Inspection on 27/07/06 for Pinewood

This inspection was carried out on 27th July 2006.

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 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 22/07/08

Pinewood 14/09/07

Pinewood 16/03/07

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 11:37 27th July to 8th August 2006 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.V305947.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.V305947.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 Mrs Susan Loftus Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21/11/05 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.V305947.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 a 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 two days beginning on the 27/7/06 at 11.37 a.m. and finished on the 8/8/06. It was the first inspection under the new providers – Sanctuary Care and the visit was timed with this in mind and to look at issues around an adult protection matter involving the management of a service user in the home. This matter is still ongoing and gave cause for concern about the safety of service users in the home. That aside, improvements were noted in most of the areas identified at the last inspection visit. However, there were an increased number of areas that needed improving and they are highlighted in this report. It is crucial that the required improvements are acted upon, as they are key to the quality of service provision at Pinewood. As part of the inspection, four service users’ files were assessed including two of the most recently admitted individuals. Three of the four service users were case tracked. The inspection also included: the assessment of staffing records (recruitment and training), policies and procedures, health and safety records; interviews with service users, staff and relatives, detailed discussions with the manager, deputy manager and team leaders, a visit to a team meeting, telephone interviews with relatives and a tour of the building. Care practice was observed throughout the inspection and interviews and discussions were held with a significant number of service users. A number of questionnaires were also sent out to service users and external professionals, but with very few responses returned. As such those responses could not be included in this report, but would be included in the next inspection report on the service. It should be noted however that written responses from two General Practitioners, seven staff members and three service users were also considered in preparing this report. What the service does well: The home provides accommodation that is usually clean, hygienic and suited to the needs of the service user group. Most service users and relatives spoken to expressed their satisfaction with the quality of the accommodation at Pinewood. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 6 It was also the case that most of the staff in the home were committed and caring in meeting the needs of the service users, although there has been some difficulty in some staff working with individuals who are able to challenge areas of unsatisfactory practice. The staff turnover in the home has been relatively low and this allowed for some degree of consistency in the care provided by the home. Service users expressed their satisfaction in seeing familiar faces on a daily basis. For most this was reassuring. Service users were supported to maintain their independence as far as possible and this included the way in which they presented. They were generally well groomed and presented in fashion/s that best suited them. There was evidence of regular visits by the hairdresser to the home and where an individual preferred to go out to a hairdresser, this would be facilitated. Service users also benefited from receiving fairly prompt support to access health care services and the management and staff ensured that the health care needs of service users were attended to. Feedback received from relatives indicated that they are kept informed of events regarding their loved ones. But there was one case in which a relative commented that she was not aware of an adult protection matter regarding her mother. However records indicated there were substantial levels of family involvement with service users in the home. In essence the management and staff actively promoted this culture and service users spoken to were quite pleased with this. Most of the relatives spoken to also stated that they are made to feel welcome, when visiting the home. What has improved since the last inspection? There was evidence of an improvement in relation to activities provided by the home. This was however affected by the fact that the activities co-ordinator had left just prior to the inspection visit. The improvement was not sustained although arrangements had progressed to secure a replacement – due to start in September 2006. A proposed plan of activities was drawn up and presented as evidence in relation to this. The management and staff however started arranging trips using a mini-bus in which small groups of individuals are taken out to various places. There was evidence that service users’ next-of-kin details were well documented on the file of each service user and a clear protocol in place for staff to use the on-call. This would ensure that service users are safer in the home, particularly when staff are unsure of action/s to be taken in the best interest of service users. A night monitoring record is now in place and this outlines the checks that are made throughout the home within a particular frequency. This record is then reviewed and signed off by the deputy manager each morning as a form of Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 7 monitoring the activity on nights. The registered manager also informed that spot checks are undertaken as part of monitoring at nights and this is positive. There was evidence that work had been undertaken with staff regarding the importance of accurately recording events as they occur in the home. This was carried out with individual staff and in staff team meetings. However it is recognised that further work is required with regards to recording, generally in the home. What they could do better: The registered persons should ensure that