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Inspection on 19/06/06 for Pinehurst Residential Care Home, Ilfracombe

Also see our care home review for Pinehurst Residential Care Home, Ilfracombe for more information

This inspection was carried out on 19th June 2006.

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

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

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

What the care home does well

This inspection found that Pinehurst provides a homely, caring environment for residents, visitors and staff. Residents are able to wear their own clothes, be called by their chosen name and bring personal items to decorate their rooms. The home provides a stable level of staff. Personal care provided at the home is good. Staff at the home access a range of services including; District Nurses, General Practitioner, Out patient appointments as well as other NHS Services. The residents at Pinehurst are treated with courtesy and respect and importance is placed on residents` privacy and dignity. Residents told the inspector that they enjoy the food at Pinehurst and that they are well cared for by staff.

What has improved since the last inspection?

The Provider and Manager have worked hard since the last inspection to meet requirements and recommendations set at the previous inspection. Action plans were available and showed a planned commitment to ensure these are met. Residents are protected on admission by a more in depth pre admission assessment to ensure the staff have all information regarding residents so they know they can meet all their needs. The new recruitment process means that all staff have all checks before they are able to work at the home. This gives residents and their families that they are being cared for by suitable staff. Training has been provided to ensure there is now a qualified first aider on duty at all times. The Manager has begun to sort out the filing system and records management to ensure she is able to locate files easily and provide evidence that care has been given. A new set of policies and procedures has been obtained by the manager and quality assurance documents obtained. Residents have their weights monitored and those at risk are monitored closely. Those residents with diabetes have records of snacks made to show they are provided with adequate diet. A new chef has been recruited and a new menu plan introduced. The Manager has enrolled on a registered Managers Award course and is part of a learning group where new ideas and issues are discussed to ensure residents receive up to date safe care. The complaints procedure has been updated to show what timescales the home must respond to complaints within. Major improvements within the environment have increased the safety and standard and safety of accommodation for residents. Five door guards have been fitted at the home, which allow residents to have their doors propped open but close automatically if the fire alarm sounds. A handrail has been fitted to the first flight of stair, which provides residents with assistance yet maintain independence. Fire maintenance and training records have been updated with systems introduced to ensure regular checks and drills are performed. To the exterior of the property: Unsightly shutters have been removed and double-glazing quotes obtained to replace broken windows. The outside of the property is decorated by many colourful baskets and planters, which give a welcoming appearance.

What the care home could do better:

Quality of life for Residents at Pinehurst has been judged in this report using the available evidence at this inspection. It is anticipated that should the Manager implement the planned changes stated at thisinspection, this quality judgement should continue to improve by the next inspection. The Manager must continue with the extensive progress that is being made and complete programmes planned or discussed at inspection. Records must be improved to show what care has been given. Care Plans should be written in such a way that details and shows all care that is needed, planned and given. Quality assurance measures should be introduced this will safeguard residents from any risks identified and get of any problems before they arise. An infection control audit would decrease the risk of infection. A quality check on the way resident money is handled would protect residents and staff from misunderstanding and error. A general quality assurance check would make sure residents and their families are always happy with the care they receive. The environment must continue to be improved to increase the safety of residents and staff. A full risk assessment of the environment should be performed and maintained. This will highlight the need to remove door wedges and replace with devices approved by the fire authority. Radiators also must be covered or changed to ensure they are low surface temperature. Water temperatures must be performed and recorded. These measures would prevent residents and staff from burns and scalds. The outside of the premises should be tidy at all times. Outside communal areas should not be used as a storage area and unwanted materials should be removed to the recycling centre promptly. By ensuring all areas of the home are clutter free and tidy would also mean hazardous substances are stored correctly and safely and would reduce the chances of infection spreading throughout the home. Training Plans discussed at inspection must be introduced to ensure staff are suitably skilled and equipped to perform their roles. Training must include completion of POVA training, mandatory training as well as NVQ training induction and Supervision.

