Inspection on 14/09/07 for Pinewood

This inspection was carried out on 14th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Pinewood 22/07/08

Pinewood 16/03/07

Pinewood 27/07/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Pinewood 96 Manford Way Hainault Ilford Essex IG7 4DA Lead Inspector Stanley Phipps Unannounced Inspection 12:00 14th to 21 September 2007 st 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 Pinewood DS0000067407.V350004.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. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinewood Address 96 Manford Way Hainault Ilford Essex IG7 4DA 020 8500 8499 020 8500 0811 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) www.sanctuary-care.co.uk Sanctuary Care Ltd Abdul Razak Okoro Care Home 54 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (40) of places Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 40) 2. Dementia - Code DE (maximum number of places: 14) The maximum number of service users who can be accommodated is: 54 16th March 2007 Date of last inspection Brief Description of the Service: Pinewood is a 54 bedded home for older people. It was previously managed by Ashley Homes and as of April 2006 has been formally taken over by Sanctuary Care. The transition process to Sanctuary began in the last quarter of 2005. All beds are contracted to the London Borough of Redbridge and one of the fifty-four beds is used as an emergency respite bed. Accessing this bed involves a specific assessment based on agreed criteria between the home and the local authority. The home is situated in Hainault and is close to local amenities and bus transport systems. It is spread over three floors and is fully accessible to people who may be wheelchair dependent. There is a large garden for the benefit of service users with open spaces to the front of the home. A large dining area, kitchen, laundry and lounge areas on each floor ensures that service users are afforded communal spaces for relaxation and activities of their choice. This also includes a quiet room next to the ground floor lounge. All residents have single bedrooms, of which approximately fifty per cent have Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 5 en-suite toilet facilities. The home is staffed on a twenty-four hour basis, providing care and support to elderly residents. The fees are charged at £480.82 and do not include hairdressing - priced at £8.00, newspapers and toiletries (variable prices), private chiropody (£20.00) and dental charges (dependent on residents finances). The home’s statement of purpose is made available to residents on request and a copy is kept in the staff office. Each service user is given a copy of the home’s service user guide, once admitted to the home. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. It was carried out over two days beginning on the 14/9/07 at 12.00 p.m. and finished on the 21/9/07. The time spent at the home gave the inspector sound opportunities to determine how residents were experiencing the service and indeed the standard of care and support that was provided at Pinewood. As part of the inspection three residents’ files were assessed including that of the most recently admitted individual. They formed part of case tracking. The inspection also entailed interviews with residents, staff, relatives and, where provided comments from external professionals. Records, policies and procedures and the facilities provided by the home were assessed. There were detailed discussions with; the manager, the registered manager from another Sanctuary service and three team leaders. Comment cards from residents and staff were also considered and a tour of the environment was undertaken. Finally this report includes consideration of the information from the Annual Quality Assurance Assessment (AQAA) that was provided by the registered persons. The inspection found that there were some positive improvements and that generally standards were getting better. There was evidence that a lot of work went into raising standards in the home with key inputs from the current manager, the registered manager from another of Sanctuary’s services and at another level, team leaders and junior staff. What was abundantly clear was that the drive for improvement was not consistent across the staff team. This inconsistency impacted upon the overall outcomes for residents and so they continued to receive an adequate level of service. This was discussed in detail with the senior managers at the inspection. It should be noted that the fourteen-bedded unit for residents with Dementia was now up and running, and the inspector spent time there assessing the quality of experiences for those residents placed in that area. The interim manager – Mr Abdul Okoro is now registered with the Commission. The likely impact of this on the service is that residents should experience some stability in the services they receive from living at Pinewood. What the service does well: Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 7 Residents enjoy opportunities for maintaining networks with their families and friends. A high percentage of residents value the input of staff in caring and supporting them. This was matched by a generally high commitment from most of the staff, some of which was evident on the day of the inspection. Access to healthcare services continues to ensure that residents’ health and welfare is promoted. Residents are encouraged to maintain their independence as far as feasibly possible and this included with their personal care. There is a good system in place to ensure that residents are able look their best – mainly through sound arrangements that are made with a hairdresser. The environment is maintained to a good standard and is clean, hygienic and free of bad odours. Residents are therefore happy and comfortable living there. What has improved since the last inspection? The statement of purpose had been updated, although