Inspection on 22/07/08 for Pinewood

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pinewood 14/09/07

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 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Pinewood 96 Manford Way Hainault Ilford Essex IG7 4DA Lead Inspector Stanley Phipps Unannounced Inspection 13:30p 22nd July to 20 August 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pinewood DS0000067407.V367983.R02.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.V367983.R02.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 deborahwoods@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd 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) Deborah Karen Woods Care Home 54 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (40) of places Pinewood DS0000067407.V367983.R02.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 14th September 2007 Date of last inspection Brief Description of the Service: Pinewood is a 54 bedded home for older people, forty of which is for residents with needs associated with the ageing process and fourteen for older people with. a diagnosis of Dementia. The latter of the two categories has been the more recent of the two types of service offered at Pinewood. The service is owned and run by Sanctuary Care. 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. A water feature has been added to the garden along with two rabbits for the benefit of residents. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 5 All residents 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 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.V367983.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection was unannounced and was carried out over the period 22/7/08 through to the 20/08/08, beginning at 13.30 hours on the first of the two days. During the course of the inspection the registered manager and senior team members were available, including the deputy manager. to contribute to the inspection process. The inspection was aimed at assessing the progress made by the registered persons in improving outcomes for residents since the last key inspection, which ended in September 2007, and the random inspection that was carried out on the 13th May 2008. While there have been improvements in many areas, the inspection found that their were major variances in the quality of care that was provided to residents at Pinewood. Some of the inconsistencies were in the critical zones such as: ‘health and personal’ care e.g. medication, and ‘protection’ – e.g. failing to safeguard residents. There was evidence that the new management team and some senior staff worked well together in. trying to improve standards in the home and. one such area was - in health and safety, particularly around food storage in the home. Staffing levels, a delay in the provision of training for staff, staffing indifference and a lack of team building strategies have all contributed to the adequate level of service in the home. At the time of writing this report the Commission thought necessary to invite both the responsible individual and the registered manager for a meeting to discuss the inability of the home to demonstrate a sustained pattern of improvement over the last two years. The meeting was held on the 19/8/08 aimed at giving the registered persons an opportunity to discuss how they propose to bring about improved outcomes for all residents living in the home. As a result of the continued failing in medication the Commission also took the decision to arrange for their pharmacist to carry out an inspection of the medication practices in the home. An assessment of medication practice, menus, policies and procedures, the records required by regulation, residents’ care plans and the environment was undertaken. Discussions were held with staff, service users, the registered manager and her deputy. Formal interviews were also held with two members of staff and three residents. The inspection also considered: information from the Annual Quality Assurance Assessment (AQAA) document that was provided by the registered persons, information contained in Regulation 37 reports over the last three months, verbal feedback from external professionals, along with a high number of comment cards that were returned from staff and residents. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Residents now have access to information that more accurately reflects what is on offer at Pinewood. Care plans were also more reflective of residents’ needs and were more regularly reviewed. There were general improvements in relation to how the healthcare needs of residents were acted upon, although there was at least one case in which there was a failing. Improvements were noted in activity provision, although several residents are unhappy with them. Meals were reportedly provided to residents’ delight i.e. hot as required. Staffing numbers have been reviewed, but not sufficient enough to deal with unplanned events and in line with the levels of dependency, which is increasing, as residents grow older. Residents are now assured that food is stored safely in the home. Regulation 37 notifications have improved both in their quality and appropriateness. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 8 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.V367983.R02.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.V367983.R02.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. Residents now have access to information in making a decision about the suitability of the home. in meeting their needs. They benefit by having detailed assessments carried out on them with assurances that a place would be offered if their needs could be provided for at Pinewood. Intermediate care is not provided at Pinewood. EVIDENCE: There was evidence that the work required to the statement of purpose more accurately reflected how the home would be staffed to meet the needs of residents choosing to live there. A deputy manager is now in place and the information regarding the respite beds in the home is now much more clearer. Residents interviewed described the document as ‘having the information to help them decide whether it is suitable for meeting their needs’. The document can be made available in alternative formats upon request. The admissions process was analysed as per regulatory requirement taking into consideration the most recently admitted residents. It remains clear that detailed assessments were undertaken of all residents and the manager leads Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 11 this process, supported by the deputy and/or senior staff i.e. team leaders. In all cases a care management summary is obtained, which enabled decisionmaking around the suitability of the home - a more thorough process. More importantly there was evidence that in most cases residents and/or their relatives are involved in the assessment process. Residents therefore have opportunities for inclusion in a fairly comprehensive process of admission. Intermediate care ids not provided at Pinewood and the registered persons are aware that in order to so do, that - structural as well operational changes to the service would need to be undertaken. Pinewood DS0000067407.V367983.R02.