Inspection on 16/03/07 for Pinewood

This inspection was carried out on 16th March 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 14/09/07

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 4DI Lead Inspector Stanley Phipps Key Unannounced Inspection 16th March 2007 11:30 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.V334288.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.V334288.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinewood Address 96 Manford Way Hainault Ilford Essex IG7 4DI 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 Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th July 2006 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 service users have single bedrooms, of which approximately fifty per cent have en-suite toilet facilities. The home is staffed on a twenty-four hour basis, providing care and support to elderly service users. 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 service users finances). The home’s statement of purpose is made available to service users 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.V334288.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and the second key inspection of the service for the inspection year 2006/2007. 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 one day i.e. 16/03/07. It considered significant levels of written feedback from service users, their relatives and staff along with an assessment of records held in the home. A tour of the home was undertaken. Staff and service user interviews were also carried out and detailed discussions were held with the interim manager, a covering manager and the deputy manager. The inspection found some general improvements that had a positive impact on the lives of service users. However, improvements are still required in critical areas such as management, protection and, health and safety amongst others. The service has been without a registered manager for some time following the resignation of the previous manager and, the disciplinary action taken against her by Sanctuary. Interim arrangements have been made since then, and this included regular support from a registered manager from another service, and more recently the posting for a three-month period of another registered manager at the home. Both managers were working alongside each other to try and ring changes, as some of the re-occurring issues are related to an established culture of the home. This culture is thought to have an adverse impact on how service users are protected, as yet again another adult protection matter had to be addressed. Service users that are able to challenge practices at the home are at risk of not having their issues appropriately handled by staff working at the home and in some respects, the organisation as a whole. As such there is an issue for service users of feeling safe at Pinewood, when concerns are raised. It has been reported that a manager has been appointed and is awaiting legal clearances before taking up the post. It is true to say that, while there are repeated requirements in this report, the current managerial arrangements had begun to move towards improving the overall standard of service provision at Pinewood. Comments made by some service users bore testimony to this. The inspector would like to thank all participants who contributed to inspection process particularly the service users, their relatives and the staff. It should be noted that work was in the process of being started in relation to providing dementia care services at Pinewood. Care must be taken to ensure that the improvements made in this report with regard to the existing service, are carried out in earnest and, not impeded in any way by new developments. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The statement of purpose has been reviewed and is much more reflective of the current service provision, although some tweaking is still required. Service user plans were more reflective of their needs and in most cases were found updated. The handling of medication had improved as medication charts were appropriately signed. Feedback received from service users generally indicated that they felt respected in the home. Greater efforts have been made to promoting service users’ choice without compromising their safety. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 7 The overall quality of the meals had improved and there was evidence that food allergies are communicated to the catering staff. The handling of complaints has improved to some extent, but could be improved further. Training in adult protection, person centred planning and equalities and diversity has been provided for some staff, while arrangements were in place for others to attend. Records required by Regulation under Schedules 2&4 of the Care Homes Regulations 2001 are now appropriately held by the organisation. There was evidence that work had started on a training and development plan and that statutory induction training was provided for staff using the Skills for Care Induction Programme. What they could do better: Clarify the arrangements for smoking in the home in the current statement of purpose. Ensure that all service user plans are regularly reviewed, including individuals that independently pay for their care. Improve the range and quality of activities in line with the choice and interests of service users. Ensure that complaints are handled robustly and reassuringly, to give service users more confidence in raising them. Review its strategy on safeguarding adults including robustly handling allegations of abuse to ensure that all staff are clear on their role in this process – and that service users are safer at Pinewood. Develop a planned programme for renewal and redecoration and carry out improvements to the environment as specified in Standard 19 of this report. Keep under review the staffing levels to ensure that maximum opportunities are provided to people who use the services to be provided with; escort support, improved levels of stimulation and good support during peak periods. Improve the quality assurance strategy in the home. Provide greater support, guidance and monitoring of staff through timely supervision and appraisals. Safeguard adults through: improved food storage and in general, food hygiene. Please contact the provider for advice of actions taken in response to this Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 8 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.V334288.