Inspection on 11/12/08 for Pinehurst Residential Care Home, Ilfracombe

This inspection was carried out on 11th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pinehurst Residential Care Home,... 08/01/07

Pinehurst Residential Care Home,... 19/06/06

Pinehurst Residential Care Home,... 15/03/06

Pinehurst Residential Care Home,... 09/08/05

Pinehurst Residential Care Home,... 15/03/05

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pinehurst Residential Care Home, Ilfracombe Pinehurst 14 Chambercombe Park Road Ilfracombe Devon EX34 9QN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Pinehurst Residential Care Home, Ilfracombe 14 Chambercombe Park Road Pinehurst Ilfracombe Devon EX34 9QN 01271862839 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Julie Farrell Type of registration: Number of places registered: Pinehurst Care Home Ltd care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is to be registered to accommodate 23 service users in the categories OP Old Age and DE(E) Dementia over 65 years of age. Date of last inspection Brief description of the care home Pinehurst is a large, detached Victorian house with large grounds to the rear, having a spacious raised decked balcony area having pleasant views across the North Devon coastline. The home is on four levels; a stair lift provides access to each of the floors. There is a choice of three lounges one of which is a conservatory; each has an individual feel to them. One lounge is adjacent to the dining room, this is situated off the reception hall, and the third also provides a dining area and is located on the lower floor. The home has 17 single rooms and 3 double rooms, these are personalised with residents personal possessions, and each room has its own bathroom and toilet Care Homes for Older People Page 4 of 29 Over 65 23 23 0 0 Brief description of the care home facility. The home is registered to meet the needs of service users aged over 65 and those with a dementia type illness. The range of fees can be obtained directly from the home including what fees do and do not include. The Statement of Purpose and Service User Guide are located in the entrance hall of the home. Brochures are also available. Commission for Social Care Inspection reports are also located within the entrance hall. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in December and last for approximately 6.5 hours. During this time people who live at the home were spoken to about their expediences of living at Pinehurst. Time was also spent talking to staff and observing care practices throughout different periods of the day. Three visiting relatives were also spoken to and asked for their opinions about how well the care home meets the needs of their relatives. The comments from all these face to face interviews are included in this report and have helped us to make a judgment on the quality outcomes for the people who live at the home. Prior to the inspection taking place surveys were sent to a sample of people who live at the home and to staff, their views and comments are also included. Care Homes for Older People Page 6 of 29 We also asked the home to provide an annual quality assurance assessment (AQAA), which gives us information about how the home ensures issues of health and safety are addressed via training and regular servicing of equipment and systems within the home. The registered manager was available throughout most of the inspection and helped to ensure that key documents were available such as plans of care, assessments, staff recruitment and training files, medication records and records relating to how the home deals with individuals personal monies. This helps us to understand how well the home is managed. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 29 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New people can be assured that the home has a good pre admission assessment process so that they can confirm that assessed needs will be met. Evidence: Pre admission assessment information was looked at for the two newest people to Pinehurst. The information detailed the individuals personal and health care needs well, but would benefit from some further input in respect of their social needs. These sections were not so comprehensive and the registered manger said that often this sort of information only comes to light once the person has been in the home for a little while and staff have has an opportunity to talk to the individual and to any visiting family and friends about interests and past social history. One person spoken to said they had chosen this home because their family had been to see it and thought it would meet their needs. The person said they did remember Care Homes for Older People Page 11 of 29 Evidence: someone talking to them prior to coming to the home, but did not have an opportunity to visit the home as they were in hospital. Staff spoken to said that when a new person was being admitted to the home, they were told verbally about their needs and then got to look at the assessment and care plan for the person. One staff member said in their survey An in depth care plan is always provided with any new resident to cover medical needs to dietary requirements. Another said The manager is excellent at conveying resident information re GPS, district nurses and the mental health team. She is always supportive of the staff and residents and listens to staff and respects their contributions about residents care plans. The information is always kept up to date about ongoing care of residents. For individuals funded by the local authority the home makes sure they get a copy of the assessment and care plan, which would detail any assessed needs. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs are well met. Evidence: Plans of care were looked at for three people. The plans give details of individuals personal and health care needs and gives directions to staff about how these needs should be met. Plans include risk assessments for moving and handling and if there is any risk to skin integrity. The home are part of the central falls data base, which is a national system for monitoring falls in older people and whether there is any trends that could be prevented. Plans of care are reviewed on a monthly basis, but are not routinely shared with the individual and/or their family. Involving the individual in the development and review of their plans of care would help to ensure care is planned and delivered in a more person centered way. Plans should also include more detail about the individuals preferred routines and whether they have any diverse needs that the home need to plan for. Care Homes for Older People Page 13 of 29 Evidence: Staff spoken to said that plans of care were available for them to look at, but that most of the information was detailed