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. Residents continue to have their needs detailed in an individual care plan that is improving. Support with healthcare has improved, including the speed at which, residents access healthcare services. This is compromised by the continuing failure to ensure safe practices when supporting people with their medication. Residents informed that they feel respected by the management and staff working at the home. EVIDENCE: Five care plans were examined and they included those of the most recently admitted residents, which formed part case tracking. It was observed that as much as seventy-five percent of the plans viewed were maintained at a good standard. Staff were generally coming to terms with the new system of care planning that was introduced and it is envisaged that the quality and content of the care planning would improve. In most cases staff were using the document as a working tool, although there is room for improvement in the literacy aspects of some of the documentation seen. The manager is aware of the areas for improvement and it was clear that residents and/or their relatives were involved in the process of identifying and planning their needs. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 13 From speaking to the: staff, residents, relatives and external professionals, it was conclusive that the healthcare needs of residents were generally 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 viewed it was clear that the staff were capable of making appropriate referrals with residents’ approval to ensure that their health needs are adequately provided for. Increased monitoring, support and guidance by the management team including the team leaders, has ensured that the healthcare needs of residents are acted upon without undue delay. The support provided to residents with their medication, while improving in some areas still does not meet the national minimum requirements of standard nine (9) of the national minimum for older persons. This is despite additional systems being put in place by the management team such as: two staff serving medication, providing staff with training and carrying out monthly medication audits’. Some of the findings included: missing signatures in some cases, excess medication in stock for one individual and missing tablets for another. What was also worrying was the fact that most of the problems were found in the specialist Dementia unit, where residents require inputs of a higher quality. Given the findings, one cannot be sure that residents are given good support overall with their healthcare. It should also be noted that this is the third inspection of the service where there are problems with medication in the home. With this in mind the Commission has decided to send in its pharmacist to do a thorough assessment of medication management in the home. It is anticipated that this specialist input would have a positive impact on outcomes for the residents that are supported with medication at Pinewood. Although the home does not meet this standard (medication), a requirement regarding medication would not be made on the basis that the CSCI pharmacist inspection would identify and detail the improvements required to improve the standards of medication practices in the home. Following the inspection visit, the management team at the home including the senior management in the organisation were made aware of the shortfalls in providing good support to residents on medication. Most of the feedback received from relatives, friends and residents was positive with regard to the way in which staff interacted with them. Over ninety- three per cent of the feedback received from residents indicated that staff always listened and acted upon what they said. One resident also stated ‘ staff continue to treat me with respect and do not force me to do things against my wishes’, while another commented: ‘you do get a smile from most of the staff and yes, they are more pleasant and sensitive to my needs’. From observing staff interacting with residents – they were professional and worked in a dignified manner with them. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 14 There was one case however during the course of the first visit, in which the dignity and welfare of a resident was compromised, putting the individual at risk. This matter was referred to the local authority as a safeguarding matter and would be covered under ‘ Protection ‘ in this report. Apart from that incident, residents were observed wearing clothes that were 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 remains a positive area of the homes operations. Pinewood DS0000067407.V367983.R02.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. Residents continue to enjoy some level of activities at Pinewood that is generally in line with their social, recreational and religious interests. There is a general feeling amongst the staff, residents and their relatives, that more can be done for the residents. 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 again mixed comments from residents with regards to the quality and level of activities provided in the home. While some felt they were okay others continued to maintain that the activities lacked variation and was not particularly in line with their interests. One service user pointed out that there were no activities for her because she had a stroke, while quite a number of residents said there were no activities at all. Some indicated that they were usually on, while others informed that they were available sometimes. In discussion with the manager, she alluded to the fact that despite having an activities’ coordinator, things did not work out quite as well as had intended. It was clear that the state of activities in the home was not to the satisfaction of the residents. A plan of activities was available, but was confined to exercises, bingo, film, arts and craft, hang man, with baking or a trip out in the Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 16 mini-bus as the other option. The range itself did not reach all residents and it was clear that there was very little in for those with Dementia Care needs, although a sensory garden was being developed at the time of the inspection. The registered persons are required to develop with residents,’ activities, which best suits their needs and interests. There was again good evidence that relatives and friends are encouraged to maintain their networks. Most of the feedback received from relatives and external professionals indicated that they are welcome to maintain their links with residents. One service user stated; “the staff are good and since the new manager came on board my daughter is kept updated of me of developments as they arise. We are quite pleased”. Another stated; “Staff make you feel as though they care, which makes a lot of difference’. One relative spoke of how he found the staff to be very pleasant and that his mum is quite happy and settled in the home, which is all he could ask for. From general feedback received and the records seen, it was conclusive that this has remained a consistent area of the home’s operations. Most of the feedback received from residents and their relatives again indicated that they were pleased with the level of control they (residents) are