further changes are to be made for it to accurately reflect the details about the home. Complaints are handled more robustly now and the value placed on complaints has increased throughout the home. There is greater awareness of safeguarding adults, which primarily arose from training and closer monitoring at a senior level in the home. This has resulted in a reduction not only in number incidents of alleged abuse, but also to the risk of residents experiencing abuse. A planned programme of maintenance is in place and there have been significant improvements to the environment since the last inspection. The plan gives clear details over improving all areas of the home. Staffing levels were generally improved, although there were periods where agency staff is used. This would need keeping under review, particularly in relation to the newly set up Dementia Unit. Quality assurance monitoring and application has improved in line with the national minimum standards for older people. Improvements were noted in the frequency of supervision and appraisals although the latter was at a slower pace. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 8 The systems of supervision, team meetings and quality assurance have had a positive impact on monitoring the effectiveness of the training provided to staff. This needs to continue. A registered manager is in place to run the home. 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. The summary of this inspection report can be made available in other formats on request. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 9 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 Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): (1,3) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. A reviewed statement of purpose is in place, but need updating further to ensure that accurate information is available to residents and/or their advocates. Residents continue to benefit from having a comprehensive needs assessment carried out on them, to reduce the risk of choosing a home that is unable to meet their needs. EVIDENCE: There was evidence that the statement of purpose had been amended to clarify the position with smoking in the home. The reviewed document was also made available to service users and it did contain information regarding the dementia unit. Residents interviewed described the document as informative as most were able to say what the home offered. This is particularly useful and more so for prospective individuals, considering moving into Pinewood. However, there were several areas that were unrepresentative of how the home is run, which could be misleading to individuals reading the document. Examples included; information about staffing levels and the combination of staff on each shift, having a deputy manager and the number of respite beds in the home. The document must be therefore reviewed to ensure accuracy. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 11 The admissions process was analysed taking into consideration the most recently admitted residents and the fact that the Dementia unit was now up and running. It was clear that detailed assessments were undertaken of all residents and the manager leads this process. In his absence the team leaders carry out by the assessments. In all cases a care management summary is obtained, which enables decision-making around the suitability of the home - a more thorough process. More importantly there was evidence that residents and/or their relatives are involved in the assessment process. Residents therefore have opportunities for inclusion in what could be described as a fairly comprehensive process of admission. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): (7,8,9,10) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users continue to have their needs detailed in an individual care plan. However, there remains an issue with ensuring that each resident benefit from a review. While sound arrangements are in place for promoting the healthcare of residents, unsatisfactory medication practices compromise their safety. Residents are however assured that they are treated in a dignified manner, during their engagement with staff. EVIDENCE: Three care plans were examined and they included those of the most recently admitted residents, which formed part case tracking. Sixty–six per cent of the sample was maintained to a good standard and this was consistent with one team leader ensuring that those care plans reflected the needs of the residents concerned. This included reviews for the residents concerned. There was no evidence in one case that a review was carried out. In discussions with the residents, they were aware of what their plans contained and were generally pleased that the contents reflected what they wished for themselves. At the time of the visit, Sanctuary Care was in the process of introducing a new system of care planning in the home. This system is even more detailed that Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 13 what was before and so training is planned to enable staff to use it. The manager has had the relevant training already and plans are in place for the cascading of this training. In essence care planning was undergoing a transition. This however should not be given priority over ensuring that reviews are carried out for all residents in a timely manner. It was clear that the needs of resident concerned were changing, which was not reflected in a review held with her. This needs to improve. Risk assessments in most cases were appropriately linked to care plans in promoting residents safety, which is positive. It was unanimous from speaking to the GP, staff, residents, relatives and external professionals that the healthcare needs of residents, were satisfactorily catered for at Pinewood. A record was maintained for each resident of the contacts made with the chiropodist, opticians, dentists, occupational therapist, the psycho-geriatrician, continence