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.V334288.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): (1,3,6) 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. Service users and their relatives now have updated information about the services they could expect from Pinewood. However, the arrangement for smoking needed to be clarified. Detailed assessments are carried out on service users prior to their admission in determining whether their needs could be met by the home. The home does not provide intermediate care. EVIDENCE: The registered persons have updated the statement of purpose and made a copy available to service users. In general it complies with the guidelines set out in regulation and reflects the new organisation and the way it intends to work. Service users spoken to were aware of the reviewed document and were happy with it. It is informative and has information to enable service users and their relatives to make a decision about the suitability of the home. However, it describes the home as a no smoking environment and then goes on to talk Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 11 about designated smoking areas. This could be confusing for individuals and needs to be clarified in the document. As part of the admissions process service users needs are assessed prior to being admitted to the home and this is usually, carried out by suitably qualified and experienced staff. A summary of the care management assessment is also obtained and this helps to determine whether the individual’s needs could be met by the home. The assessments are also useful in identifying the external support and facilities that are to be provided outside the home. A detailed assessment was in place for the most recently admitted service user, which is in line with the admission procedures of the home. Service users are therefore assured that their needs would be met, once they are admitted to Pinewood. Pinewood DS0000067407.V334288.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 good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users benefit from having their needs detailed in their individual plan of care. However, greater attention must be given to ensure that all service user plans are regularly reviewed. Sound arrangements are in place to meet their healthcare needs and this includes support with medication-the handling of which has improved. Service users are happier with the respect and privacy that is provided to them at Pinewood. EVIDENCE: Service user plans examined bore evidence that the health, personal and social care needs of individuals were recorded for each individual. A system remains in place to ensure that a plan is in place for the night as well as for the day. There was evidence that service users are encouraged to participate in the process and feedback received from one relative informed that she was happy to be involved in her mother’s care. The registered persons had a system in place to ensure that the service user plans were updated and reflective of the current needs of service users. However, there was one case in which a selffunding service user did not have her service user plan reviewed. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 13 This was compounded further by the fact that the individual did not have an annual review. At the time of the visit, this was being arranged. It is important that all service user plans are kept updated at all times. This would ensure that service users needs are kept under review in order to provide the best possible care to them. Risk assessments were linked to the service user plans and were generally reflective of ensuring service user safety. It was noted that plans were in place to introduce a new care planning system in April 2007 and staff were expected to have training in relation to this. All service users were registered with a GP and a record is held on all health appointments to include dentists, opticians, practice nurses, continence advisors and chiropodists. One good example of health care support was where an individual had input from an occupational therapist, the falls clinic and a speech and language therapist amongst others, in relation to her wellbeing. There was also evidence that due to the distress experienced by the individual - the covering manager was working with the GP to have appointment with the speech and language therapist speeded up. This is positive as an outcome for the service user concerned. At the time of the visit, sound arrangements were in place to limit the incidence of pressure sores. In one case where a service user had ulcerated legs, appropriate arrangements were in place to have them dressed regularly and records were kept. In another case staff had acted promptly to secure input from the McMillan nurses, to ensure that the best possible care and support is provided. Some service users were using spectacles and hearing aids and this was positive as it enabled them to be a part of normal daily living. Feedback from relatives and service users was positive in relation to the healthcare and support provided by staff in the home. There was evidence to support the fact that service users are encouraged to manage their medication as far as possible. Appropriate assessments were in place to ensure that this was carried out in a safe manner. Service users in some cases are also supported to monitor their blood sugar levels and this is