CARE HOMES FOR OLDER PEOPLE
Pinetree Lodge Nursing Home Dryden Road Gateshead Tyne & Wear NE9 5BY Lead Inspector
Mrs Katie Tucker Key Unannounced Inspection 8:30 27 , 28 June, 5th, 19th July 2006
th th 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.V301675.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. Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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.V301675.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Pinetree Lodge Nursing Home is owned by Mental Health Concern and opened in 1984. It is designed to accommodate the needs of older people with dementia care and nursing needs. The fees at the home are £634 but several grants and funding bodies pay these monies. The home is a purpose built bungalow style facility. It is divided into three units and provides nursing care for people with mental health needs, predominantly those needs associated with dementia-type illnesses, in each unit. 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 facilities are located 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.V301675.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 3 days. One inspector spent 12 hours at the home speaking to people using the service, staff and visiting relatives. Prior to the visits the inspector also spoke to health professionals that visit Pinetree Lodge. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at the service user plans. Mental Health Concerns headquarters were visited so further information could be gathered about the operation of the home. Also information supplied by the home and comment cards were used to make decisions about the quality of service. Pinetree Lodge provides nursing care for people with a dementia-type illness and care for people with mental health needs. Some of the people have difficulty communicating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection all of the key standards were checked. What the service does well:
The manager is very competent. She constantly has the interests of the residents, as the focus for all service developments and this is reflected in staff practices. Relatives and staff said that they found her to be very approachable and that she ‘really cared about then as well as the residents’. She expects staff to work to the best of their ability and constantly achieves this because of her excellent management skills. The majority of residents using Pinetree Lodge have lived with dementia for some considerable time and now experience great difficulty completing any task. Staff work with people in a way that respects and treasures them regardless of the severity of their disability. Staff constantly chatted to the residents and encouraged them to join in. Staff also used a variety of different methods to help people make decisions about the care they were receiving. Mental Health Concern’s staff training department is extremely active and all of the staff have access to a wide range of training. The type of training offered includes access to degree and masters level courses as well as secondments onto nurse training. Mental Health Concern is not only the owner of Pinetree lodge but also a charity. Headquarters staff champion the recognition of people with mental Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 Page 6 health needs as full citizens. They run service user boards and provide people with mental health needs opportunities to gain employment. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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.V301675.R01.S.doc Version 5.2 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 and 6 Although improving some shortfalls remain in the assessment information. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. 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 are sometimes limited information is being recorded and at times the terminology used needs to be revisited. 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. Staff have been asking families to complete these forms but this is producing very limited information. Therefore the manager has decided that staff with the relative and resident need to fill in the form.
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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 and 10 The service user plans do not always reflect the care and good practices seen at Pinetree Lodge. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The care plans vary in depth and quality. On the whole when writing care plans, staff do include the full amount of information needed to show how to meet someone’s needs. But they are not writing plans around how to work with people who have challenging behaviours. Also staff are not using information about people’s strengths or previous routines to inform the plans. In practice staff were meeting resident’s needs and were very aware of the best way to work with people but this was not recorded. Therefore their good practice was not evidenced. Although risk assessments are being generically used, assessments for showing that the risks people take have been judged to be acceptable need to be extended. Also risk management strategies must be applied more widely. These types of plans show the strengths people have and the common day risks they can continue to safely take.
Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 Page 10 Staff impose limitations on some residents because of their dementia or mental health needs such as needing to be accompanied when outside the home and locking kitchenette doors. These practices must only be undertaken when evidence is available to show that people would be at great risk if they went out by themselves or used the kitchenette. Otherwise people should be free to access all communal areas or go out when they want. When limitations are imposed for a particular individual this needs to be recorded. Staff are working with some people around making choices that do not harm themselves or others. However the staff are not recording these agreements so cannot reconfirm the decisions with the resident. When residents have to follow Pinetree Lodge’s house rules can be recorded in a standard contract. Recently there have been problems with the chemists and some medications have not been delivered on time. Therefore staff have used other people’s medication but this is not a good practice. The manager is aware of the problems and is in the process of putting measures in place to ensure this does not happen again. Also it was unclear as to whether staff made a copy of the prescription sheets prior to sending them to the chemist. Copies need to be kept so staff can make sure they have received all of the prescribed medication. 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. Staff and residents had formed good working relationships and this assisted and contributed to the pleasant atmosphere that was present. Relatives said that the staff team were ‘amazing and really looked after their relative’. Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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 Staff are very dedicated and have excellent dementia care skills but the organisational constraints affects the overall rating. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Throughout the visit staff spent a great deal of time chatting to residents and trying to engage their interest. The senior manager and manager are looking at ways to work further with the residents who are no longer able to speak. Recently Mental health Concern purchased a people carrier for the home. This has been an invaluable asset and resident regularly go out for a variety of trips. Staffing levels have improved and this has allowed staff to complete more activities with people. All of the activities staff are designing are tailored to meet the specific needs of each resident. Relatives said that they could visit when they wanted and were always made to feel welcome. They were extremely complimentary about the service and staff. Also the residents, who were able, spoke warmly about the staff. Relatives said ‘staff are a marvel’. Pinetree Lodge is divided into units and each has a keypad system. Since the last inspection the main unit has been opened up a little so people can now
Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 Page 12 walk to the main door. However, the residents in the other units cannot walk freely through the building. Plus the conjoining communal areas are locked but have windows so this tends to cause people frustration. Kitchenettes, bathrooms, bedrooms and at times toilets are locked throughout the day. The majority of residents 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. Recently the manager changed the lock for one person but as yet the owners have not put measures in place to make sure all of the locks are changed. 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 during the day. Also no one has overall responsibility for monitoring the general diet residents have had on a daily basis. During the inspection it was evident that at times people were not receiving five portions of fruit and vegetables a day. Mental Health Concern recognised that these pressures prevented staff from monitoring people’s overall diet and diluted the service offered to people. Thus Mental Health Concern agreed to look into providing dedicated kitchen staff for Pinetree Lodge. This has not yet happened. Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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): 16 and 18 The manager and staff proactively deal with complaints and concerns. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is made available to residents and relatives through the service user guide. Residents said that the found the staff and manager ‘listen to what you have to say and sort things out if they can’. They felt the manager and staff are open and willing to listen to concerns people may have. The relatives felt that any concern they had would be dealt with and action would be taken to make sure the problem did not reoccur. 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. When incidents of physical aggression by residents to one another have occurred appropriate action has been taken to reduce the chance of this occurring again. However, senior managers did not make the local authority adult protection officer aware or notify CSCI. Senior managers were made aware of this shortfall have immediately put measures in place to ensure this did not happen again. Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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 The lack of an updated call alarm system and lack of action by the owners to attend to the requirements around the building leads to major shortfalls in this area. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The senior manager was made aware that CSCI is concerned that the recent refurbishment did not include the provision of individual locks for bedrooms, lockable cabinets and appropriate nurse call alarm systems within all the bedrooms. This has been an outstanding requirement since 2003. Currently the call alarms are up a height so they cannot be easily reached. The manager has started to take action to provide these items but this is limited to individual’s rooms. But much of the falls prevention equipment cannot be used because they need to be plugged into a call alarm and this has the potential to leave residents at risk of injury. Pinetree Lodge has been specifically set up to provide dementia care. The manager is starting to make environmental changes to make the home more
Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 Page 15 user-friendly such as using different colour schemes in different areas. The owners have been obtaining information about how make adaptations to the building. Dedicated domestic staff are employed and the home was clean. Staff have received infection control training. Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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 Staff are competent and very skilled. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: 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. 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 confirmed that they are going to employ dedicated kitchen staff. Mental Health Concern has a dedicated training department. This department provides staff with opportunities to go on a wide range of training. Mandatory training such as food hygiene is being completed. 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 ensures new staff are supervised until the induction training has been completed.
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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): 31, 33, 35 and 38 The manager is very competent and the management systems are working effectively. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The manager has strong leadership skills and a track record of running good services. She has helped staff understand the importance of providing personcentred care and actively promote this to others. A team of finance staff at the head quarters look after the personal allowance records. Relatives and resident’s when they need information can get this from the manager via the intranet system. Only small amounts of money are held on behalf of residents. Receipts are kept. When money collects in the accounts held at head quarters this is sent to the appointee or relative to put in people’s savings accounts.
Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 Page 18 Recently CSCI has not been notified of incidents although agreed procedures were in place whereby alerts would be made via email. The senior manager was made aware of this problem and has taken action to resolve the problem. Mental Health Concern has a very comprehensive quality assurance that is repeatedly tested and amended when shortfalls are found. There were no health and safety issued noted at the time of the inspection. Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 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 OP7 Regulation 14 Requirement The assessment documents and care plans must continue to be up dated. Risk taking assessments must be extended. 2. OP7 15 Care plans must be developed around how staff work with people who display challenging behaviour. Information must be recorded around restrictions that are imposed. (Required at the last inspection – timescale 11/09/06) 20/12/06 Timescale for action 22/11/06 3. OP14 12(2) Sch3 (3)(q) 20/12/06 4. OP22 13 (4) (a) & (b) The alarm call cord system must 25/08/06 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, must be employed. (Required at previous inspections – timescale 25/08/06) 20/12/06 5. OP27 18 (1) (a) Pinetree Lodge Nursing Home DS0000018176.V301675.R01.S.doc Version 5.2 Page 21 6. OP33 37 CSCI must be notified of incidents affecting the well-being of service users. Where measures to protect vulnerable adults have been taken the appropriate authorities must be notified. 27/09/06 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.V301675.R01.S.doc Version 5.2 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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