afforded in their lives. Various forums remain in place to facilitate this, which includes, care plan reviews, residents meetings, the process of complaints and informal discussions. There was evidence that advocacy is encouraged and residents are supported to access this facility whenever the need arises. Residents are also encouraged to handle their finances and in many cases, they have the support of their relatives. So in many respects residents are supported to exercise choice and control in their lives. However, this was not the experience of one resident that was in a vulnerable state on the first day of the inspection. The individual concerned relied on staff to care for her and this did not happen, neither in line with her expectations nor that of the National Minimum Standard relating to choice and control. This experience would be covered separately under ‘Protection’ standard. Supper was observed on the first day of the inspection and it was varied, with a range of sandwiches that were 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 had improved since the last inspection. It positive to report that the quality of meals have been improving now over the last two inspections, which could only be a positive experience for people using the services. To add to this the catering personnel is more consistent staff group. One of the key impacts of this is that food storage has been maintained at a very good standard. This means that residents are less at risk from experiencing any food – related illnesses. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. Residents and their relatives continued to feel assured by the management’s handling of complaints. While there are systems in place to safeguard residents at Pinewood, much more needs to be done to ensure that all residents are safeguarded at all times. EVIDENCE: Feedback received from most residents and their relatives indicated that they were aware of the complaints procedure and who they would approach if they were unhappy with any aspect of the service. The procedure is made widely available to via the notice board and in the statement of purpose and service user’s guide. The registered manager is quite open about complaints and has demonstrated a willingness to embrace and treat them as a way of developing the service. Senior staff spoken to also expressed a very similar sentiment. The complaints record was examined and found to detail all complaints and the respective, which is in line with regulatory guidance. Despite some improvement in safeguarding adults at the last inspection, which is supported by a reduction in the number of safeguarding issues over the period, residents are not assured of being protected from abuse at Pinewood. Safeguarding training that had started from the time of the last inspection had not been rolled out to all staff. This and the fact that a number of staff needed refresher training that had not been delivered, is unsatisfactory. During the course of the inspection a safeguarding issue came up in relation to neglect of a resident living at the home. Although the Commission did not carry out an investigation into the matter, the service user concerned was used as part of Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 18 case tracking, and as such significant evidence was gathered from a range of sources regarding the matter. From the evidence gathered it was clear that the resident and her relative was let down by the management and staff at the home. One of the big failures was the quality of the information that was written on the resident during the course of the day, which basically demonstrated that there was an absence of care delivered. More worryingly was the fact that a senor member of staff had contributed to the documentation referred to. This incident resulted in the resident being transferred out of the home to another service. Following this and prior to writing this report another safeguarding issue came up and this was being dealt with through the Local Authority’s safeguarding coordinator. There were concerns around the staffing levels and how they were deployed in the home. In July 2008 there was a significant increase in the number of falls, most of which the residents were found on the floor. Key improvements are required in this standard to improve the protection of residents living at Pinewood. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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 continue to live in a well-maintained, 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: Feedback received from residents, staff and relatives was extremely positive about the physical condition of the home. The homely feel to the environment was ever present and a number of residents were observed relaxing and using various parts of the home. Redecoration works to other areas were being carried out to bring the rest of the home in line with the standards of the new Dementia Unit. The home was free from offensive odours and had a light and airy feel to it. A program of maintenance was available for inspection and there was good ventilation throughout the home. The home is centrally heated throughout with thermostatically controlled valves for personal safety and comfort. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 20 An assessment of the toilets and baths, including those in the Dementia Unit indicated that they remained adequate and suitable for meeting the specific needs of residents. Throughout the inspection 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 modern and effective for cleaning soiled articles. Good procedures and rigorous cleaning schedules are in place for the control of infection. 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.V367983.R02.S.doc Version 5.2 Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ safety and welfare is compromised by the lack of permanent staff with specific and updated training to meet their needs. While recruitment practices remain generally robust, staffing competence despite there being a good level of commitment also compromises the safety and welfare of the resident group. EVIDENCE: The staffing rosters were examined on both visits to the home and the numbers did satisfy the minimum required to carry meet the needs of the residents at the home. However, it only took one emergency to cause disruption to the point where one resident failed to receive appropriate care all day. There were no senior staff members on the Dementia Unit during the two days of the inspection. To make matters worst on day one, neither of the support workers had any form dementia training. The manager explained that a senior staff from the main unit was keeping an eye on the two support staff, but this does not meet the minimum requirement set by organisation, neither would it meet the National Minimum Standards for Older Persons. The above evidence was heavily triangulated by the feedback received from residents, staff and relatives. It must be noted that in July 2008 there was a very high incidence of resident falls and in most instances residents were found on the floor. This is quite worrying. The registered manager was actively in the process of recruiting staff, but a strategy must be put in place to safely meet the needs of a resident group