positive. There were improvements noted in the recording of medication in that staff were more consistently recording when drugs were administered to service users. Staff responsible for the administering medication had appropriate training to so do and this ensures that service users get the best possible support with their medication. Medication storage including that of controlled drugs was appropriately undertaken. Service users are therefore safe with the medication practices in the home. Feedback received from service users and their relatives overwhelmingly supported the view that service users were respected and their privacy upheld. More emphasis has been placed on recording service users wishes, so that staff have a greater awareness and understanding of their needs. In supporting service users with personal care, there was an acute awareness around their privacy and relatives spoken had a similar view. From the feedback forms Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 14 returned approximately ninety seven percent felt that their views were always listened and acted upon and, this is positive. One individual chose not to have a key worker and this was respected without adversely impacting on the care and supported that was provided by the home. One service user with diverse needs stated; ‘the staff here gives me respect for who I am and although I prefer to be back in my flat, I am quite comfortable here’. Service users were wearing their own clothes and in many respects were allowed to express their individuality in relation to their dress. They were also addressed by their preferred names and for those requiring assistance with meals – this was done in a sensitive manner. Adequate arrangements are in place for service users to be seen by external professionals in private and, service users are supported to independently open their mail. Pinewood DS0000067407.V334288.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 good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. At Pinewood service users enjoy some level of activity, which in itself is sporadic. They benefit from maintaining links with their family, friends and the local community. Greater emphasis has been placed in ensuring that they are given choice and control in their lives and, improvements in the provision of meals ensure the nutritional requirements of service users. EVIDENCE: On the day of the inspection there was very little stimulation provided for service users, as the television was on with a group of service users sat around it. It was accepted that some individuals chose to use their time, best-suited to them. However, in speaking with others they described that very little activities take place in the home. They outlined bingo, quizzes and reminiscence as the key activities that they do, which was irregular. Approximately ninety-five per cent of the feedback from staff indicated that activities were inadequate for the stimulation of service users. The deputy manager informed that the activities coordinator had recently left and they were in the process of filling that gap. During the latter part of the day, some service users were receiving nail care and others were involved in a game. There was good evidence that service users were afforded choice in relation to routines and activities, as one or two was observed looking at a newspaper, while some were watching television in Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 16 their rooms. Staff do recognise and support service users to celebrate their birthdays and on the day, a ninety-third birthday celebration was planned. The deputy manager was also planning a buffet for mothering Sunday and had plans in place for an Easter parade on the 5/4/07. Whilst service users looked forward to this, it did not go far enough to providing stimulation to the service user group. Activities must be provided taking into consideration the choice and interests of service users to ensure a more fulfilling life at Pinewood. It should be stated that the interim manager following feedback at the inspection provided an improvement plan outlining how he would meet this standard. There continues to be high levels of involvement with relatives of service users. Most of the feedback received from relatives indicated that they were made to feel welcome by the staff at Pinewood. They also indicated that they were notified and informed about the progress and developments regarding their relations. This included invitations to events and service user reviews. It was the case that many were involved in the financial affairs of service users. Where arranged service users can also visit their relatives who may take them out. Staff continued to cater well for ensuring that the family/friends networks are maintained in the interests of service users. This is a fairly consistent area of the homes operations. Feedback received from service users indicated that they were felt more able to take control of their lives and this is positive. One service user spoke of how pleased she was to be receiving communion from the vicar on a regular basis. It was observed that sound arrangements were in place for religious observance in the home and the interim manager has proposed to make this more widely advertised in the home. On sampling service user plans it was clear that service users’ skills and abilities were more detailed and risk assessments were updated. Service users were therefore encouraged to do as much as they could without compromising their safety. There was good evidence that service users had access to advocacy and in two of the most recent cases, they effectively worked in the service users best interests. One service user stated; ‘I am so grateful to the advocate who took on this matter for me. It gave me renewed faith that there are people that are prepared to support you’. The experience of using advocacy has been positive for the individual concerned. Relatives are also very