in the daily notes kept on each person. These do give a good picture of how individuals are monitored in terms of their general health and emotional well being and show that people have visits from their GP and other health care professionals such as chiropodist, optician and community nurse team. People who live at the home said Staff make sure that all our needs are seen to, you only have to ask. I am very happy here, we are well looked after. A visiting family said We can not speak highly enough about this home, my xx would not be alive if it wasnt for Pinehurst, they deserve seven stars. A few staff via anonymous surveys did raise the fact that the home does not have any hoists and they have some people who are unable to weight bear. This was discussed with the manager who said that whilst they do not have hoists as part of their own equipment they do have good input from the community physiotherapists and hoists have been hired and loaned for individuals when they have been assessed as needing them. A few of the more frail people living at the home should now be reassessed to ensure that staff can safely assist them to move. The registered manager agreed to do this as a matter of urgency, but also said that this had not been raised directly to her before now. The medication records and storage was looked at and discussed with the registered manager. They have just had a new medications trolley delivered and will put this to use once they have been able to secure it to a wall when not being used. Medications are currently stored in a locked cupboard and stock is regularly checked and returns sent back to the pharmacy. Records in relation to the medication that is not for some reason electronically recorded on the MARS (medication records sent from the pharmacy) and is therefore handwritten in should always be double signed and record quantity received. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of the home are flexible and some activities are planned but may not meet all individual needs and wishes. Evidence: During this inspection people were observed to be choosing where they spent their time and confirmed that they decided what time they got up. One person said the staff are very good, I like to get up early and they bring me a cup of tea and will come back and see if I need a hand with anything. Four visiting relatives were spoken to who said that they could visit at any time, that they were always made welcome and that they were kept informed about how their relative is doing. They confirmed that staff assist individuals to stay in touch with their family and friends, helping them to write cards, and enable them to receive calls from family and friends. Relatives also confirmed that there were various activities offered. One person said they liked looking at the art work done by people living at the although their relative choose not to join in. Surveys returned by people in the home showed that activities were offered Care Homes for Older People Page 15 of 29 Evidence: sometimes and comments included I dont always feel like being social. There are activities available and I always get asked. another person said in answer to does the home offer a range of activities would like a little more The registered manager explained that they had someone who came in a few times a week to do craft and art work and also coordinated other activities such as singsongs and any outings. Staff who returned surveys felt that overall the home offered people good care but made the following comments The residents need more mental stimulation, maybe group games, entertainment and outings. I think it would be nice for service users to have trips out more. This is an area where the home could look to involve people who live there and their Representatives in using their quality assurance to gain their views and opinions about how they could improve on activities offered. The home has a weekly menu plan, but this did not appear to be available to people to see to enable them to make choices about what they wanted. One person said yes you can ask for something else, usually I ask the staff in the kitchen. This would not be an option for less mobile or more confused people and the home should give some thought as to how menu choices can be presented to people in a format they can easily understand, perhaps using pictures and photos. Overall people spoken to said they enjoyed their meals and that there was a good choice and variety offered. During the lunchtime observed, everyone eat the same lunch, so no alternative appeared to have been offered. The meat was a little tough, and staff offered assistance to cut it up in a very caring and respectful way. The meal was served in an unhurried manner in a pleasant dinning room. People were not offered a tea or coffee at the end of the meal and although a cold drink was poured for everyone, staff did not say what it was, or whether there was any choice. One person said they would have liked a cup of tea of coffee after the meal, but normally had to wait for an hour afterwords. This was discussed with the manager on the day of the inspection who said that different juices were given throughout the week, but took the point that a choice was not offered each day. She said that hot drinks could be made available throughout the day if people wanted them. People who returned surveys said about the food. Would like more vegetables. They could improve, we dont have enough vegetables and when we do they are not cooked, too hard for dentures. This should be reviewed again as part of the homes quality assurance programme in using surveys to assist them to improve the quality of care and support offered. Since this inspection the registered provider has stated that they have spoken with their local meat supplier in respect of the stewing steak being tough and has given assurances that the home always provides fresh fruit and vegetables throughout the Care Homes for Older People Page 16 of 29 Evidence: week so that a balanced menu is offered. They have said they will make sure that people who live at the home have further opportunities to discuss menu options when they do surveys again. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views are listened to and acted upon Evidence: The home has a stated complaints process and the registered manager keeps a record of all complaints and compliments and any actions taken to resolve any issues identified. This was looked at and we are happy that the home have responded quickly and fairly to any complaints raised. They have not had any new complaint this year and the Commission have not received any either. Those people who were able to say commented that they would be able to speak to the manager about any concerns they had and comments from surveys included I am quite happy with everything, I Love Pinehurst, my views, my room, the food. Another said The staff are all lovely and Julie the manager is excellent. A staff member said in their survey always supportive of the staff and residents and listens to staff and respects their contributions Staff have training in the protection of vulnerable people and this helps them to understand what constitutes abuse and who they should report it to. Staff spoken to said they would go directly to the manager in the first instance for advice and support. The home stated in their AQAA that they have policies and procedures in place to Care Homes for Older People Page 18 of 29 Evidence: ensure that people in the home are protected. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pinehurst provides people with a clean warn and homely environment. Evidence: During this inspection a tour was made of all communal areas and some of the individual bedrooms. Individuals spoken to said that they were happy with their accommodation, some people have lovely views of the countryside and bedrooms have been personalized. Comments from surveys included Perhaps the owner of the home could update the kitchen and do some more decoration in room. Some of the fixtures and fittings need renewing and There are odours once in a while, staff always observant and deal with immediately. The registered manger said that they will be refurbishing the kitchen in the New Year and also have plans to extend one of the bathrooms and install a more modern assisted bath. The home was found to be clean and the AQAA submitted gave details of how the provider ensures the environment is well maintained and equipment is serviced on a regular basis. Care Homes for Older People Page 20 of 29 Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff group are reasonably well trained and supported, but recruitment practices must be more robust to protect the people who live at Pinehurst. Evidence: Staff spoken to and those who returned surveys said that they had regular updates on training needed to do their job well, such as first aid, moving and handling, medications, basic food hygiene as well as care of people with dementia. Staff on duty appeared to have a good understanding of the needs of the current group of people living at the home. Staff were observed to provide care and support in a professional and caring manner. One person was encouraged throughout they day to sit down and talk as they appeared agitated and wandering at times. Staffing levels appear sufficient for the number and needs of the current people living at the home, with four carers on during the morning, two during the afternoon and then three from four pm, with one waking night and one sleep in. Staff and individuals who live at the home said that the numbers of staff available was sufficient. One person said there may be the odd occasion when you ring your bell you have to wait, but overall they are very good. The staff recruitment files were checked for the two newest members of staff and they Care Homes for Older People Page 22 of 29 Evidence: had been employed before references and other relevant checks that would ensure they were suitable to work with vulnerable people were back. This compromises the safety of the the people who live at the home. The registered manager agreed this was a lapse in their normal processes, but they had been made short staffed and needed to fill vacancies. She accepted that the checks should have been done and agreed to get POVA first done on both as a matter of urgency. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the best interests of the people who live there. Evidence: The manager is qualified and experienced to run the care home. The staff and individuals who live at the home were all complimentary about her skills in listening to them. One staff member said The manager is excellent at conveying resident information re GPS, district nurses and the mental health team. She is always supportive of the staff and residents and listens to staff and respects their contributions about residents care plans. The information is always kept up to date about ongoing care of residents. Another staff member in their survey said Julie the manager goes out of her way to try to make the place feel as homely as possible. Birthdays, parties are catered for with the involvement of families. Events such as Easter, Halloween, Christmas, the home is decorated to involve the service users in these events. Care Homes for Older People Page 24 of 29 Evidence: Relatives who were spoken to said that the management approach was open and that they could speak to the manager with confidence about any concerns they may have. The registered manager said that they use surveys to assist them to get a view from the people who live at the home. She said that the last survey completed, they had looked to make some menu changes in light of comments received. They should revisit this in their next quality assurance surveys as we received a number of comments about the menus. These have been highlighted in a previous section of the report. During this inspection monies held on behalf of individuals were looked at. The home has an audit trail to show how monies are being spent. They have been advised to ensure that they give family members a receipt for any monies brought into the home. The AQAA gives us details about how the registered provider ensures that the home is well maintained, health and safety checks are completed and regular servicing of equipment. Staff confirmed that they had ongoing updates on training in areas of health and safety to ensure they can do their job safe and competently. The registered manager stated that their induction programme was in line with National guidelines of the Skills for Care. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 18 The home must ensure that staff have all relevant checks and references in place before commencing employment This will ensure that only people who are suitable to work with vulnerable people are employed 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Plans of care should be developed and reviewed with the individual or their family members to ensure that care and support in planned in a person centered way. The home should ensure that where hand written entries are made in the medication records (MARS) that these are double signed and that all medications are recorded as what quantity have been received into the home. The home should ensure it has a process to consult with and provide activities that suit individuals needs. The home should ensure that menu choices are in a format that are accessible to the people who live there so that they can be assisted to make choices. Page 27 of 29 2 9 3 4 12 15 Care Homes for Older People Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!