advisors, the diabetic and practice nurses to name a few. From the records it was clear that the staff were able to capable of making appropriate referrals with residents’ approval to ensure that their health needs are adequately provided for. The general practitioner’s view was that residents receive good care at Pinewood and that he had no concerns with how the service was managed. From the case tracking of three residents, their health needs were in the main well provided for. However, it was observed that one resident complained about pain in her heel, which was recorded but not given as part of the handover. No action was subsequently taken and so the individual concerned was left with the discomfort. A system is in place for countersigning the notes made by carers, but this was not carried out on this occasion, leaving the outcome for the resident - unsatisfactory. A medication policy is in place for the benefit of staff with the responsibility of supporting residents with medication. Training has also been provided for those individuals charged with that responsibility. At least one resident has been enabled to manage her medication, which is positive. Most of the others were, supported by staff and through observation there were several weaknesses, which compromised residents’ safety. It was observed on at least two occasions that medication was placed in front of residents while they were having their lunch with no arrangements to ensure that they were, taken by the individuals concerned. In one case a resident removed the drug from the minim cup and started rolling the drug around on the table. At this point, the inspector drew it to the attention of one of the managers. An audit out of the drugs held in the home was carried out and none of the most recent stock had been accounted for i.e. checked in, except for one drug. To make matters worse drugs were actually missing from bubble packs without any matching signatures on the medication records. In one case a significant amount if drugs were unaccounted for. An audit was immediately undertaken and the report submitted to the Commission, which bore evidence that most of Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 14 the drugs were accounted for. It should be noted that the major concern for unaccounted drugs at the time was on the Dementia unit, which was quite disconcerting. The manager informed that senior staff members have delegated responsibilities for ensuring the safe handling of drugs in the home. He proposed to carry regular drug audits to ensure that medication practices are in line with their policies, the national minimum standards and its associated regulations. However, current medication practices need improving to provide residents with the best possible support for their healthcare. There was extremely good feedback from relatives, residents, external professionals and staff to support the view that respect and dignity is given a high profile at Pinewood. Some of the comments received from residents included; “ the staff here are really gentle and sensitive when helping me with my bath”, “ the girls always knock on my door before entering my room and ask if I am comfortable, when assisting me to use the toilet” and “ staff here are so good they treat you as though you are part of their family – they are fantastic and do care”. The positive comments were validated throughout the course of the inspection. One resident with diverse needs was observed being enabled to maintain her independence within a risk management framework. Residents wear clothes that are consistent with their culture and in most cases communication aids such as spectacles and hearing aids were, worn by residents. Phones are available to residents to communicate with the outer world and sound arrangements are in place for residents to be seen by external professionals in private. This is a positive area of the homes operations. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,14,15) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents enjoy some level of activities at Pinewood that is generally in line with their social, recreational and religious interests. However, this must be kept under review. They also enjoy maintaining strong links with family, friends and the local community. Their lifestyle is enhanced by the enabling choice in their lives. Meals are generally satisfactory and suited to their needs. EVIDENCE: There were mixed comments from residents with regards to the quality and level of activities provided in the home. While some felt they were okay others felt, that more needed to be done. One of the adverse comments included; “the activities coordinator seems to be more involved in caring, she could be seen helping with meals, taking people to the shops and I would to take part in quizzes. There is no plan of activities, although the lady said that she had put one up”. An activities coordinator was recently appointed and the registered manager provided a programme of activities, which was not widely available to all residents. Comments provided by some staff indicated that – there should be more activities and stimulation for residents. In discussion with the manager, he showed an awareness that the activities could be improved and in his AQAA, identified areas such as trips, shopping, Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 16 holidays and more importantly individual choices of activities. This is particularly important to ensure that residents in the dementia unit are given appropriate stimulation to lead fulfilling lives. In discussion with the supporting manager, she indicated that work in this has begun in this area i.e. for the dementia unit. It must be stated that there are activities in the home and some of the examples taken from records and discussions with residents included; church services, music and movement weekly on both of the main units, outings (Southend and a drive around Essex) on the