CARE HOMES FOR OLDER PEOPLE Pinehurst Residential Care Home Pinehurst 14 Chambercombe Park Road Ilfracombe Devon EX34 9QN Lead Inspector Clare Medlock and Andrea East Unannounced Inspection 19th June 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 Pinehurst Residential Care Home DS0000062484.V297562.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. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinehurst Residential Care Home Address Pinehurst 14 Chambercombe Park Road Ilfracombe Devon EX34 9QN 01271 862839 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) Pinehurst Care Home Ltd Julie Farrell Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 6th March 2006 Date of last inspection Brief Description of the Service: Pinehurst is a large, detached Victorian house with large grounds and a spacious decked balcony area complete with flowers and garden furniture, 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 a welcoming and individual feel to them. One lounge is adjacent to the dining room, which is situated off the reception hall, and there is also another dining room on the lower floor. The home has 17 single rooms and 3 double rooms, these are homely, and are personalised with residents personal possessions, each room has en-suite toilet facilities. The home is registered to meet the needs of service users aged over 65 and those with a dementia type illness. The home has a new Manager. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection. It occurred on Monday 19th June 2006. The inspection was performed by two inspectors and consisted of speaking with residents, relatives, staff and management at the home. A full tour of the building took place. Records, Care Plans, staff files and other documents were inspected. Three staff questionnaires, two relative questionnaires and five resident questionnaires were received regarding Pinehurst and the Manager produced a detailed pre inspection questionnaire. What the service does well: What has improved since the last inspection? The Provider and Manager have worked hard since the last inspection to meet requirements and recommendations set at the previous inspection. Action plans were available and showed a planned commitment to ensure these are met. Residents are protected on admission by a more in depth pre admission assessment to ensure the staff have all information regarding residents so they know they can meet all their needs. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 6 The new recruitment process means that all staff have all checks before they are able to work at the home. This gives residents and their families that they are being cared for by suitable staff. Training has been provided to ensure there is now a qualified first aider on duty at all times. The Manager has begun to sort out the filing system and records management to ensure she is able to locate files easily and provide evidence that care has been given. A new set of policies and procedures has been obtained by the manager and quality assurance documents obtained. Residents have their weights monitored and those at risk are monitored closely. Those residents with diabetes have records of snacks made to show they are provided with adequate diet. A new chef has been recruited and a new menu plan introduced. The Manager has enrolled on a registered Managers Award course and is part of a learning group where new ideas and issues are discussed to ensure residents receive up to date safe care. The complaints procedure has been updated to show what timescales the home must respond to complaints within. Major improvements within the environment have increased the safety and standard and safety of accommodation for residents. Five door guards have been fitted at the home, which allow residents to have their doors propped open but close automatically if the fire alarm sounds. A handrail has been fitted to the first flight of stair, which provides residents with assistance yet maintain independence. Fire maintenance and training records have been updated with systems introduced to ensure regular checks and drills are performed. To the exterior of the property: Unsightly shutters have been removed and double-glazing quotes obtained to replace broken windows. The outside of the property is decorated by many colourful baskets and planters, which give a welcoming appearance. What they could do better: Quality of life for Residents at Pinehurst has been judged in this report using the available evidence at this inspection. It is anticipated that should the Manager implement the planned changes stated at this Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 7 inspection, this quality judgement should continue to improve by the next inspection. The Manager must continue with the extensive progress that is being made and complete programmes planned or discussed at inspection. Records must be improved to show what care has been given. Care Plans should be written in such a way that details and shows all care that is needed, planned and given. Quality assurance measures should be introduced this will safeguard residents from any risks identified and get of any problems before they arise. An infection control audit would decrease the risk of infection. A quality check on the way resident money is handled would protect residents and staff from misunderstanding and error. A general quality assurance check would make sure residents and their families are always happy with the care they receive. The environment must continue to be improved to increase the safety of residents and staff. A full risk assessment of the environment should be performed and maintained. This will highlight the need to remove door wedges and replace with devices approved by the fire authority. Radiators also must be covered or changed to ensure they are low surface temperature. Water temperatures must be performed and recorded. These measures would prevent residents and staff from burns and scalds. The outside of the premises should be tidy at all times. Outside communal areas should not be used as a storage area and unwanted materials should be removed to the recycling centre promptly. By ensuring all areas of the home are clutter free and tidy would also mean hazardous substances are stored correctly and safely and would reduce the chances of infection spreading throughout the home. Training Plans discussed at inspection must be introduced to ensure staff are suitably skilled and equipped to perform their roles. Training must include completion of POVA training, mandatory training as well as NVQ training induction and Supervision. 