updated information is made available to service users and their relatives, particularly in relation to the recent changes in the organisation. Service user plans must reflect their current and changing needs and this is important for all individuals living in the home. More effort needs to go into ensuring that service users’ rights are respected and this includes their right to make choices, their right to complain and their right to remain safe whilst receiving services from Sanctuary Care. There needs to be a monitoring system to ensure that the recording on the medication charts is in line with the home’s policy and other related guidelines and regulations. From this visit improvements could be made in relation to promoting service user choice and independence, without compromising their safety. The arrangements with meals in the home needs to be reviewed to ensure that all service users are receiving nutrition in line with their requirements, including where there are specialist needs. It is important that service users are protected from abuse and for Pinewood this means the provision of key pieces of training to include; adult protection, whistle blowing, equality and diversity, rights and responsibilities amongst others. They are identified throughout this report. Although the environment is generally satisfactory, ground floor carpets needed improving and works are to be carried out in bathroom 40. Service users could also be made safer by ensuring that staffing details are held in accordance with Schedule 2 of the Care Homes Regulations 2001. The quality of their care in the home could also be enhanced with the development and implementation of a training plan for the staff team. Given the outcome of a recent incident and the management’s handling of it – reviewing the management operations in relation to meeting a key objective i.e. service user safety, is required. This could take the shape of support for Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 8 the manager and/or reviewing the protocols around dealing with service user protection, where the manager may be implicated. Staff support and development could be enhanced through annual appraisals and this would have a positive impact on the quality of service provision in the home. Finally some improvement is required in relation to food handling to promote the well being of service users. Otherwise, health and safety practices are generally satisfactory at Pinewood. 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. Pinewood DS0000067407.V305947.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.V305947.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (1,3,6) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A detailed assessment of service users’ needs is carried out prior to their admission in determining whether they could be met by the home. Service users and their relatives also have updated information about the services they could expect from Pinewood. However, this information would be more effective to service users if is kept updated. The home does not provide intermediate care. EVIDENCE: An updated statement of purpose and service user guide is normally available to service users and their relatives. The information contained in these documents enables individuals to determine the services and facilities offered by the home. During the course of this visit, feedback received from a service user and their relative indicated that they had no information about the home prior to moving into it. This is particularly important in enabling someone to make a more informed choice and hence must be made available to service users and their relatives where necessary. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 11 Although it is crucial to make the information available to respective individuals it is as important to have these documents updated. At the time of the visit these documents were in need of review, particularly with respect to the fact that a new organisation now runs the service. The registered manager informed that they were being reviewed, but she had not received the revised version. The registered providers must therefore complete this piece of work and make the documents available to the home and service users. 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 staff who are trained to so do. 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. During the course of the inspection the file of most recently admitted service user was assessed and evidence of detailed assessments were in place. Management and staff were therefore able to not only identify the various needs of the individual, but they also detailed a plan of action for how were met. An example could be drawn from the fact that staff on the day of the visit were assisting the most recently admitted service user to have her bloods done with the practice nurse. Pinewood DS0000067407.V305947.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (7,8,9,10) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users generally benefit from having a service user plan detailing their needs and this includes their health care needs. As part of maintaining service users’ health, support is given with medication and this includes support to self–medicate. However, there were variances in consistency in the service user plans that were not in the best interests of some service users. Medication practices in the home, particularly with regard to the recording needed improving. Most service users were pleased with the level of respect and privacy they received. However the management and staff need to ensure that all service users in the home feel respected. EVIDENCE: Four service users’ plans were examined and they included that of the most recent service users, as well as service users who were part of case tracking by virtue of recent incidents in the home. There is a good system of service user planning in the home in that they generally detailed the health, personal and social care needs of most service users. There are specific plans for the night and for days. The system enables service user participation where possible and they are reviewed at regular periods. However it was clear from the samples assessed that the quality of recording and maintaining these service Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 13 user plans was inconsistent. In one case the health, personal and social care needs were thoroughly covered in the plan and this included risk assessments that were linked to the service user plan as well as changes that were identified from a review. In at least two of the other cases the service user plan was not updated, neither was the risk assessment that was linked to the service user plan. Another example is where a review took place on the 20/4/06 for one individual and up until the visit in July the service user’s plan remained unchanged. The registered manager stated that she thought it had been done and from the evidence it had not. It was not therefore possible for the manager and staff to demonstrate that they were meeting the needs of those individuals. Other weaknesses identified included review documents being unsigned and undated. The quality of recording was also an issue and this has been recognised by the deputy manager with plans in place e.g. supervision, to improve in this area. It was acknowledged that work had started on updating service user plans by the time of the second visit to the service – 8/8/06. 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. At the time of the visit, the mobile opticians were due to come and service users were informed about the arrangements to have their eyes checked. Evidence was provided to demonstrate that the home had written to follow up physiotherapy plans for a service user who had treatment for a stroke. Service users’ weight is monitored and the staff engage service users in indoor activities to ensure that they maintain some form of mobility. Feedback received from one GP indicated that the standard of care in the home had recently improved, while another stated that the care was satisfactory. In general the health care needs of service users were satisfactorily provided for. At the time of the visit two service users were able to manage their own medication with staff support and this is positive. Most other service users were provided with medication from the staff that are trained to carry out this task. The home has a dedicated person who takes the lead (Team Leader) in monitoring and managing the handling of medication. The deputy manager oversees this. Service users’ relatives were satisfied with the support given to their loved ones with regard to medication. Medication storage was satisfactory and the administration practices were mostly in line with the policy/procedures of the home. However a significant number of gaps were found in the charts for some service users and an audit trail could not satisfactorily determine the outcome for the service users concerned. This needed to improve to ensure the safe handling of medication in the home. Feedback received from relatives and most service users indicated that they were treated with respect and their right to privacy was maintained. Staff were Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 14 observed generally giving support to individuals in a dignified manner. However there was one service user who did not feel that her choices and wishes were respected by the management and staff at the home. The service user concerned is able to voice her individual preferences/dislikes and it did not matter that she was from an ethnic minority grouping. One example provided was where it was known and recorded that the individual was unable to chew properly, but was provided with unripe tomatoes for supper one evening. This caused her great distress as she stated ‘ they know I can’t eat this – why do they keep doing this to me’. There were a number of other examples provided by the service user and it became clear that over time issues around the service user’s choices, increased over time, without being adequately dealt with. The outcome was clashes between the manager and the service user and this led to the service user being labelled as challenging. It is imperative that all service users are treated and made to feel respected whilst in the care of Pinewood. Pinewood DS0000067407.V305947.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,14,15) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users enjoy some level of activity, which could be enhanced further. They also enjoy maintaining links with family, friends and the local community. While some service users are encouraged to exercise choice and control in their lives, more needs to be done to ensure that the each service user is given this opportunity. This must be extended to the nutritional needs of service users in the home. EVIDENCE: From assessing the records held on activities, there was evidence that activities had increased when compared to the last inspection. This was however disrupted as the activities coordinator moved on. Arrangements were in place for a replacement to commence in September 2006. Evidence of a proposed plan of activities was provided at the inspection and this was devised in conjunction with the wishes and needs of service users. The deputy manager also indicated that there were plans to explore the use of a visiting activities team to increase weekly outdoor activities. At the time of the visit the plan was to have external activities twice per week and to this end arrangements for use of a mini-bus have been finalised. Up to eight service users went to see a play by Manford Way Primary School on the 18/7/06 and arrangements were made to take a group of service users on the 3/8/06 to Southend using the mini-bus. A small group also went to Crowthers Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 16 to an outdoor garden to have tea. Plans were in place to do outings in small groups to places that service users chose. Service users spoken to about the play were quite pleased to have been out and some service users were quite pleased about plans for increased external activities. Other service users were not too keen to get out and the test for management and staff is to ensure that some form of stimulation is provided for them, internally or otherwise to prevent feelings of isolation. During the inspection it was observed that one service user was engaged in doing crossword puzzles, some were watching television, while several were listening to the radio