mini-bus, Karaoke (two-monthly) and an indoor entertainer brought in at various times. On both days of the inspection the levels of activities varied from listening to music, to watching television, a couple of people going to the shops, while some were involved in a sing-a-long. On the Dementia unit residents were engaged with each other in small groups, as there were eleven of them in total. It must be said that the level of activities were low in this area and the fact that the unit was fairly new might have attributed to this. It was reported that residents in this unit, participate in the ‘movement to music’ sessions that were recently introduced in the home. It was clear that more needed to be provided for this group – even though it may be over shorter periods of time. Plans were in place to develop a sensory room in the dementia unit and the registered manager intends to review the activities weekly with the activity coordinator. He also plans to have this topic as a recurring item on the resident’s meeting agenda. The inspector had sighting of the residents’ minutes for October 2007 meeting, which showed four planned in-house entertainment activities for the month of December. One of the positives of the manager’s involvement in promoting equality and diversity is that; it is compulsory that residents using wheelchairs have the benefit of attending weekly outings, which is positive. Despite this, it became clear that the current level and quality of activities need improving. This must be kept under review. There was good evidence that relatives and friends are encouraged to maintain their networks. One hundred percent of the feedback received from relatives and external professionals indicated that they are welcome to maintain their links with residents. One relative stated; “the staff are excellent in making me feel welcome and informing me of developments as they arise. We are quite pleased”. Another stated; “Staff make you feel inclusive in what’s happening with residents”. One relative spoke of the increased confidence she felt in supporting her mother to complain, which is positive. Relatives were observed taking residents out during the course of the inspection and this has been a consistent area of the home’s operations. Most of the feedback received from residents and their relatives indicated that they were pleased with the level of control they are afforded in their lives. Various forums are in place to facilitate this, which includes, care plan reviews, residents meetings, the process of complaints and informal discussions. There Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 17 was evidence that advocacy is encouraged and in a most recent case this had been used to maximum effect by the resident concerned. One individual currently manages her medication and feels quite empowered in so doing. More importantly she was able to describe the intended outcome for each of the drugs used, which is positive. Where possible residents are also encouraged to handle their finances and in many cases, they have the support of their relatives. This is a consistent area of the home’s operations. Lunch was observed on the first day of the inspection and it was varied, generally well presented and in most cases reflected the residents’ choice. There were menu plans in place, which were in the main pre-determined by residents at their meetings. Views on the meals provided in the home were generally mixed with most individuals claiming that they were improving. It must be noted that meals at Pinewood have been an ongoing concern with regards to fluctuations in their consistency. As a result, Sanctuary Care as of summer 2007 brought the catering services in-house. The objective was to achieve a sustained period of consistent improvement in the meals provided at Pinewood. Although there was a relaxed atmosphere during the course of lunch and residents were sensitively supported, there were several concerns raised about cold food being provided in the home. This was also observed at the inspection, in the main dining lounge where a resident was served his lunch, while others had started their dessert. It was as though he was forgotten. Despite the evident delay, he was served the meal as though it had just been prepared, and it was cold. One of the positives to come out from the feedback from the inspection was that the head caterer plans to walk the floor among residents more often to stay in touch with the dining experiences of residents. There was a good supply of food and drink in the home and residents were pleased with the range of snacks and refreshments that were available. Residents on special diets were also pleased with the range of food that was available to them. However, appropriate steps must be taken to ensure that residents are served with hot and appetising meals that are consistent with their preferences. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): (16,18) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents and their relatives are assured by the management’s handling of complaints, that their concerns would be addressed as and when they arise. Improvements in staff training and safeguarding protocols in the home now provide a safer environment for residents living at Pinewood. EVIDENCE: “I have a bit more faith in the complaints procedures now”. “If I am unhappy, I know exactly who to complain to”. “The new manager listens when I have a concern”. These are some of the comments made by residents, during the course of the inspection and they summarised the general view of residents’ awareness and confidence with the complaints’ processes in the home. Staff interviewed, demonstrated a positive attitude towards dealing with complaints, indicating that they would dealt with promptly and in line with the home’s complaints procedures. A form is in place for staff to record concerns and/or complaints. An appropriate complaint’s log was maintained and relatives spoken to were