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 Residential Care Home DS0000062484.V297562.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 Pinehurst Residential Care Home DS0000062484.V297562.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents, families and Representatives are given sufficient information to decide whether Pinehurst is the right place for them to be. Staff obtain adequate information on residents to ensure they are able to care for the residents. EVIDENCE: A Tour of the building confirmed that the home have a Statement of Purpose and Service User Guide available for Service Users, visitors and Healthcare Professionals to access. Inspection of these documents confirmed that all information required was present. Discussion with the Manager confirmed that changes to the Pre admission questionnaire have been made, following an unforeseen incident occurring within the home. This has caused the Manager to amend the questions that are asked to ensure a more in depth history regarding mental health issues are obtained. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 10 Inspection of both Private and social service funded contracts confirmed that each Resident has a contract which contains all information required and is signed by Representatives of the Resident. Discussion with the manager and records confirmed that the Manager has requested social service Care Managers to review the care given to the Residents to ensure the package of care is meeting the residents needs. Discussion confirmed that most Residents are admitted from hospitals and do not have an opportunity to have trial visits although this could be an option if appropriate. The Manager confirmed that in most cases the family visit the home to make the final visit. Five Resident questionnaires were received prior to this inspection. All stated that enough information was received. One stated that the home had a good reputation. Another said that family members had chosen the home. All four questionnaires ticked the box that residents always receive the care and support they need. Pinehurst Residential Care Home DS0000062484.V297562.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Judgement: The residents’ health care needs are fully met and the service users health, personal and social care needs are set out in an individual plan of care. The residents feel they are treated with respect and their privacy is upheld. The homes policies and procedures for dealing with medicines do not protect the service users from harm. EVIDENCE: Observation, Records and discussion with the Manager confirmed that staff at the home access services from heath care professionals. These include General Practitioners, District Nurses, Speech and language therapists, continence specialist, sensory team and physiotherapist. Records confirmed that these services are arranged within the home or within the local community. Two services users files, which held a range of information, including care plans; initial assessments and ongoing assessments were examined. The files showed details of residents past history and ongoing care that was not always Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 12 reflected in the care plans and documents generally were not well completed in that they had not been consistently signed, dated or reviewed in any detail. In a similar way the ongoing daily records of the care provided by staff to residents showed care being delivered but this was not reflected in the individual care plans. The manager was aware that the current system of recording needs to be improved and was able to produce the format for a new system which if well completed would address these issues. It is important to ensure care plans and records of residents care are well completed so that staff had consistent information about the care needs of residents and how they are cared for, so that resident’s needs are fully met. Residents spoken to consistently said that they felt well cared for, that staff helped them care for themselves or helped them to obtain outside professional help for example from there Doctor. The members of care staff spoken too were able to give a detailed description of the care needs of residents and said that they felt confident in providing care to residents. The homes medication administration system is a pre packed blister pack system that the local pharmacy delivers with some additional boxed or liquid medicines. The storage area of the medicines were, clean, tidy and secure and the systems for the collection and disposal of medicines were well managed. The recording of medication was on the whole well completed, however there were gaps in some staff signing to say that they had given or omitted medicines. This included recording of the measuring of insulin levels for the residents with diabetes, where there appeared to be two recording systems one of which had entries missing. Members of staff spoken too clearly understood the importance of the accurate recording of the administration of medicines and had a detailed knowledge of how the system worked. Poor recording puts residents potential at risk from harm as staff may be unclear about the medication given and omit medication that is required or give the incorrect amount of medication. A Tour of the building confirmed that spare dressings and prescribed dressings are kept within the home in case the district nurses need extra supplies. Appropriate storage was discussed with the Manager. During the inspection a district nurse visited the home she was complimentary about the Manager and care provided at the home. The issue regarding dressings was raised and the nurse agreed to the removal of these items from the home. This will protect residents from having expired products used and dressings that are not prescribed. Discussion and records confirmed that the staff at the home now weigh residents and regular intervals and record fluctuations in weight within the care plans. This is done using bathroom scales. Nutrition for Residents at risk and those with diabetes is now monitored using a ‘snack recording’ chart. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 13 Five Resident questionnaires were received regarding this service. Three stated that residents feel they receive the care and medical support they need. The other two questionnaires stated this usually happened. No comments were received. The Manager stated that the home had not received any complaints but that many Thank you cards had been received. These were produced. Comments included: ‘You all do a great job’ ‘She was well cared for at Pinehurst’ ‘Thank you for all the care and attention. No one could have cared for her more personally or professionally’ ‘Auntie always felt happy and content. Thank you for all the attention you gave her.’ Staff seen on the inspection were seen and heard to interact well with residents. Laughter was heard during the inspection. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service . Judgement: Residents maintain contact with their family and friends and the local community and their lifestyles match what they prefer and met their interests and needs. The residents receive a wholesome balanced diet in a choice of venue either in the homes dining room or in their own private rooms. EVIDENCE: A Tour of the building showed many pictures displayed around the home of residents and staff enjoying trips out around the community and enjoying other festivities. Resident’s files which include assessment and personal history information included details of resident’s interests, preferences and religious following. The ongoing daily records of how residents spend there time in the home showed regular contact from family and friends and some outside appointments that residents have attended. Residents confirmed that staff tried to accommodate any requests they made and that there were no restrictions on the time they went to bed or got up in the morning. Social activities in the home such as Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 15 bingo sessions and one to one discussions with residents are not always recorded and it is important to record these events as these activities show how residents are supported in remaining physically and mentally active. Confirmation of formal entertainment was displayed within the office and discussion with the manager confirmed other formal events are arranged at the home. However the sickness of the activities coordinator has interrupted this programme of events. A Tour of the building also confirmed evidence that Knitting and crocheting and enjoyed by some residents and jigsaws, dominos, bingo games and piano are also available. A board displaying the date and day of the week was within the lounge area, which helps remind residents what day of the week it is. During the inspection England flags were displayed within the lounge area. Residents seen in the lounge confirmed that they were enjoying the world cup football celebrations. Staff rosters show that on some evenings/nights two male carers work in the home unsupported by a female carer, this means that female residents have to have personal care needs met by male carers. This did not appear to raise any concerns for residents as they did not mention it as a problem and the residents spoken too were pleased with the care they received from all the staff. However, there was no evidence that the homes manager or staff had asked residents or their representatives if they were happy for care to be delivered this way. It is important that residents and their representatives are consulted on who ever cares for them male or female so that residents and staff are not placed in a situation that may be distressing. This is particularly important for residents who are unable to communicate their needs and preferences. The homes kitchen was clean and tidy and the care staff spoken too were able to describe residents preferences and any special diets such as low fat or diabetic diets. There were no ongoing records of what the resident’s meal choices had been so that it was difficult to determine the range of foods available to residents. The recording of the meals residents have received is important as it not only demonstrates the choice and range of foods, it indicates the kind of food, the nutritional value of the meals residents have received and if there was an outbreak of vomiting, foods could be eliminated as a possible cause. Discussion with staff and the Manager confirmed that breakfast is served between 7.30 and 8.30 depending on resident choice. Morning coffee and biscuits follow this at 10.00 and a hot lunch from 12.00 onwards. Afternoon tea and biscuits or cake is served mid afternoon and tea between 5pm and 6pm. Prior to bed residents are offered a warm milky drink and snack between 7.30 and 7.45. Discussion with the manager confirmed resident have access to Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 16 refreshments overnight and a record of snacks is now kept to show that residents at risk or those with diabetes have regular meals. On the day of inspection lunch was sliced ham with parsley sauce, mash and peas. Chicken stock was being prepared for fresh homemade chicken soup that evening. Four of the five resident questionnaires confirmed that meals were enjoyed at the home. One questionnaire stated that there is not always enough seasoning, but that staff have provided salt and pepper dispensers for personal use. Observation and the visitor’s book confirmed that residents are able to receive visitors at any reasonable time. One relative comment card was received. This stated that staff welcome them to the home and that families can visit their relative in private. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents feel able to complain knowing the manager will act on them appropriately. The planned adult Protection training will help protect residents from abuse ensuring staff are aware of how to recognise, prevent and report any allegations. EVIDENCE: Observation confirmed that the complaints procedure is displayed within the Statement of Purpose, Service User Guide and on a poster within the entrance hall. This has been improved to include the timescales in which the Provider and Manager must respond to a complaint. Minor changes to this document are needed to show the National Care Standards Commission are now called the Commission for Social Care Inspection. The Manager stated that no complaints have been received since the previous inspection. No Complaints have been received by the Commission for Social Care Inspection. The one relative questionnaire stated that they had not needed to make a complaint but knew who to report to. Of the five resident questionnaires four stated that they knew who to complain to and the other commented that although they do not know how to complain their family would do this and know how to complain. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 18 Training records confirmed that POVA(Protection of Vulnerable Adults) Training has been arranged, although not all staff had received this yet. The Manager stated that she has joined a ‘Care Forum’ at college where she is performing her Registered Managers Award. At this forum staff have discussed the subject of Elder abuse and adult protection and have shared information and documents, which included the multi, disciplinary Devon County Council Alerters Guide. Staff records confirmed that all staff have had Criminal Records Bureau and POVA checks performed and this included ancillary and maintenance staff. These documents and staff training ensure staff are aware of the different types of abuse and are aware of how to prevent and correctly report them should they arise. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,25 and 26. Quality in this outcome area remains Adequate. This judgement has been made using available evidence including a visit to the service. Judgement: Some areas of the home are not providing residents with a safe environment. The home is clean, pleasant and hygienic EVIDENCE: A Tour of the building confirmed that the Provider and Manager had worked hard to meet previous Requirements and Recommendations set at the last inspection. However some requirements still had not been met. On the outside of the property shutters have been removed from windows improving the appearance. Decorative hanging baskets and colourful flowerbeds decorated the appearance. To the rear of the building a fenced area with gate to the garden had been completed but the area outside a residents bedroom was used for storage of unsightly equipment. The Manager stated that this was until this could be taken to the recycling centre. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 20 Peeling paint and wallpaper has been replaced and some rooms have been redecorated. During the inspection a corridor was being re decorated. The Manager explained that the plan was to replace carpet as each area was to be decorated. Handrails have been fixed to staircases to assist residents who chose to walk up and down the stairs instead of using the stair lift. The Manager explained that windows identified at the previous inspection have been measured for replacement and this was due to be replaced. A tour of the building confirmed the laundry was well stocked and had been fitted with a wash hand basin. Gloves, aprons and hand soap dispensers were available throughout the home. The cleaner’s cupboard was located on the ground floor. Inspection of this area showed that clean hand towels were being stored with dirty cleaning equipment, which may cause a risk of infection. The Manager stated that she had asked the Health Protection Agency for an infection Control manual. This was obtained by the Manager by the end of this inspection. There are some areas of the home the homes bathroom, a storage area and a cupboard that have become cluttered and are in need of emptying, cleaning and re-tidying. This will help to maintain good hygiene practices reducing the risk of cross infection. The Manager stated that the last Environmental Health Office inspection was in December 2005 and the Provider had put a vent into a cupboard, replaced a base to a cupboard, cupboard fronts and planned to change the drawers. All private areas of the home seen were personalised with photographs, small items of personal furniture, flowers and pictures. The Home employs a maintenance man who performs regular and ad hoc repairs around the home. Action plans and records were produced showing the areas identified at the previous inspection had been organised for change or improvement. The home has a number of radiators that have not been guarded and this is a potential health and safety risk as residents may fall and injure themselves (burns) on the radiator. Water temperatures are not consistently recorded and this puts residents at risk from scalding, as staff are not routinely checking water temperatures. Fire doors were being propped open by devices that have not been approved by the Fire Authority; this puts residents and staff at risk if there was a fire in Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 21 the home. This was also raised at the previous inspection. The Manager confirmed purchase of new door guards shortly after inspection. The home does not have written risk assessments for the premises. Written risk assessments are important as they demonstrate that the home are taking their Health and Safety responsibilities seriously, they show the action the home has taken to identify and address any health and safety risks in the home and provide consistent information to staff managing the home so that risks can be minimised. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The New recruitment procedure and planned staff induction and training programmes will begin to protect residents as they are introduced. EVIDENCE: Observation and discussion with the Manager confirmed that a system has been introduced to ensure staff files can be accessed at all times whilst protecting the privacy of the staff. Five staff files were inspected on this occasion. Three staff files recruited by the New Manager confirmed that all information required had been obtained and Criminal Records Bureau/POVA (Protection of Vulnerable Adults) checks performed. The Manager showed new induction programmes obtained to make sure all staff have received sufficient information and training to work safely. The Manager confirmed that staff induction; supervision and Training were incomplete and inconsistent. She explained and showed a new system and evidence of training that has occurred so far. The Manager stated that she was confident that all staff would receive all mandatory training. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 23 The Manager stated that she is encouraging staff to do NVQ training but staff was not interested at present. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is currently poor. This judgement has been made using available evidence including a visit to the service. Judgement: Resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected in some areas but not others. EVIDENCE: Quality in this outcome area is currently poor, however should the Manager implement changes stated at this inspection this rating should increase. All staff spoken with were complimentary about the Manager. Four staff questionnaires were received and one stated that the Manager was working hard to improve the standard of the home so it meets all requirements. Residents spoken to said they liked the staff and the Manager. All relative questionnaires said that staff at the home informs them of any changes in their Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 25 relatives condition. One visiting healthcare was extremely complimentary about the Manager at the home. Staff questionnaires all stated that the Manager gives clear directions and is contactable outside working hours. The Manager confirmed that she is currently undertaking the Registered Managers award and finding this interesting and has started attending a care forum where ideas are shared with other managers. Staff questionnaires were inconsistent when they asked whether staff receive regular supervision. The Manager stated that supervision was to be introduced at the home. Policies and procedures have been purchased into the home. The Manager stated that she is currently ensuring these are suitable for Pinehurst. The home has a well-established system of recording and administrating residents finances, which was well managed and well recorded. An area of improvement is in purchasing a book for recording transactions rather than a loose unnumbered page system as this reduces the risk of information being lost. The home does not currently have an ongoing written system of monitoring the quality of the services provided in the home. The manager has obtained a quality assurance system that she is considering how best to introduce into the home. The day to day care and welfare of the residents is promoted and protected as the residents care needs and preferences are met. However shortfalls in the recording of residents needs, diet, activities, risk assessments and in some parts of the homes environment for example the radiators that are not guarded (please also see environment) potentially put residents and staff at risk. Staff training was not complete, however the Manager provided evidence that a system to ensure all staff have received mandatory training is being introduced. The Manager also stated that there is now a qualified first aider on duty at all times. Although cleaning staff have a tray to carry round cleaning products, bottles of shampoo, cleaning products and other COSHH (Control of Substances Hazardous to Health) products were located throughout bathrooms within the home. The Manager gave assurances these bathrooms would be tidied up and products stored in a safe manner. Service Records confirmed the Manager and Provider regularly ensure that Gas, Electric and other equipment are regularly maintained. The Manager also produced evidence to show that new systems have been introduced to ensure fire equipment; drills, training and checks are performed at the home on a regular basis. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 26 Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 2 3 3 1 2 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 3 1 3 3 2 3 1 Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 12,13.23 Requirement Timescale for action 01/12/06 2 3 OP25 OP26 4 5 OP26 OP33 6 7 8 OP38 OP38 OP38 Water temperatures must be regulated and checks put in place to ensure water is not at a temperature to scald residents. 12(1a) The Provider must ensure all 13(3) radiators are guaranteed low surface temperatures. 12(1a) The Manager must areas of the 13(3) home such as the homes bathroom, cupboards and storage areas are cleaned to reduce the spread of infection 12(1a) Risk assessments for the 13(3) environment must be completed, dated signed and reviewed. 24 The home must have a quality assurance system that monitors the quality of services provided in the home and must include consultation with service users. 12,13.23 Door wedges must be removed and door openers approved by the fire authority fitted. 18(1ci) The Manager must continue with 13(3) the planned programme of staff mandatory training. 13(4)(a)(c Regularly reviewed risk ) assessments must be held for each resident to show if they are DS0000062484.V297562.R01.S.doc 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 Pinehurst Residential Care Home Version 5.2 Page 29 at risk from any unrestricted window openings on the upper floors of the home and action must be taken to remove risk. 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 OP7 OP7 OP9 Good Practice Recommendations Review and update all documents so that they are dated signed and fully completed. Extend ongoing daily records and make sure care detailed in daily records is reflected in the residents care plans The Manager should improve the management of the medication system by: o Reviewing and updating medication records o Ensuring out of date dressings and prescribed dressings are not stored on the premises. The Manager should consider extending records to show the foods residents have received and the activities they have pursued. The Manager should continue with the planned POVA Training for all staff The Manager should ensure all areas of the home are tidy and clutter free, including the downstairs bathroom The Provider should continue with the double-glazing programme. The Manager should ensure areas of the garden accessible to residents are not used as storage of materials waiting to go to the recycle centre. The Manager should consider performing an infection control audit using the tools provided in the Health protection manual The Manager should continue encouraging staff to do NVQ training The Manager should continue with the planned induction and training programme The Manager should review and update the recording system for residents finances The Manager should continue with the planned programme DS0000062484.V297562.R01.S.doc Version 5.2 Page 30 4 OP12 OP15 OP18 OP19 OP19 OP22 OP26 OP28 OP30 OP35 OP36 5 6 7 8 9 10 11 12 13 Pinehurst Residential Care Home of staff supervision. Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pinehurst Residential Care Home DS0000062484.V297562.R01.S.doc Version 5.2 Page 32 - 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. 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