either in their rooms or in the quiet lounge. Late afternoon activities included skittles and games that staff organised. Feedback received from relatives and service users indicated that they were generally happy with the activities. A minority felt that they were of no interest to them and the management and staff need to address this when revamping their activity programme. It should take into consideration individuals who prefer one to one activities – if even for short periods. There continues to be high levels of involvement with relatives of service users, although there was one reported case in which a relative indicated that she was not notified of an adult protection matter involving her mother, until much later on in the process. A high percentage of feedback from relatives indicated that they were made to feel welcome by the staff and management at Pinewood. They also indicated that they were notified and informed about the progress and developments regarding their loved ones. 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. On balance the home caters well for ensuring that the family/friends network is maintained in the interests of service users. A number of relatives spoken to were aware of the recent changes in the organisation and this is positive. Most service users spoken to felt that they were actively involved in making choices that would enable them to take control of their lives. One of the most recently admitted service users was unhappy in the way in which he was placed at Pinewood by the local authority i.e. Redbridge. From his discharge documents, he was clear that his placement at the home was temporary until a suitable alternative to his private home could be found. He was distraught to learn later on that his placement was permanent. The deputy manager worked alongside this service user and his family and has since engaged the use of an advocate to support the service user in dealing with his personal situation. Further evidence could be drawn from the fact that two service users were supported to handle their medication. This is positive. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 17 It was however observed that there were examples in which the actions of the manager and staff did not enable some individuals to exercise choice and control of their lives. One example of this is where a newly admitted and partially sighted service user was served lunch that was neither cut up nor served in a container that would enable her to easily get the food onto the cutlery and into her mouth. The food was placed in front of her and a notification made that it was there. The staff then left and for a considerable period after the service user was struggling to get food even onto to the cutlery. This was brought to the deputy manager’s attention. Appropriate action was not taken to ensure that the service user was in control of feeding independently and in a dignified manner. Another example could be drawn from the case of the service user who made her likes and preferences known for example, to have soft fruit amongst other things and there was an ongoing struggle in meeting some requests made by the service user concerned. This invariably led to an incident in which the service user was allowed to walk out of the home in a manner that compromised her safety. This is an area that requires improving as although in some cases service users are enabled to exercise choice and control in their lives – others were not. Meals at Pinewood have been over recent years the subject of concern raised by service users and to some extent their relatives. In an interview held with one of the service users who keenly comments and participates in matters relating to the service, she actually felt that the meals were getting better. For others there did not seem to be any improvements. One service user wrote ‘I never really eat them’. Another commented that ‘the meals are served in large portions, putting some service users off – and with the afters were not appetising’. There was evidence from examining the files of service users that were case-tracked – of clear assessments relating to dietary needs. This included service users from ethnic minorities. There, however, seems to be some difficulty in ensuring that the meals identified, were matched to individuals’ choice/s and/or needs. At the time of the visit the management was planning a meeting with Cater–Plus, the caterers, to look at meals in the home. Examples of concerns included an individual that requested pureed vegetables and was given them boiled, but not pureed, on the day of the inspection. It was observed on the same day that other service users had soft diets, so it was not clear as to why one service user could not have what she requested although it was recorded in her service user plan. The same service user has vegetarian meals and although a menu plan was drawn up with the service user and the deputy – the level of protein intake was marginal. In another case a service user had a stomach allergy to a vegetable and the caterers knew nothing of it. This invariably put the service user at risk, particularly as one of the concerns raised by service users is the number of different caterers that come in from day to day. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 18 Menus were in place and was varied and looked wholesome on the day of the visit. Meal times were unrushed, although on the day it was over thirty-five minutes late. Lunch on the day was lamb and vegetable pie or sausage in batter, boiled potatoes, broccoli and creamed swede. Dessert included fresh fruit or plum and custard. There is a list of alternatives, for example, if someone wanted fish instead of meat they would have to notify the kitchen by 10.00 am. The menu board has alternatives advertised ‘always available’. It was reported that one of the regular caterers was on long term sick and that Cater-plus was recruiting. The management and staff need to however take strategic action to demonstrate that the meals provided by Cater-plus adequately meet the specific and individual needs of all service users in the home. It would also be useful to continue holding forums with service users to establish their satisfaction and suggestions to meals in the home. This is particularly important given the needs of the service user group. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (16,18) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users have access to a satisfactory complaints procedure and this, along with a satisfactory adult protection procedure, should promote their safety. However the handling of both complaints and adult protection matters in the home must improve for service users to enjoy maximum protection. EVIDENCE: A complaints procedure is in place and service users and relatives spoken to were aware of it. However the culture in which concerns and complaints are embraced needs to be altered. This is to ensure that service users and their relatives feel assured that bringing complaints and having them appropriately dealt with, would not be viewed as negative on the home’s part. All staff interviewed indicated that they would support service users to complain. However there was evidence that the handling of a string of complaints made by one service user resulted in a breakdown in trust by the service user with the management of the home in relation to the management of her complaints. On the one hand the manager felt that she was doing all she could, but the service user was left feeling that she was making trouble, even when her complaints and/or concerns were valid. Evidence of this was observed during the course of the inspection. Prior to the visit the home indicated that they had no complaints and this may be viewed in one sense as good. However it is more important to have complaints recorded against the home that are robustly handled, leaving the complainant satisfied that their issue/s is/are dealt with. They would be Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 20 reassured if they knew that they have the right to complain and voice dissatisfactions, including when dissatisfied with the outcome of the investigation, that they could go on to another stage, as the complaints procedure suggests. Concerns must be treated in a similar manner. An adult protection procedure was in place at the home and most of the staff interviewed showed an awareness of it. There was evidence that a number of them required adult protection refresher training. There is also a need to ensure that whistle blowing is actively promoted in the home. Just prior to the Inspection, actions taken by the management of the home placed a service user at risk. This is currently being dealt with by the registered providers in conjunction and in accordance with the local authority’s adult protection protocol. Some staff failed to challenge the actions of the manager in this incident and this inaction left the service user at risk. It was the second incident of its kind in the last year where service users concerned were made unsafe under the guise of rights versus duty of care and the safety of the individuals concerned. This is an area that the organisation needs to address as a matter of urgency – to ensure that all staff understand that they have a duty of care and legal responsibility to ensure the safety and well-being of service users in their care, whilst balancing this against the rights of service users. The inspector spent some time discussing this with the deputy manager and a group of team leaders in the interest of promoting service user safety. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (19, 20, 24, 26) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users generally live in a safe and well-maintained environment at Pinewood. They also enjoy the benefit of personalising their bedrooms and accessing all parts of the home in a safe and comfortable manner. The home could be made more pleasant by replacing/deep-cleaning the ground floor carpets and replacing and redecorating the panel in bathroom 40. EVIDENCE: All service users and relatives spoken to expressed their satisfaction with the physical layout and décor of the home. There are adequate systems in place to ensure that the home is maintained to a good standard. Staff interviewed informed that Sanctuary (Registered Provider) is responsive to issues of repair, once identified. During the visit, there was evidence that a new vent had been fitted for the fridge/freezer and a new air conditioning system was fitted in the kitchen. The top floor of the building was also being redecorated and furnished and there were no service users in there at the time of the visit. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 22 Service users felt that despite the hot summer they were comfortable at the home. There were no reports of dehydration or individuals with sun related strokes. Several service users were in the garden on the first visit and they were appropriately clothed and enjoyed the benefits of fresh air and relaxation, whilst there. Whatever the choice made by service users they were pleased in the way in which they were accommodated at Pinewood. Several service users allowed the inspector to view their bedrooms, which were in a good state of repair. They also contained the personal possessions of service users and this was varied in each case. Some individuals used their rooms to maximise their comfort and peace of mind and this included things like listening to radio programmes, and watching television including as in one case, a football match. All service users were happy with their private spaces. The home was also clean and hygienic and this included the laundry and kitchen areas. There was no evidence of offensive odours in the home and the infection control practices by staff ensured the safety of service users. However the home could be made more pleasant by either replacing or deep-cleaning the carpets on the ground floor. These carpets looked worn, dull and had a negative effect on the ambience of the home. Another enhancement required is to redecorate and secure a panel cover in bathroom 40. Pinewood DS0000067407.V305947.