that is getting older, and in most cases a bit Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 22 more dependent on the staff to support them. While it is a credit to the management and staff at the home, that at least two of the residents were above one hundred years old, the overall safety and welfare of all residents must be prioritised. Over ninety per cent of the feedback received from staff indicated that the staffing numbers were inadequate to meet the ageing resident population. They also commented that working with most of the agency staff meant that they had to work much harder to ensure the good quality and consistent service provision. The management is strongly advised to take this situation and its impact seriously. While in most cases residents felt that they were generally safe in then hands of staff, the fact that allegations relating to their protection from abuse are coming may indicate that not every resident is in fact offered adequate protection. Fifty per cent of the staff have achieved at least an NVQ Level 2 in Care, which means that they have a good understanding of the basic principles of care. One member of staff has started their NVQ Level 3, with three undergoing their NVQ Level 2 in Care, which is positive. The key lies in the staff having a working knowledge of the needs of the elderly and understanding the impact of the ageing process upon that group of people using the services. At the previous inspection over seventy-five per cent of the staff had achieved Level 2, which is down to fifty percent at this inspection. This could be explained through staff leaving for various purposes, i.e. independently, disciplinary. 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. This remains a safe aspect of the home’s operations. At the time of the inspection most of the staff were in receipt of an induction and the most recently recruited were in the process of having 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. However, a large number of staff were in need of refresher training. The deputy manager and up to five members of staff have been on ‘a Train the Trainers’ course, which should help to address the need for staff to receive the training they need to carry out their duties effectively. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 23 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): (31,33.35,38) 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 structures and 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. Health and Safety practices in the home now provide a safer environment for all that use the home. EVIDENCE: A new registered manager has been appointed since the last inspection and it was clear that she got stuck into the challenges of bringing about improvements to the service. She has a solid management background and commenced her Registered Manager’s Award in March 2008. She demonstrated a good understanding of the needs of the resident group and has attended training in Dementia, having also completed the ‘Train the trainers’ course. Most of the feedback from staff and residents was positive Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 24 about her contributions and management of the service. There have been difficulties in bringing about changes to a new way of working and some staff found it challenging. She however has good support from her line manager and feels confident that the service would improve. This has been demonstrated with an improvement in the quality of Regulation 37 notifications to the Commission. Good mechanisms are in place to promote quality assurance in the home. 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 and at the time of writing this report, another had started. External professionals spoken to confirmed that their views on the service were sought and an annual development plan is in place for the home. A service user, relatives and friends meeting is held monthly and the outcomes from the residents’ meeting are discussed in staff meetings. An internal audit of the service has also been carried out. Monthly provider monitoring reports have been regularly carried out on the service. Residents are therefore assured that the organisation would take steps to improve the quality of the service it provides. The home has an administrator that is responsible for maintaining the financial activity within the home and this works out quite well. Most of the residents’ families assist them with handling and managing their finances. Records are kept of all financial activity and a place for the safekeeping of valuables is available for residents. The financial policy is available to all staff and from interviews held they were knowledgeable about it. The administrator is monitored externally as part of the organisation’s quality assurance practices. A satisfactory 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 facilitate this. The health and safety files were assessed and found to be in order e.g. electrical wiring, PAT testing, fire drills, call point testing, hoist and lift maintenance, health and safety risk assessments and Legionella monitoring. In discussion with the maintenance officer, he was satisfied that the home was complying with health and safety legislation. Health and safety signs were appropriately posted and arrangements for infection control were satisfactory. Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X x 3 Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 12,13 Requirement Timescale for action 17/11/08 2 OP12 16(2)(m) &(n) 3. OP18 12,13 4. OP27 18(1)(a) The registered persons are required to ensure that the healthcare needs of residents are adequately provided for at all times. This includes the support provided to residents with their medication. This is to ensure that the health and welfare of all residents is promoted at all times. The registered persons are 17/11/08 required to provide activities that are in line with needs, wishes and interests of residents. This is to enhance the wellbeing of residents. The registered persons are 17/11/08 required to take appropriate steps including the provision of refresher ‘safeguarding training’ for staff in need of such training. This is to reduce the risk of residents being abuse. The registered persons are 17/11/08 required to review the staffing deployment and the staffing levels to ensure that they meet the residents’ needs, (including their specialist needs) at peak DS0000067407.V367983.R02.S.doc Version 5.2 Pinewood Page 27 5. OP28 18(1)(c) (i) 6. OP30 18(1)(c) (i) times, and to cover emergencies that may occur - at all times. This would ensure that the needs of residents are met at all times. The registered persons are 17/11/08 required to ensure that staff are equipped with the skills and knowledge to carry out their functions safely and effectively. This is to ensure that they remain safe at all times. The registered persons are 17/11/08 required to ensure that staff are provide with their refresher training in all mandatory areas. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Pinewood DS0000067407.V367983.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V367983.R02.S.doc Version 5.2 Page 29 - 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. 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