much happier with the home’s handling of complaints. This is an improving area of the homes operations. A strategic plan is in place for ensuring that all staff have the benefit of refresher training in safeguarding adults. Three staff members have already been on it and the plan includes ensuring that all the senior staff receive the training as a matter of priority, followed by the junior staff members. There is also a plan to bring this training in-house to ensure accessibility for all. A safeguarding adults protocol is firmly in place and is widely available to all staff Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 19 working in the home. For new staff, this forms an integral part of their induction. There have been several changes noted since the last inspection, one of which is; that the management of the home has been reportedly seen on the floor by residents much more now, than previously. The other significant change is that there has been a reduction in the level of safeguarding adults’ issues since the last inspection and importantly – in one case where abuse had been substantiated – action was taken by the registered persons to deal with the issue. An integral part of this, has been the acquisition of a better understanding of the registered persons role, particularly in working with external agencies to safeguard adults. Due consideration needs to be taken in taking appropriate action through internal reviews and strategic planning in cases where residents needs become more of a challenge. Safeguarding adults is an improved area of the homes operations. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): (19,21,26) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents now live in a well maintained, more pleasant and safe environment at Pinewood. They continue to have access to good toilet and bathing facilities and sound systems are in place to ensure that the home is clean and hygienic. EVIDENCE: There have been improvements to the physical environment, since the last inspection. This included; the floor coverings in the reception, the adjoining lounge, the corridor leading to the kitchen and the main entrance areas. The walls along the corridor leading to the kitchen have also been redecorated. Feedback received from residents, staff and relatives was extremely positive about the works carried out. There is a more homely feel to the environment now than there was previously. Plans were in place to redecorate other areas of the home to bring it in line with the standards of the new Dementia Unit. A redecoration plan has been supplied to the Commission, but this detailed only the period and the duration of the works to be carried out. The plan should detail specifics in relation, what and the areas to be covered. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 21 An assessment of the toilets and baths, including those in the Dementia Unit indicated that they were adequate and suitable for meeting the specific needs of residents. More importantly, a number of residents were observed independently using these facilities, while others were supported to so do. The facilities were fitted with appropriate locking devices to promote both the safety and privacy of residents. They also strategically cited near to dining areas and bedrooms to ensure ease of access. Sound arrangements remain in place for laundering residents’ personal clothing. Ancillary staff have the responsibility for cleaning the home, washing and ironing as most of the residents needed support in this area. The equipment used, is effective for cleaning soiled articles with good procedures in place for infection control. Training is provided for laundry staff in health and safety and all residents were pleased with this aspect of the service. There were no complaints of missing items and the system used for protecting residents’ possessions was satisfactory. The home complies with environmental standards and this ensures that residents are safe living there. Pinewood DS0000067407.V350004.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. JUDGEMENT – we looked at outcomes for the following standard(s): (27,28,29,30) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Generally residents receive a good standard of care from a team that is motivated, skilled, trained and, in adequate numbers at most times - to meet their needs. However, the staffing levels and combinations must be kept under review to ensure that residents’ needs are met at a consistently high standard. Residents’ safety is assured by the home’s effective recruitment practices and they receive care and support from a team that closely managed and supported. EVIDENCE: On the first day of the inspection, the staffing rosters were assessed and it was clear that they made difficult reading. However, from the conclusions drawn given the number of residents and types of needs – the staffing numbers were adequate. There was generally ten staff on in the morning and nine in the afternoons with four on nights. A team leader usually leads each shift, but there may be up to two on duty at a time with the manager. The deputy manager’s post is vacant, and this was part of the original structure at Pinewood. It was noted that the Dementia Unit has a capacity of fourteen, and there were ten in the unit on the day with one in hospital. The ratio of staff to residents during the course of the visit was one to five, which was satisfactory. While there was evidence that the staffing levels generally reflected the needs of residents, feedback from staff, residents and relatives indicated that there are shortages at times, which compromises the quality of care that is delivered. These shortages arise out of sick leave, and vacancies that the Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 23 manager had started to fill. The concerns for residents and relatives, was about the risks to the levels of consistency. One resident stated; “it is always better to see a