Inspection on 14/06/05 for Pinehurst House Nursing Home

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pinehurst House Nursing Home 30/04/07

Pinehurst House Nursing Home 05/01/06

Pinehurst House Nursing Home 20/01/05

Pinehurst House Nursing Home 05/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Pinehurst House Nursing Home Pinehurst Off Filmer Lane Sevenoaks Kent TN14 5AQ Lead Inspector Elizabeth Baker Announced 14 June 2005 9:30 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. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Pinehurst House Nursing Home Address Pinehurst Off Filmer Lane Sevenoaks Kent TN14 5AQ 01732 762871 01732 763922 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) BUPA Care Homes Limited Mrs Kerry Joanne John Care Home 30 Category(ies) of Care Home with Nursing - 30 Old Age registration, with number of places Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20 January 2005 Brief Description of the Service: Pinehurst House Nursing Home is a care home providing nursing care for 30 Older People. BUPA Care Homes Limited is the registered provider. Pinehurst House is a purpose built establishment, which was first registered in 1986. Resident accommodation comprises thirty single bedrooms and three sitting/dining rooms all of which are on the ground floor. All bedrooms have a TV and telephone point. Bedrooms do not have ensuite facilities. All rooms used by residents are connected to the nurse call system. There is a central inner courtyard, which provides appropriate seating and a sensory garden. There is ample car parking. The home is located near to the main A25 trunk road and approximately two miles from Sevenoaks Town Centre. Sevenoaks has a good range of amenities including shops, banks, places of workship, restaurants, a cinema and theatre. Sevenoaks is well served by public transport. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over six hours on the 14 June 2005. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. Residents, relatives and staff were spoken with. Four residents and two members of staff were formally interviewed. In response to the announcement of this inspection, the Commission received a total of 13 comment cards from residents (9) and GPs (4). Some of their comments have been incorporated into this report. Some judgements about the quality of care, life and choices were taken from conversations with residents and relatives, direct observation and evidencing records held at the home. Some records were inspected as part of the case tracking and to assess work on requirements and recommendations made at the previous inspection. At the time of the visit 27 residents requiring nursing care were residing at the home. Registered Manager Mrs K John provided assistance throughout the inspection. What the service does well: Residents can choose whether to participate in group activities or not and are encouraged to maintain outside contacts and interests, including Bridge Clubs. Sufficient numbers of staff are employed to enable them to carry out their duties in an unhurried manner. The manager and staff have a clear understanding of their respective roles and responsibilities, resulting in a well run home. A resident said “[staff] are very good and there is little they could do to improve things”. Residents and their advocates are encouraged to be involved in the composition and review of care plans. One relative said “they [staff] had not missed a trick” in the amount of detail recorded. Residents are involved in changes affecting services and facilities provided. This includes the organisation’s current drive to improve the variety and quality of meals and menus. The Provider continues to demonstrate its commitment to ensuring all staff are trained to provide appropriate care. Indeed three-quarters of unregistered care staff are now trained to NVQ level II care. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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 standard(s) 2, 3, 4 and 5 The pre admission process assists prospective residents and or their representatives in deciding whether the home is suitable for their needs or not. EVIDENCE: All residents are provided with terms and conditions of residence, which sets out the rules and responsibilities of both parties. Registered Nurses assess prospective residents prior to a decision of admission being made. Additional information is obtained from care management if appropriate. This practice ensures the home only admits those residents whose medical and social needs can be met. Residents are initially admitted on a trial period to ensure the placement is suitable. Residents and their advocates are encouraged to visit the home to see the facilities and meet staff and existing residents. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 9 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) 7, 8, 9, 10 and 11 Personal care is offered in a way to protect residents’ privacy and dignity and promote independence. Residents’ nursing and personal care needs are met, although records do not always evidence this. EVIDENCE: For case tracking purposes, care records of three of the four residents interviewed were inspected. The content of record keeping has improved, although some care staff continue to use some meaningless phrases, such as “care as planned” and “all care given” when recording the daily care provided. This situation prevents a clear record of the resident’s day being described as evidence of the actual care provided. For a resident whose skin condition had deteriorated, care staff recorded “Sudocrem” had been applied. The corresponding medication administration record chart did not include this preparation. For a resident receiving pain relief analgesia on a “when required” basis, there was no corresponding pain chart to monitor the effectiveness of the treatment plan. The daily records of one resident referred to occasional episodes of aggression. Reference to aggression had also been included in pre admission details provided by care management. However there was no mention of this in the resident’s care plan. The home uses the Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 10 “Standex” model of care records. The model does not require care staff to record details of the residents’ medical diagnosis on admission. Although this information is obtained during the pre admission process, it is the home’s practice to keep pre admission documents separate from the working care records. This situation prevents a complete picture of the residents’ medical needs being