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (27,28,29,30) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Generally service users receive a satisfactory standard of care from a team that is motivated, skilled and in adequate numbers. Service users would be safer once key pieces of training are provided and the registered persons maintain records held on staff in accordance with the Care Homes Regulations 2001. EVIDENCE: Staffing rotas were examined in detail and there was evidence that the numbers on shift were capable of meeting the needs of the service user group. The management also used staff creatively to ensure that at peak times i.e. mealtimes that a shift from 12 midday to 8 p.m. was in place to ensure that service users received care and support they required. Most of the feedback received from staff, service users and their relatives indicated that the staffing numbers on duty were adequate. In general there are seven support staff with two team leaders in the mornings and six with the same number of team leaders in the evenings. This is with the current occupancy at thirty eight service users with mixed levels of dependency and is satisfactory. Apart from the staffing numbers a high percentage of staff had achieved their NVQ level 2 in Care qualification. The deputy manager has achieved an NVQ level 3 in Care along with one of the night team leaders. Four of the six team leaders have also achieved their NVQ level 2 in Care and seven of the fourteen support staff have also achieved this qualification. The deputy manager advised that an incentive is given to staff for achieving their NVQ qualifications and this is positive outcome for service users. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 24 Most staff therefore have a basic qualification in care with plans for others to achieve their qualification in relation to the NVQ achievements. This means that they have at least a basic understanding of care. Service users generally receive care that is safe and this could be evidenced in one respect by the reduction in the number of accidents for example in relation to service users falling, since the last inspection. While this is positive more needs to be done to ensure particularly in relation to adult protection and whistle blowing that staff are provided with this training as a matter of priority. The most recent adult protection matter in the home highlighted the need for this. Another example was observed where one staff started in May 2006 and had only had a two-day training in Dementia. It is important that the more is done to ensure that training in equality and diversity, rights and responsibilities, person-centred, and statutory mandatory training is provided to staff at Pinewood. (See standard 18). There was evidence that in general service users are safe in relation to the recruitment practices of organisation. A number of staffing files were examined and contained most of the recruitment information required by regulation. However, recent photographs were not on file from at least two assessed from the sample and this needs to corrected. The registered persons must ensure that information held on staff is in line with Schedule 2&4 of the Care Homes Regulations 2001. The deputy manager completed a training and development needs analysis for the staff. This is useful as it identified important areas of deficiency, which needs to be addressed to improve staffing competence. One such area that is being worked on internally is the quality of recording in service user plans. Plans were in place to have areas such as infection control and basic food hygiene is planned for October 2006. It is imperative that a training and development plan is in place for the staff. This should include opportunities for staffing familiarisation with care practices and policies – particularly of the new organisation. Pinewood DS0000067407.V305947.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (31, 33, 35, 36, 38) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users benefit from a home that has a sound management structure, which in practice protects their financial interests. Staff supervision supports this, although this could be improved. Improvements in the managerial operations are required to ensure that the welfare and best interests of service users are promoted at all times. This includes monitoring of health and safety practices in the home. EVIDENCE: The registered manager is qualified to run the service by virtue of her training and qualifications. She leads a team including: a deputy manager, six team leaders and support workers in providing care and support to service users living at Pinewood. She has, as part of her job description, a key responsibility in ensuring that the written aims and objectives of the service are achieved. Responses received from most of the staff, service users and relatives indicated that they were happy with the management of the service. One service user stated that ‘the management of the home is improving’. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 26 However, in a recent incident, the safety of a service user was compromised and this involved the management of the home. The registered providers are currently looking into the matter. There is however a need for reviewing the management operations and supervisory arrangements in the home to ensure that service users are not put at risk in the future. This action would also ensure that a key management aim and objective e.g. ensuring service user safety, is achieved. Most service users stated that they felt safe at Pinewood and relatives spoken to, endorsed this. Staff are generally provided with an induction to ensure that they are familiar with the policies, aims and objectives of the home as well as the needs of the service user group. In relation to the incident referred to above, the registered providers, despite being aware that the management of the service placed the service user at risk – failed to protect the service user from direct contact with the person who had placed them at risk. This meant that for some time while the issue was investigated, the individual had daily contact with that person. The service user reported a feeling of vulnerability and continued to be unhappy in the home. The registered providers must look at how they handle matters like this in the future – with a view to prioritising the safety of service users. They would also need to have a clear strategy place for managing the home while the registered manager is away, with regard closing the matter. This will be monitored and followed up by the Commission in conjunction with either the area manager or an appropriately