familiar face – as it is reassuring”. For staff, some of their experiences included agency staff not wanting to work and so they (permanent staff) end up with additional pressure to meet residents’ needs. In other feedback from staff, some indicated that they were promised in meetings that there would be three staff to the fourteen residents on the Dementia Unit, where the specialist needs are greater, but this has never happened. It was noted that good domestic arrangements are in place for ensuring that the home is clean and tidy. However, the registered persons are required to keep under review the staffing levels and arrangements to ensure the residents needs throughout the home, are adequately met. It was noted that over seventy-five per cent of the staff have acquired at least an NVQ Level 2 in Care, which should ensure positive outcome for people using the services. The registered persons have an incentive scheme in place for staff achieving this qualification. In essence most of the staff team had a sound understanding in the provision of good basic care, which was in most cases observed, being translated into practice during their engagement with residents. The recruitment files of three of the most recently recruited staff were examined and it was clear that the home’s management was operating in line with their procedures. Detailed application forms were appropriately checked, there was close monitoring of references and appropriate Criminal Records Bureau checks to ensure the safety of residents. All staff had the experience of being interviewed and were not employed unless the registered persons were satisfied that they are fit to work with the resident group. All staff had a statement of their terms and conditions, as well as a copy of the GSCC code of conduct – which details the standards expected when working with residents. There was evidence that residents are being involved in staffing recruitment, which is positive. The manager informed that applicants are made aware of this, which is positive. All staff were in receipt of an induction and the most recently recruited had theirs in line with Skills for Care Induction standards. Staff also had the benefit of foundation training as well as training that enabled them to improve and achieve outcomes for people using the service. Some of the training that was provided over the last twelve months included; first aid, dementia, medication, moving and handling, care planning, safeguarding adults and fire. It was noted as much as seven team leaders are qualified in first aid, which is positive. Comments from residents included; “ the staff are excellent”, “ most of the staff here are honest and do a great job”, and “ the staff make you feel valued here, particularly the care staff”. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 24 A training and development plan is in place, which is based on outcomes for service users. A training needs analysis has been carried out and this is picked up through staff supervisions and appraisals. Feedback received from staff was generally consistent in stating that the home provides adequate training in equipping them to carry out their responsibilities. Staff, relatives and external professionals were also satisfied with the skill and knowledge levels of staff. In the feedback received from staff, a view was expressed that certain staff were prioritised in relation to the NVQ training, which resulted in some going off to complete this privately. This evidence could not be triangulated, but the registered persons may wish to monitor this. Another concern raised informed that team leaders, were at times paying little credence to staff from ethnic minorities, irrespective of their skill and knowledge levels. While this piece of evidence could not be triangulated, the registered persons may wish to explore under their equality and diversity strategy, the validity of the concern raised, as if this occurs, it could have an adverse impact on outcomes for residents living at Pinewood. A recommendation would be made in this report for the registered persons to consider team-building events as a way of teasing out and dealing with any such experiences or perceptions. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): (31,33,35,36,38) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents benefit from a home that has improved its management practices, which positively impacts on the quality care they receive. Good quality assurance systems and a staff team that is well supported provide positive outcomes for people who use the service. While there are some extremely good health and safety practices in the home, more needs to be done in the area of safe food storage. EVIDENCE: The registered manager is experienced and suitably qualified for the role in which he is entrusted. As such he demonstrates a clear understanding of the needs of the service user group and focus of the service. He has been working with the registered provider in ensuring that the financial and strategic objectives of the service are met. Residents, relatives and most of the staff team were commendable about his management of the service, which is enhanced by having clear systems for staff to follow. At present the deputy Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 26 manager’s post is vacant, but he has the support of another experienced registered manager in the quest for demonstrating a sustained pattern of improvement at Pinewood. He has demonstrated a sound awareness of the needs of the resident group. He also showed a positive commitment to working with the Commission. A recommendation was made during his registration for him to pursue the RMA award and refresher training in the Redbridge safeguarding adults procedures, which would be repeated in this report. There were improved mechanisms to promote quality assurance in the home and again the registered manager is proactive in ensuring that systems were in place to