readily available to ensure all their care is met. Residents and their advocates are encouraged to participate in the composition of care plans. Indeed a relative said that she noted “[care staff] had not missed a trick” when writing about her relative. To prevent residents’ acquiring pressure sores, the home has a range of pressure relieving and preventative equipment, which is used on an assessed needs basis. The home has a room in which medications and nursing aids and sundries are safely kept. Registered Nurses administer medications to residents where support is required. GPs review their residents on a six monthly basis or more frequently if required, to ensure prescribed medications are still appropriate. All four comment cards received from GPs indicated staff demonstrate a clear understanding of the care needs of residents, they can see their patients in private, any specialist advice is incorporated into their care plan and their medication is appropriately managed. Following a recommendation made at the last visit the Registered Manager has obtained details of residents’ wishes and preferences in respect of death and dying. This will minimise any undue distress to relatives and advocates at a stressful time. Residents said staff treat them with respect and dignity when providing personal assistance. Friends and guests are invited into the home to enable residents to continue their community activities, including bridge clubs. A relative said they visit most days and are always made welcome by staff. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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, 13, 14 and 15 Residents are served appetising and varied meals and choose where to eat them. Residents are enabled to continue their links with the community and choose how to spend their day. EVIDENCE: The home employs two activities coordinators, who provide a range of group activities. For residents who prefer or whose condition necessitates it, one to one activities are also provided. Residents are able to choose whether to partake in the activities or to stay in their rooms and watch TV, listen to the radio or read. Residents said how much they enjoyed assisting staff and relatives in preparing the hanging baskets, which are displayed in the inner courtyard and outside residents’ rooms. The activities coordinators obtain social and biographical information from residents or their advocates during the admission process. This assists staff in ensuring activities reflect individual residents’ preferences. Residents are provided with a monthly programme of activities, including trips out. Current and past trips have included Comp Gardens and Aylesford Priory. Choirs and soloists, as well as pianists, entertain residents. A June garden party has been arranged and residents said they were looking forward to this but hoped the weather would improve. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 12 Some residents described how their relatives speak to the Home Manager if they have a query about the continuing funding of their residence. The Manager assists enquirers in contacting the relevant agencies responsible for funding arrangements. The provider has published a detailed booklet on the subject of funding, which is available to residents or their advocates on request. The process helps to minimise residents’ fears and worries at a difficult time. Residents are provided with a choice of meals and can choose where to eat them. Residents’ comments about the food included “the food is sometimes alright, but can be too peppery for me”, “super food” and “excellent chef”. Five of the nine returned comment cards from residents indicated they like the food with the remaining four indicating they sometimes like the food. The Chef endeavours to talk with residents on a daily basis when taking the dessert trolley around at lunchtime. As part of the organisation’s commitment to improving menus and the quality of meals, the Chef has commenced on the “Chef’s Best” training course. Residents have been asked to participate in the process and they are encouraged put forward suggestions for their specific choice of meal to be added to the menu each month. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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) 16 and 18 Residents are protected from risk by the home’s complaint and adult protection procedures. EVIDENCE: A detailed complaints procedure is displayed in the main reception room, which includes details of the Commission, should complainants wish to contact the organisation direct. Complaint information is also available in the information file provided in each bedroom. Following a recommendation made at the last inspection, records are also kept of any verbal “low” level complaints made to staff, so that the Manager can monitor and take any necessary action to address them. Staff are trained in adult protection issues to ensure they understand what constitutes abuse and the action they must take if they suspect or witness such a practice. The Commission has received no complaints about the service since the last inspection. Seven of the nine returned comment cards from residents indicated they know who to speak to if they had a concern about their care. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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 standard(s) 19, 21, 22, 25 and 26 Improvements to the environment will enhance residents’ quality of life. EVIDENCE: The grounds are kept tidy and attractive. However not all areas are easily accessible to residents because of the different levels. Certain areas of the block paving and car park at the front of the home have sunk, which presents a hazard to residents, visitors and staff. Ramps from some bedrooms are too steep and others were noted to be rotting. Indeed one resident said how they would like to go out in the gardens more but cannot do so as the paths and access are not safe. The ramps and uneven areas were subject to requirements made at the last inspection. Whilst acknowledging the provider has initiated building and ground level surveys to be carried out, the ongoing situation prevents some residents going out and about as they wish to. Settlement cracks were noted in some bedrooms and the walls in a bedroom used by a self-propelling wheelchair user had been badly contact damaged. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 15 This situation does not provide residents with a homely and pleasant environment. To ensure the home maintains adequate fire protection and precautions expected of a facility providing nursing care, the Health Technical Advisor of Kent Fire and Rescue Service inspected the home in March 2005. This resulted in two requirements of the Workplace Fire Precautions Legislation being made. The Manager said the work has been completed. The home has a range of WCs and bathrooms, which are suitable for residents who require assistance. Residents are encouraged to move independently around the home and one resident said she tries to do this every day so she maintains her mobility. One resident with a hearing impediment demonstrated how she uses earphones when watching her TV so she does not disturb neighbouring residents. Bedrooms do not have ensuite facilities. However a resident said she doesn’t mind not having her own ensuite toilet as she can easily access the one near her room. Bedrooms have large French windows. This provides residents with good lighting and a view whether they are in bed or sat in chairs. A resident commented that although they feel the cold their room is always kept at a temperature that meets their need. The home was clean, tidy and odour free. However the carpets in two particular bedrooms were badly stained and did not provide the residents with a pleasing environment. Since the last inspection the doors to the sluice rooms have been fitted with locks, thereby improving the safety for both residents and visitors. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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 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, 28, 29 and 30 Staff morale is good resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. EVIDENCE: The number and mix of care staff on duty is based on the current assessed needs of residents. A relative said staffing ratios at the home are good. Staff were seen carrying out their duties in an unhurried manner. In addition to care staff, staff are employed for administration, reception, activities, catering, housekeeping, laundry and maintenance. Staff turnover is low. Indeed some staff spoken with said they have been at the home for many years and enjoy working there. This situation ensures residents receive appropriate and continuity of care. Good systems are in place for the recruitment, appointment and induction of staff to ensure residents are safely cared for. The organisation is firmly committed to ensuring all health care assistants are appropriately trained, 75 of which are now qualified to NVQ level II or above in care. A training matrix is maintained which includes details of statutory training such as moving and handling, health and safety and first aid. Registered Nurses and health care assistants are also required to attend clinical training sessions, which are either provided in-house by an appropriately trained member of staff Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 17 or externally by organisations such as the South West Kent Primary Care Trust. These sessions ensure care staff remain current in nursing practices. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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 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) 31, 32, 33, 35, 36 and 38 Residents and staff are supported by a competent, qualified and experienced manager. EVIDENCE: Mrs John is a Registered General Nurse and has over fourteen years experience of working with Older People. Mrs John has also attained the requisite management qualification. Residents and staff spoke openly about their experiences of living and working at the home. Staff said they receive regular supervision, which enables them to discuss practice issues and training needs with their respective line manager. The manager endeavours to see residents three or four times a week. A member of staff said the manager is very accessible if they need to speak to her. Details of the manager’s weekly whereabouts are now displayed to inform staff, residents and visitors of her availability. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 19 A resident said “[staff] are very good and there is little they could do to improve things”. Residents and relatives views on the services and facilities provided are regularly sought. An external satisfaction survey is carried out annually and residents are informed of the outcome. Residents are now provided with an inhouse newsletter to keep them informed of recent events and any changes, which may have occurred. The Chef has provided all residents with a letter explaining the provider’s intention to implement improvements to menus and meals and the phases and action this will take. The home maintains personal allowances for some residents. For security purposes the monies are held in a special bank account, which is then subdivided into individual resident accounts. Residents and or their advocates are provided with regular balance statements, if that is their wish. The returned pre inspection questionnaire indicates the home’s equipment and systems are appropriately maintained and surveyed as required. Staff receive health and safety training covering moving and handling, food hygiene, fire and first aid. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 x 3 3 x x 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 3 3 x 3 3 x 3 Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 21 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 19 Regulation 13 Requirement This refers to the steep gradient of the external ramp exits from some residents bedrooms; and the uneven level of some areas of the car park and pathway (Matter not yet resolved) The condition of some of the external ramps, including handrails, leading from residents bedrooms must be made improved. A programme of carpet deep cleaning or replacement must be instigated. Residents bedrooms must kept in a good decorative state. Timescale for action 30/09/05 2. 19 13 30/09/05 3. 4. 19 26 23 23 31/08/05 31/08/05 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. 2. 3. Refer to Standard 7 8 8 Good Practice Recommendations Care plans must be complete of all assessed needs and problems. Clinical risk assessments must be available to monitor the effectiveness of treatment plans. Care staff must ensure they record meaningful statements H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 Page 22 Pinehurst House Nursing Home on residents daily condition and experiences. Pinehurst House Nursing Home H56-H06 S26196 Pinehurst NH V225412 140605 Stage 4.doc Version 1.30 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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