CARE HOMES FOR OLDER PEOPLE
Pinetree Lodge Nursing Home Dryden Road Gateshead Tyne & Wear NE9 5BY Lead Inspector
Mrs Katie Tucker Unannounced Inspection 22nd November 2005 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 Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 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. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Pinetree Lodge Nursing Home Address Dryden Road Gateshead Tyne & Wear NE9 5BY 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) 0191 4774242 0191 4786702 Mental Health Concern Mrs Kathleen Bailey Care Home 34 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (34), Mental disorder, excluding learning of places disability or dementia (5) Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th July 2005 Brief Description of the Service: Pinetree Lodge Nursing Home is owned by Mental Health Concern and opened in 1984. The home looks after older people with dementia care (memory loss) and nursing needs. Pinetree Lodge has been built as a large bungalow so people will not have to use stairs. It is divided into three units. There are a variety of lounges and dining rooms throughout the building as well as a sensory room. One lounge provides access to an internal courtyard and a sensory garden has been created. The home is situated in a residential area just off Durham Road in Gateshead. Other healthcare services are provided in the same grounds. Public transport is within easy walking distance and this gives access to local shops and social amenities. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Pinetree Lodge inspection was carried out as part of the routine yearly programme. No one working for Mental Health concern was told that the visit was to take place. An inspector visted Pinetree Lodge and spent 8 hours at home. The inspector looked at the residents’ records, staff training records, staff information, and medications records. The staff were asked about the residents’ records, the guidelines for protecting residents, their training, staffing levels and changes to working practices. The residents and relatives were asked similar questions. Pinetree Lodge provides a service for people with memory loss. So some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection key standards were focused on but not all were checked. What the service does well: What has improved since the last inspection?
Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 6 The manager has continued to fill existing vacancies at Pinetree Lodge. Now many vacancies have been filled. This has relieved much of the pressure staff were facing and the number of shifts staff had to cover has been reduced. Vacancies remain for 2 nurses and 2 care workers. The manager was hopeful that these vacancies would also be filled. With the vacancies being filled the care worker who often works as an activities co-ordinator has started to have some work some days in this role. Over recent months outside entertainers have visited. Also some of the relatives organise activities when they visit and staff are able to spend a little more time with people. Staff recognise the need to tailor activities to people’s needs and have started to use information from the life histories to do this. Additional specialist equipment has been purchased, which help staff look after residents such as high/low beds and standing aides. Staff reported that this type of equipment made marked improvements in the way they could care for people. 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. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 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 the following standard(s): 3 Staff are in the process of completing the wide range of assessment records are available. Therefore shortfalls will continue to exist until these are completed. EVIDENCE: A new assessment document has been introduced in the home. This has been specifically designed to give information about the needs of people with a dementia- type illness. It is a very comprehensive tool, which provides a lot of information about all aspects of people’s lives and needs. Staff have been filling these in but because of the recent staffing constraints were finding this a slow process. Staff are hopeful that they will be able to finish completing these records soon. Staff know that residents’ life histories are vital in this type of service. People with dementia tend to revert to previous routines and patterns of behaviour. When staff know the history they can work more effectively with people and reduce people’s anxieties and frustrations. Once the staffing issues have been resolved they are intending to concentrate on this aspect of the service.
Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9 Although the staff in practice show that they help residents to make decisions about their lives, are aware of associated risks and plan people’s care, this is not always reflected in the care plan. Medication practices are good. Staff access further healthcare when it is needed. EVIDENCE: The staff have a very in depth knowledge of the people using the service and their needs. Full assessment information and care plans are being put in place. Residents, if able, or their relatives work with staff to write the service user plan. Staff and CSCI acknowledge that over the last year staffing levels have hindered the work people wanted to complete on developing these records and these records will be looked at during the next inspection. Risk-taking assessments are to be developed. These types of plans identify the strengths people have and the common day risk that would be still acceptable for someone to take. The assessment tool for bedrails is incomplete. Bedrails are also classified as mechanical restraints and care plans around this type of physical intervention have to be in place.
Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 10 Because of the nature of their needs some of the residents cannot do everything they would want. Staff need to record information about people’s choices and wishes that cannot be respected. Also Pinetree Lodge’s house rules need to be recorded in a standard contract. The medication practices are in line with those expected. None of the residents could manage their own medication and staff are recording why people could not do this task. Staff have formed very good links with the local hospitals. Many of the residents continue to see consultants. Also staff have repeatedly shown that they can seek out medical support when it is needed. Staff have successfully worked with people to reduce the anxiety they experience. The staff use a wide range of skills to find out what is upsetting residents and how best to resolve people’s concerns. Relatives said the care was ‘exceptional and staff made them feel part of the care team’. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 and 15 Dedicated activities co-ordinator hours would enhance the service offered at Pinetree Lodge. EVIDENCE: Staff try very hard to spend time with people but the high dependency needs of people mean that activities can be limited. Some relatives complete activities when they visit. Plus staff try to find meaningful tasks for people to complete again this can be hindered when staff are busy. Although a care worker provides activities as part of his role these hours are not protected. This can markedly reduce time spent on activities when he is needed to cover care shifts. Pinetree Lodge needs to have a dedicated activity co-ordinator. Each Pinetree Lodge units has a keypad system, which means that people cannot walk through the building when they want. Also bathrooms, bedrooms and at times toilets are locked throughout the day. Residents, who are able, cannot have keys to their bedrooms as the locks are all the same. Thus people cannot choice whether to keep their room open or not. These restrictions need to be recorded in the standard contract. At present Pinetree Lodge does not have kitchen staff and care staff undertake this task as part of their daily routine. A large number of people require oneto-one assistance during the meals or will need to have food at different times
Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 12 during the day. Mental Health Concern recognised that these pressures prevented staff from monitoring people’s overall diet and diluted the service offered to people. Thus they agreed to provide dedicated kitchen staff for Pinetree Lodge. This has not yet happened. Relative said that they could visit when they wanted and were always made to feel welcome. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The manager follows the local authorities protection of vulnerable adults procedures. EVIDENCE: Pinetree Lodge has an appropriate protection of vulnerable adults policy and follow Gateshead Social Services Department guidance. This guidance does, however, require Mental Health Concern to put in a section about what they would do if an allegation of abuse were made. Staff have had training around protecting residents. The Social Service Department is in the process of organising training for all the staff working in care. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Once the refurbishment programme of Pinetree Lodge has been completed the environment will more readily meet the needs of the residents. EVIDENCE: Pinetree Lodge is located within a residential area of Gateshead. It is a purpose built property and is a single storey building. Thus the home can meet the needs of someone with a physical disability. Plans are in place to complete a full refurbishment of the home. This will include the provision of individual locks for bedrooms and appropriate nurse call alarm systems within all the bedrooms. Currently the call alarms are up a height so they cannot be easily reached. Also much of the falls prevention equipment cannot be used because they need to be plugged into a call alarm. As yet dates have not been given about when this work will start. Pinetree Lodge has been specifically set up to provide dementia care. But environmental adaptations that assist people with memory loss have not been put in place. The manager is very aware of small environmental changes that
Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 15 could be made to make the environment more user-friendly such as using different colour schemes in different areas. The owners have been obtaining information about how make adaptations to the building and have said that when the home is redecorated these changes will be made. Dedicated domestic staff are employed and the home was clean. Staff have received infection control training. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The lack of dedicated laundry, kitchen and activities staff make it difficult for staff to meet the complex needs of residents. The staff team are extremely dedicated and constantly work overtime to meet the needs of people. EVIDENCE: Mental Health Concern are working hard to establish a stable staff team in the home. Staff vacancies are gradually being filled. The core staffing team is 2 first level nurses (RMN) and four care staff are on duty during the day and during the night a 1st level nurse (RMN) and three care staff. The manager is not counted in the staffing numbers. Staffing vacancies remain but the owners are working hard to fill the posts. Staff said because so many posts had now been filled they felt more able to give a good quality service and attend to areas such as record keeping. Domestic staff are employed but not laundry or kitchen staff, as it was expected that care staff would complete the latter two tasks. The residents are extremely dependent on care staff to meet all of their needs. Mental Health Concern have said that they are going to employ dedicated kitchen staff. Staff have said that when day and night time hours spent on laundry tasks were added up about 3 to 4 hours were spent per day on this task. Larger items are sent to a local laundry but staff wash all of the residents clothes. This level of work would fulfil a part-time post and a dedicated laundry person would reduce the number of clothes inadvertently spoilt.
Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 17 Mental Health Concern has a dedicated training department. This department provides staff with opportunities to go on a wide range of training. Recently the mandatory training such as food hygiene was showing signs of slippage as some staff had not completed this required training. However, action has been taken to make sure people receive all of the necessary training. More than 50 of care staff have completed NVQ training and the qualified staff are able to go on various courses including degrees. Staff records are kept centrally but these can be seen via an intranet link. Personnel staff make sure that CRB checks are completed, references obtained and full employment histories taken. The manager was made aware that there have been some changes to the regulations around employment and new staff now need to be supervised until the induction training has been completed. Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 38 There are minor shortfall in the maintenance of health and safety at Pinetree Lodge. EVIDENCE: Maintenance checks are being made regularly by the home and as planned by contracting engineers. The manager was advised to monitor all outstanding maintenance issues and it was recommended that Mental Health Concern employ a dedicated handy person to complete minor maintenance works. High/low beds have been purchased and the number of bed rails being used is reducing. But appropriate risk assessment need to be in place for those people who still use bed rails. Mental Health Concern has put in place a quality assurance tool and this is regularly reviewed.
Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 2 Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7OP3 Regulation 15 Requirement The assessment documents and care plans must continue to be up dated. Risk taking assessments must be developed (required at previous inspections –timescale 12.08.05) Information must be recorded around restrictions that are imposed. A dedicated activities coordinator post must be created The alarm call cord system must be replaced during the planned redecoration and alternative means for summoning assistance must be in place in the interim. (Requirement made at previous inspections -timescale 25.08.06) Dedicated kitchen staff, laundry staff and handyperson must be emoployed. Risk assessments for bed rail must adher to health and safety executive guidelines Timescale for action 11/09/06 2 OP7 12(2) Sch 3(3)(q) 16 (2) (n) 13 (4) (a) & (b) 11/09/06 3 4 OP12 OP22 22/05/06 25/08/06 5 6 OP27 OP38 18 (1) (a) 13 (4) (a) 22/05/06 30/01/06 Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Pinetree Lodge Nursing Home DS0000018176.V253859.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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