of mandatory health and safety training. A maintenance folder contains confirmation of servicing of equipment and facilities in the home. As required the testing of all portable electric appliances (PAT testing) has been undertaken. Fire training, drills and fire safety checks have been completed as required. An accident book is maintained and accidents are audited three monthly. Pinebeach DS0000020485.V315682.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 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement The registered person must ensure that a full and detailed care assessment has been undertaken before the resident is admitted to the home. Previous timescale of 30/06/05 not met. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A minimum of 50 of care staff must be trained to NVQ level 2 with evidence of core and optional National Occupational Standards being attained. Previous timescale of 31/12/05 not met.
DS0000020485.V315682.R01.S.doc Timescale for action 1. OP3 14 31/03/07 2 OP7 13 31/03/07 3 OP9 12(2) 31/03/07 4. OP28 18 31/03/07 Pinebeach Version 5.2 Page 24 5 OP30 18 The registered person must ensure that the persons working at the care home receive training appropriate to the work they are to perform. The registered person must consult people about the service, collate results from consultations and produce responsive action plans to ensure that the home is run in the best interests of residents. 31/03/07 6 OP33 24 The home needs to ensure that all parties are consulted in any surveys that are conducted. Previous timescale of 30/09/06 not met. 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Double signatures verifying medicines for disposal and ensuring that individual medicines are moved from blister packs on the day corresponding to the date prescribed must be carried out to ensure the safe administration of medicines. 1. OP9 Pinebeach DS0000020485.V315682.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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