involved in the welfare of service users, including their financial affairs. The registered persons have acted positively in encouraging and enabling service users to access support to ensure that they maintain control over their lives. There was an improvement in the meals provided as a whole and despite the absence of a catering manager, most service users were happier with the meals provided at Pinewood. An assessment of the dietary needs of service users is carried out upon admission and, those needs are notified to the kitchen and reflected in the service user’s plan. One service user wrote about Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 17 the meals; ‘they usually look very appetising, but I don’t eat much’. One relative wrote; ‘A suitable meal is always chosen for my mother’. Lunch on the day was scampi, chips and green peas with an alternative of mashed potatoes. Most of the service users had the main course and were pleased with it. The sweet was fresh fruit or apple tart and custard. There was evidence that diabetic options were available as well as soft diets for individuals making that choice. Menus were varied and service users spoken to, informed that they were given choices with all meals. There were adequate supplies of food in the home. Service users have several opportunities between the main meals to have drinks and/or a light snack. For individuals with eating problems, appropriate action was taken to monitor and improve their nutritional state. During the mealtimes, the environment was fairly relaxed. However, it is important that the registered persons continue to consult with service users about the quality of the food provided in the home, on an ongoing basis. Although the quality of the food had improved, the storage and hygiene was below acceptable standards and this is covered under health and safety (Standard 38) in this report. Pinewood DS0000067407.V334288.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 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 access to copies of both a satisfactory complaints and adult protection procedures, which should promote their safety and peace of mind. However, the handling of both complaints and adult protection matters in the home require greater robustness for service users to enjoy maximum protection at Pinewood. EVIDENCE: There was some evidence of improvement in relation to handling complaints by the registered persons. A system has been implemented to ensure that an audit trail of complaints could be carried out. The home’s reviewed statement of purpose also makes reference to the importance of staffing role in the complaints process. Staff interviewed demonstrated a clear understanding of service users right to complain. However, there remains a lack of embracing complaints and concerns when raised by service users, which has an adverse impact on service users coming forward with them. One example was where a staff recorded that a service user commented that the tea she had was terrible. A team leader signed off this record, which is good practice, yet not even a query was even raised as to what was wrong with the tea. This was a missed opportunity to deal with an issue at an early stage, which could have an impact on the quality of service one receives. The failure by the junior carer to act on this information was compounded by the senior staff simply signing off the report. The registered persons need to continue monitoring and working with staff to enable them to take complaints more seriously, but positively. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 19 It should be noted that over ninety-five percent of the service users knew how to complain, using the procedure available to them. They even felt that they would involve their relatives if they were unhappy at the home. However, up sixty-per cent would not come forward and complain. One individual recently raised a complaint and told of her experiences in the past of complaints not being handled appropriately – sometimes with no feedback. Interestingly, she also indicated that despite having an advocate on this occasion that she was ever so worried that she could be persecuted or even victimized for making the complaint. The organisation’s handling of complaints needs to improve to ensure that service users feel safe, when they raise issues affecting them in the home. Although there is a satisfactory adult protection procedure in the home and staff have had relevant training, there remains issues that led to a major adult protection matter in the home. It was conclusive that the individual was subjected to psychological abuse and at the time of writing this report the organisation was preparing to take action against staff to ensure that service users are not exposed to this type of abuse in the future. What is of most concern is that there are implications for senior staff in the home. Bearing in mind that a similar situation under adult protection led to the departure of the previous manager in 2006, the registered persons need to look at its adult protection strategy from the management-downwards. The interim position is generally more satisfactory in that there is an experienced acting manager is in place alongside a covering manager who had been brought in to oversee the service from the latter part of 2006. Feedback from the service user concerned in the most recent matter indicated that she felt more secure with the current managerial arrangements at the home. Safeguarding adults is a critical aspect in providing services to the service user group and the organisation needs to continue making improvements in this area. This includes making referrals as appropriate to the Department of Health for inclusion on their register of staff that may be exposing service users to abuse. Pinewood DS0000067407.V334288.