identify development areas and bring about change. Evidence of this can be drawn from the fact that a survey was carried out in August 2007 involving the views of service users and their relatives. External professionals spoken to confirmed that their views on the service were sought and an annual development plan is now in place for the home. It was reported that Sanctuary Care carried out an internal audit of the service in August, although the results were not available at the inspection. Monthly provider monitoring visits are carried out and reported on and forums such as staff and residents’ meetings allow for constant feedback and hence potential development of the service. This is an improved area of the homes operations. Staff were positive about the support and direction they received at the home. Most informed that their supervisions were regular and helpful. There was evidence that up to fifty percent of the appraisals were carried out with a clear plan as to how they would be completed by December 2007. These forums staff opportunities to; obtain feedback on their work, make contributions towards developing the service and enhance their professional development. Most staff felt that they could approach the registered manager informally, in relation to personal or work-related issues. Many staff have recognised that this is yet another new start for them, from a management perspective, which may involve a bit of a culture shift. There have been some staff changes since the new manager has come on board. This is an improving area of the homes operations and residents would benefit from a stable and empowered staff team. An updated health and safety policy is in place for staff to follow in promoting the safety of residents. They also receive training to ensure that theory is put into practice and good arrangements such as random monitoring are in place to enable this. The health and safety files were assessed and found to be in order e.g. PAT testing, fire drills, call point testing, hoist and lift maintenance, health and safety risk assessments ((July 2007) and Legionella monitoring. Health and safety signs were appropriately posted and arrangements for infection control were satisfactory. A health and safety audit was carried out in March 2007 and the recommendation to update and sign off the health and safety policies had been carried out. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 27 It was also very positive to see that the home had ‘Emergency Crisis Plan’ in place to deal with major emergencies. Team leaders are designated to take the lead in this area should there be a crisis in the home. However, there is continued concern over the poor storage of dry and frozen foods in the home, which compromises the health and safety of residents. The inspector found shrimp and various cereals inappropriately stored and from brief discussions held with some of the junior catering staff, it was a case of not taking collective responsibility for food safety. This must improve and detailed discussions were held with the management about this repeated failing. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 28 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 2 X 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 3 x x x x 3 STAFFING Standard No Score 27 2 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 x 2 Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4(1)(b) Requirement Timescale for action 21/11/07 2. OP7 15(2)(a) 3. OP8 12,13 4. OP9 12,13 5. OP12 16(2)(m) (n) The registered persons are required to review the statement of purpose to clarify the staffing and respite care arrangements in the home. The registered persons are 21/11/07 required to ensure that service user plans are regularly reviewed. This was a previously made requirement with a timescale of 30/05/07. The registered persons are 21/11/07 required to ensure that all concerns regarding healthcare are acted upon in a timely manner. The registered persons are 21/11/07 required to ensure that medication practices are in line with National Minimum Standard 5.4 for Older Persons and the Care Homes Regulations 2001. The registered persons are 30/11/07 required to keep under review the activities in the home to ensure that they are regular and that they adequately meet the needs, interests to include the DS0000067407.V350004.R01.S.doc Version 5.2 Page 30 Pinewood 6. OP15 16(2)(i) 7. OP27 18(1)(a) 8. OP38 13 specialist needs of residents. The first part of this requirement has been previously made with a timescale of 30/05/07. The registered persons are 21/11/07 required to make appropriate arrangements for all residents to have their desire for hot food fulfilled. The registered persons are 21/11/07 required to keep under review the staffing levels to ensure that the meet residents’ needs, including their specialist needs at all times. The registered persons are 21/11/07 required to ensure that food storage in the home is appropriate and that staff carry this out in a safe manner. This requirement was previously made with a timescales of 15/10/06 and 25/05/07. 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. 4. Refer to Standard OP19 OP27 OP30 OP37 Good Practice Recommendations The registered persons should include in their maintenance programme specifics relating to the timeframes and areas to be redecorated. The registered persons should review the format currently used for the roster to improve its legibility. The registered persons should explore team building as a way of teasing any reference to inequality with regards to staff relations in the home. The registered manager should pursue the registered managers award and refresher training in the Redbridge Safeguarding Adults Procedures. Pinewood DS0000067407.V350004.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Pinewood DS0000067407.V350004.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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