named individual in the organisation. There was evidence of monthly provider visits, which looked at issues in the home with regard to the overall quality of care provided at Pinewood. This is positive and should go some way into improving standards. There was also evidence that the registered providers were engaging with service users with regard to the care and support they receive. From discussions held with the administrator and assessing the financial records maintained by the home – service users’ financial interests were safeguarded. A random sample of service users’ funds and receipts were looked at and they were satisfactorily maintained. Petty cash was also adequately maintained and a clear audit trail could be established of how funds are handled. An external system of monitoring is also in place to ensure that the financial operations are in line with the policies of the organisation. Team Leaders and support staff interviewed felt that they were supported in the main to do their job. There is a system of formal supervision for staff and they were satisfied with this. They also have regular team meetings and this allows for contributions and discussions in relation to all aspects of the home. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 27 The inspector attended a meeting and staff were supported to air their views and this was positive. One of the key areas of discussion involved having a staff representative attend external meetings held by Sanctuary. It was a new area for them and it generated quite a bit of discussion on the subject. It was generally felt that staff are given the support they need to do their jobs. All staff and service users indicated that they had good support from the deputy manager, as she is always there for them and leads by example. One service user described her as ‘an angel from heaven’. However an area requiring improvement from a management point of view is to ensure that staff appraisals are carried out annually. The health and safety practices in the home were generally satisfactory, and records examined bore evidence of this. Systems were in place to ensure that tests for Legionella are carried out. Risk assessment for safe working practices such as moving and handling, infection control, fire, food hygiene and COSHH substances were also in place. Staff interviewed were aware of their responsibilities under health and safety and most had a structured induction in line with the Learning Skills Council guidelines. Hand washing facilities were adequate and health and safety signs were prominently displayed. Certificates of safety for electrics, the lift and gas were also in place. There was one area that required improving and this related to food storage. Items of food were found improperly stored in a kitchen cupboard and this poses a risk to service users. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X X X 3 X 2 STAFFING Standard No Score 27 4 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 6(a) Requirement The registered persons are required to review and update the statement of purpose for the benefit of service users. The registered persons are required to ensure that service user plans are updated and reflect the current needs of service users. The registered persons are required to ensure that medication charts are signed at all times. The registered persons are required to ensure that all service users are treated with respect at all times. (See standard 10). The registered persons are required to ensure that practices in the home promote service users choice without compromising their safety. The registered persons are required to ensure that (1) Meals provided are in line with service user needs, including their specialist needs and (2) A clear system of communication is in DS0000067407.V305947.R01.S.doc Timescale for action 15/10/06 2 OP7 15 15/10/06 3 OP9 13(2) 15/10/06 4 OP10 12(4)(a) 15/10/06 5 OP14 12(3) 15/10/06 6 OP15 16(2)(i) 15/10/06 Pinewood Version 5.2 Page 30 7 OP16 22 8 OP18 13 9 OP26 23 10 OP29 19 11 OP30 18(c) 12 OP31 9 13 OP33 24 place to ensure that food allergies are communicated to the caterers staff. The registered persons are 15/10/06 required to handle all complaints in accordance with Regulation 22 of the Care Homes Regulations 2001. (Also See Standard 16 of this report). The registered persons are 15/10/06 required to ensure that service users are protected from abuse by providing training in: adult protection including whistle blowing, person centred planning, diversity and equalities and, rights and responsibilities – for the benefit of staff. (Also see Standard 28). The registered persons are 15/10/06 required to replace or deep – clean the ground floor carpets and to replace and redecorate the panel in bathroom 40. The registered persons are 15/10/06 required to hold records in line with Schedule 2 of the Care Homes Regulations 2001. The registered persons are 30/10/06 required to have a training and development plan for staff and to ensure that statutory induction training is provided to all staff working in the home. (Also see Standards 18 and 28 of this report). 30/10/06 The registered persons are required to review and provide support as required for the registered manager to ensure that the stated aims and objectives of the service are met, particularly with regard to maintaining service user safety. The registered persons are 30/10/06 required to review their protocols in relation to how they handle concerns around ‘the protection DS0000067407.V305947.R01.S.doc Version 5.2 Page 31 Pinewood 14 OP36 18(2)(a) 15 OP38 13 of service users’ in the home. The registered persons are required to ensure that annual appraisals are carried for all staff. 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. 15/12/06 15/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP14 Good Practice Recommendations The registered persons should hold regular meetings with Cater–Plus with a view to improving meals and ensuring consistency, once these improvements are made. Pinewood DS0000067407.V305947.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 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.V305947.R01.S.doc Version 5.2 Page 33 - 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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