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): (19,21,25,26) 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. Service users enjoy living in a safe, pleasant and clean environment at Pinewood. They have access to bathrooms and toilets that are of good quality, which are sufficient to meet their needs. Sound policies and procedures are in place to maintain the control of infection in the home. However, improvements are required to communal areas to make them more homely. EVIDENCE: The physical layout of the home generally remained satisfactory, although one of the quiet rooms outside the main office had been lost to house the team leaders. This space was critical to allowing service users wishing for a quiet space to go and relax and possibly listen to music as a group. It was explained that it was due to the start of the works on the dementia unit and it is envisaged that this would be reviewed. Service users have alternative spaces to relax although this was limited on the ground floor. A large number was observed using the main communal lounge in front of the television on the day of the visit. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 21 A programme of maintenance was not available for the home, although there was evidence of works being carried out to several parts of the building. It was noted that the carpets in the reception area and adjoining lounge and the flooring to the main entrance needed replacing. These areas failed to give the home a warm and homely look. The registered persons made a provision to replace carpets, but referred to doing so in due course, which is indeterminate and unsatisfactory. A clear system of planning with timelines for carrying out the works, must be in place. The floor covering along the corridor leading to the kitchen was in need of replacement, and the walls in the same area were in need of redecoration. That area looked neglected. Although service users and their relatives were generally happy with the structural layout of the home, the registered persons must ensure that the home is well maintained. There are a number of toilets and bathrooms throughout the home, cited on all floors. They are well suited to the needs of the current service user group, many of whom were seen accessing them with ease on the day of the inspection. Repairs to the bathroom (#40) panel had been carried out as required by the last inspection report. The facilities also had suitable locking devices that enabled service users to maintain their privacy. Separate arrangements were in place for the cleaning of soiled linen and, toilets were proximate to dining and sitting areas. Feedback received from service users indicated that they were pleased with the lighting, heating and ventilation in the home. Private rooms were centrally heated with the capacity to be altered in making each room comfortable for individual service users. One service user commented; ‘my room is always nice and warm and I have a good deal of natural light coming through my window’. Adequate safeguards were in place to prevent service users from the risk of being burnt or scalded. The handyman regularly monitors this and evidence was available to confirm that steps are taken to prevent risks from Legionella. The home has a designated laundry, which is well away from the kitchen and dining areas. Sound arrangements were in place to ensure that soiled linen is transferred appropriately to this facility. Ancillary staff have the responsibility for cleaning and ironing, as most of the service users are unable to undertake this responsibility. The laundry equipment is suitable for cleaning and disinfecting soiled linen and facilities for hand washing were appropriately cited throughout the home. Policies and procedures related to infection control were appropriate and staff were aware of them. Adequate arrangements were in place to ensure that service users laundry is returned to them and there were no complaints from service users regarding this. The service and facilities is known to comply with the Water Supply Regulations 1999. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 22 Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 23 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. Service users generally receive support from a staff team that is motivated, trained and skilled in meeting their needs. Robust recruitment practices ensure the safety of service users. Staffing levels need to be reviewed to ensure that service users needs are met at all times. EVIDENCE: The staffing rosters were assessed and generally contained a consistent pattern of staff on day, evening and night duty. On the day of the visit, service users sat for long periods alone in the quiet area. The fact that an activity coordinator was not in post made it difficult for the staff to fill that role and carry on with their other duties. This impacted on the level of stimulation that service users received on the day. Most of the feedback received from service users indicated that staff, are usually available to them. A small percentage informed that staff, have a lot to do and so their (SU) expectations were not very high in terms having of greater levels of interaction with them. However, over ninety per cent of the staff felt that the staffing levels were inadequate in the home. Staff commented that this limits taking service users out and, when there is a need for an escort it further limits their ability to engage with them. The registered persons need to review this to ensure that their staffing deployment takes into consideration peak times of the service, escort support and the range of stimulation provided for service users in the home. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 24 There was good evidence to indicate that a significant number of staff have achieved at least a NVQ Level 2 in Care, which provides a sound understanding of the basic principles underlying the provision of good quality care. Plans were also in place for other staff to pursue this qualification. It is also positive to see that the staff were receiving ‘Skills for Care’ induction training, which provides a solid focus and platform on which they are able to provide good quality care. The recruitment files were examined and found to be compliant with regulation. Robust procedures were followed and there was clear evidence that the organisation recognises the importance adopting such an approach in order to provide a good service. There was no evidence to indicate that people using the service get the opportunity to be a part of the recruitment process, but this is something the registered persons should aspire to. The inspector was satisfied that the recruitment practices offered some safeguards to people using the services. A training and development needs analysis had been carried out for the most of the staff, apart from the most recently recruited individual. The deputy manager was in the process of carrying this out. From the training records, viewed there was evidence to confirm that staff were provided with regular training, that was in line with the service objectives. Structured induction is in place and staff interviewed confirmed that they found it effective in enabling them to understand the philosophy and objectives of the service. Service users spoken to informed that staff did a good job at supporting them in meeting their individual objectives. The registered persons would however need to continue to monitor the effectiveness of its training programme for staff. This is important in ensuring that the knowledge and skills gained from training are transferred into the work environment. As stated earlier in this report, there remain issues that staff are grappling with in relation to complaints and protecting vulnerable service users, hence the reason for the recommendation. Pinewood DS0000067407.V334288.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 adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Adequate management arrangements are in place to run the service and, the financial interests of service users are generally protected. Although quality assurance systems are in place to promote the best interests of service users, more work is required in areas such as staff supervision, health and safety and quality monitoring to enhance the quality of the services at Pinewood. EVIDENCE: The home is without a registered manager although two experienced and qualified registered managers from other areas within the organisation are providing cover at the present time. One of the managers was introduced on a part time basis shortly after the departure of the previous registered manager (2006) and the (Interim Home Manager) other has been in place for a threemonth period from March 2007. This is to facilitate the appointment of a new manager. At the time of writhing this report, the Commission was informed Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 26 that the recruitment of a manager was at the point of awaiting clearance for a work permit for the individual. The home is therefore in a major transition phase. However, it is essential for the development of the service that a permanent manager is appointed to run the service. It must be noted that over the last year there have been two major failures by the service to safeguard adults, the former of which involved the previous registered manager. At the time of writing this report the registered persons advised that action had been in line with DOH guidelines with regard to safeguarding adults, concerning this. Feedback from service users informed that the home is more settled with the current provisional arrangements and that both managers were making strides to improve the quality of life for them. Some concerns were raised by some service users about the current lower level management i.e. the team leaders and their ability to work in line with the philosophy and objectives of the service. The current interim manager and his colleague were looking into this and were starting to explore and trouble shoot with a view to bringing about improvements in the home. The registered persons must however monitor this, while doing their utmost best to secure a permanent manager for the home. While an internal audit had been carried out 6/3/07, there was evidence to confirm that the quality assurance monitoring of the service had not been robust. Quality surveys were not carried out involving service users and external professionals and there has been within recent times a reduction in the monthly provider reports available to the Commission. There was a failure to ensure that staff were adhering to policies and procedures and this had been picked up by the interim management team. To this end a plan had been devised by that team, which included setting up local procedures with the team, conducting regular audits on; care plans, medication, the call bell and, night routines. There were also plans to ensure that staff read the policies and procedures and signing them off to confirm they have. These measures should bring about improvement, but must be backed up with some of actions outlined in the previous paragraph. The registered persons are also required to have in place an annual development plan for the service. The financial interests of service users were again assessed as good and this view, was shared by the service users spoken to. An administrator takes the responsibility for managing the internal finances and an appropriate representative from the organisation monitors her work. Although service users’ finances were not assessed on this occasion, there were no concerns raised either by service users or their relatives. At the previous inspection samples of funds held on service users behalf, were appropriately managed. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 27 Service users therefore have some assurance that, their finances once deposited with the organisation are safe. From talking to staff and this included the deputy manager, it was clear that there were gaps in supervision and appraisals for staff. It was acknowledged that work had begun in these areas, however it is critically important for this work to continue. This would ensure that staff are not only supported, but are encouraged to provide a consistent service. Some of the issues e.g. of staff failing to act in line with procedure and/or having difficulty in moving along the direction of travel of the organisation, could be picked up in this forum. One member of staff informed that she did not have supervision for four months and did have concerns with regard to how some things were done in the home. It was clear that some of the issues raised with the inspector could have an adverse impact on the individual’s ability to do the job to the highest standards and so supervision and appraisals must be in place to identify and develop strategies for dealing with such issues. One good example is the case in which the two recent adult protection matters bore a striking resemblance. It was clear that critical lessons had not been learnt from the first incident. At the time of the visit, there was evidence that the deputy manager did not have an annual appraisal and at least two of the team leaders were due for supervision. A plan has since been sent to the Commission outlining timescales for carrying out the supervision and appraisals. There was evidence that the managers covering the service was aware of the need promote safeguarding, and has developed a health and policy that is in line with health and safety requirements and legislation. Records examined indicated that appropriate arrangements were made for electrical, gas, heating and lift safety. Fire drills, fire call-point testing and portable appliance testing has also been carried out regularly. Arrangements were also in place for pest control and most recently there was a problem with rats in the home, which was managed swiftly and effectively. It required some major work and the feedback received from relatives and service users, this was handled satisfactorily. However, there was poor management of food storage in the home, which was partly put down to the absence of a catering manager. The areas were highlighted on the day of the inspection, and included the poor storage of meat, milk and other items of food. There was generally poor maintenance of the kitchen area. Action was taken immediately and on the day to remedy the failings, however a system of monitoring and maintenance must be robustly carried out to ensure the safe handling of food in the home. This would ensure service user safety. It must be noted that a requirement was made at the last inspection to improve the food storage, which came up again as a failing at this inspection. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 28 Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 29 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 3 X X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 3 X 2 X 3 2 X 2 Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 4(1)(b) Requirement The registered persons are required to review the statement of purpose to clarify the arrangements for smoking in the home. The registered persons are required to ensure that service user plans are regularly reviewed. The registered persons are required to provide regular activities in line with the choices and interests of service users. The registered persons are required ensure that all complaints raised are notified and robustly followed up. The registered persons are required to review its strategy to: ensure that all staff (including seniors) understand the importance of safeguarding adults and, ensure that adult protection issues in the home are dealt with in a robust manner at all times. The registered persons are required to; have in place a planned programme of DS0000067407.V334288.R01.S.doc Timescale for action 30/05/07 2. OP7 15 30/05/07 3. OP12 16(2)(m) 30/05/07 4. OP16 22 30/05/07 5. OP18 13 30/05/07 6. OP19 23 15/06/07 Pinewood Version 5.2 Page 31 7. OP27 18(1)(a) 8. OP33 24,26 9. OP36 18(2)(a) 10. OP38 13 maintenance for the renewal and redecoration of the home and, to carry out the works specified in Standard 19 of this report to ensure a more homely environment. The registered persons are required to review the staffing levels to ensure that adequate staff are in place; at peak periods, to provide escort support for service users and, to provide support for activities and stimulation. The registered persons are required to improve their quality assurance in the home to include; 1) acquiring the views of service users and external professionals (surveys), 2) carrying out regular monthly provider visits with reports and, developing an annual development plan for the home. The registered persons are required to ensure that annual appraisals are carried for all staff, along with regular formal supervisions. The first aspect of this requirement was previously made with a timescale of 15/12/06. The registered persons are required to ensure that food storage in the home is appropriate and that staff carry this out in a safe manner. They must also ensure that food hygiene is appropriate and safe at all times. The first aspect of this requirement was previously made with a timescale of 15/10/06. 30/05/07 30/06/07 30/06/07 25/05/07 Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 32 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. Refer to Standard OP30 OP31 Good Practice Recommendations The registered persons should maintain a system for monitoring the effectiveness of the training provided for staff. The registered persons should continue in earnest to progress the appointment of a permanent manager for the home. Pinewood DS0000067407.V334288.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 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.V334288.R01.S.doc Version 5.2 Page 34 - 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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