CARE HOMES FOR OLDER PEOPLE
Pinewood Lodge Oxhey Drive Watford Hertfordshire WD19 7HR Lead Inspector
Yoke-Lan Jackson Key Unannounced Inspection 10:00 21st July and 10th 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 Lodge DS0000019496.V305602.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 Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Pinewood Lodge Address Oxhey Drive Watford Hertfordshire WD19 7HR 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) 0208 421 7900 0208 421 7961 www.quantumcare.co.uk Quantum Care Limited Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Pinewood Lodge, provided by Quantum Care Limited, is a residential care home registered for 60 service users in the Old Age and Dementia category. The home charges £400 - £565 per week. The building is a purpose built home that was completed in 1997. It comprises a two-storey building with a main entrance to the first floor at upper ground level and a lower ground floor. There are parking facilities at the front of the building. Accommodation is offered in four 15 bed units. Each unit has a separate lounge and dining area, a fully fitted kitchenette, a medication storage area and a staff workstation. All bedrooms are in excess of 12 sq. metres in area and have en-suite toilets and sinks. The assisted bathroom and assisted shower room are nearby. The home has an administrative section on the ground floor, a fully fitted stainless steel equipped kitchen with appropriate storage rooms and cold storage equipment and a well-equipped laundry. Other facilities available to service users include a ground floor conservatory and first floor hairdressing salon. The gardens extend around the home, which is screened from the road and neighbouring buildings by mature hedges and trees. There are pleasant patio areas with seating for service users and visitors. The garden is accessible to wheelchair users. Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 21/07/06. The deputy manager was present. Further discussion took place with the registered manager and the inspection was completed on 10/08/06. There were 59 service users in the home and one vacancy. The inspection began with a tour of the building. All 4 units were inspected. Some time was spent observing how the staff interacted with the service users. Service users, relatives and staff were interviewed. Documents were examined and the inspection ended with a general discussion with the managers. (See below for details of the inspection findings). What the service does well: What has improved since the last inspection?
The standard of administration and management of the service is improving since the current manager was appointed. Her registration with the Commission for Social Care Inspection was approved this month (August 2006). All the communal areas have been redecorated. There is an ongoing maintenance programme for all the bedrooms. The staff training programme, including mandatory training, has been updated to ensure that the care needs of the service users are being met by a team of dedicated staff. Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 6 What they could do better:
Care plans were not kept secured in accordance with the Data Protection Act 1998. It was noted that the written care plan files were left in an unlocked drawer by the staff workstation in the corridor area. During the lunch period, there were occasions when the service users were left on their own with no staff supervision in the dining room as the two staff were busy elsewhere, either attending to the personal care needs of individuals or sorting out the lunch time duties. The staffing level must be increased by one during peak periods to ensure that service users are supervised at mealtimes. In a recent CSCI survey, one comment received was “sometimes there is a lack of communication between staff.” Another comment received was “sometimes the staffing level is a bit low resulting in less care than usual.” The results of the recent survey are given below. (See Statutory Requirements) Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 7 Results of CSCI Questionnaire to Service Users
Number received: 5 out of 20 sent out Q1 Have you received a contract? Yes 4 No 1 No Response 0 Q2 Did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Yes 5 No 0 No Response 0 Do you receive the care and support you need? Always 4 Usually 1 Sometimes Q3 0 Never 0 No Response 0 Q4 Do the staff listen and act on what you say? Yes 5 No 0 No Response 0 Q5 Are the staff available when you need them? Always 4 Usually 1 Sometimes 0 Never 0 No Response 0 Q6 Do you receive the medical support you need? Always 4 Usually 1 Sometimes 0 Never 0 No Response 0 Q7 Are there activities arranged by the home that you can take part in? Always 3 Usually 0 Sometimes 2 Never 0 No Response 0 Q8 Do you like the meals at the home? Always 4 Usually 1 Sometimes 0 Never 0 No Response 0 Q9 Do you know who to speak to if you are not happy? Always 3 Usually 2 Sometimes 0 Never 0 No Response 0 Q10 Do you know how to make a complaint? Always 4 Usually 0 Sometimes 1 Never 0 No Response 0 Q11 Is the home fresh and clean? Always 3 Usually 2 Sometimes 0 Never 0 No Response 0 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 Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 8 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 Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 9 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, 2, 3, 4, 5. Standard 6 is not applicable. Prospective service users have the opportunity to visit and assess the facilities and suitability of the home. They have the information they need to make an informed choice. A thorough assessment is carried out prior to admission of a prospective service user. Quality in this outcome area is Good. The judgement has been made using available evidence including a visit to the service. EVIDENCE: Each service user is given a Service user Guide on admission. The pre-admission assessment documents were seen in the care plan files examined. The home will only admit service users whose needs can be met. A recent admission said that her daughter visited the home before she moves in. She said that she was “well treated.” In a recent CSCI survey one comment received was “we had an extensive tour of the home and had conversations with the staff.”
Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 10 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, Service users are treated with respect and their right to privacy is maintained. They have access to specialist medical treatment and other healthcare services. Each service user has a written care plan, which is reviewed regularly. Medication is administered in accordance with legislation. Quality in this outcome area is Good. The judgement has been made using available evidence including a visit to the service. EVIDENCE: The service users appeared content and well cared for. Recently, the home had admitted 2 service users with Grade 3 pressure sores that were not disclosed by the hospital staff at the time of the pre-admission assessment. The Commission, CSCI was notified immediately after the service users were admitted into the home. The management was advised to notify the Adult Protection Team of the relevant Social Services department. Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 11 The managers said that the home is able to meet the care needs of these service users with the support of their own doctor and the district nurse. The district nurse attends regularly to see to the dressings for these service users. Their condition is improving. The written care plans have been revised and updated. Risk assessments are carried out when necessary. The administration of medicines is by a trained member of staff. The Medication Administration Record Charts examined were correctly filled in. On the day of the inspection, due to extreme hot weather, the storage cupboard for medicines had a room temperature of at least 30 degrees centigrade. Extra cooling units were put in place to ensure that the room temperature is maintained below 25 degrees centigrade. The temperature is recorded regularly and is maintained. Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 12 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. Service users are helped to exercise choice and control over their lives. They are encouraged in the activities provided which are flexible and varied. Service users maintain contact with their family and friends. The meals provided are nutritious and wholesome and mealtime is unhurried. Quality in this outcome area is Good. The judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has planned activities and day trips to places of interest. There is organised in-house entertainment twice a month and parties are arranged. There was a planned garden party on 29th July 2006 for service users and their families and friends. On the day of the inspection, there was music and dancing in the afternoon in one of the units. One service user commented in a recent CSCI survey that “Since being here, I have had my nails painted, have attended church services, have received entertainment, have been on a picnic, done colouring and have been on a ‘smoothie tasting’ event.”
Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 13 Lunchtime was observed to be unhurried. Staff were on hand to help those service users who needed assistance. Service users gave positive feedback about the meals served. One said, “The meals are very good.” Another said that “the food is well cooked and well presented.” Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 14 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, 17, 18 The home has a robust Complaints Policy and Procedure. Service users’ legal rights are protected. Quality in this outcome area is Good. The judgement has been made using available evidence including a visit to the service. EVIDENCE: The service users and relatives interviewed said that they are aware of the home’s Complaints Procedure. Any issue raised is dealt with as soon as they are raised. One service user said, “I know who to speak to not only to complain but also to give them praise for all their hard work.” Staff have their training on abuse and issues concerning the protection of the vulnerable. They have training on Adult Protection Procedures. The home follows the procedure laid down by the Hertfordshire Social Services. Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 15 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, 21, 22, 23, 24, 25, 26. Service users live in a comfortable and homely environment. There is a planned maintenance programme. Quality in this outcome area is Good. The judgement has been made using available evidence including a visit to the service. EVIDENCE: On the day of the inspection, the home appeared well maintained. All communal areas have been redecorated. The decorators were busy completing the paintwork in the corridor of one of the units. The bedrooms examined appeared clean and tidy. Service users spoken to seemed content with their bedrooms. There were items that reflected their individual lifestyles. One service user commented that the home “is well looked after and maintained.” Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 16 In the dementia unit 1 fire apparatus and 1 box unit were removed and misplaced by a service user. Since the inspection, the apparatus has been replaced in its original location and is now firmly attached to the wall. Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 17 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. Service users are supported and cared for by a team of dedicated staff. The training programme and the skill mix of staff ensure that the care needs of the service users are being met. However, the staffing level in the residential units is inadequate at meal times. Quality in this outcome area is Adequate. The judgement has been made using available evidence including a visit to the service. EVIDENCE: On the day of the inspection, members of staff were observed to interact well with service users. However, it was observed that, at times, service users were left unsupervised in the dining room (Blue Fern unit) during lunchtime because the two carers were busy elsewhere. The staffing level must therefore be increased from two to three during mealtimes to ensure that service users are supervised appropriately. The home provides induction training for new staff and has a mandatory training programme for all staff. Other topics include Nutritional Needs, Falls Prevention, Infection Control, Dementia and Quality Care. (See Statutory Requirements) Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 18 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, 32, 33, 34, 35, 37, 38. The standard of administration and management of the service has improved since the appointment of the new manager, whose application for registration with the Commission has been approved. The health and welfare of the service users and staff are promoted and protected. However, the safety of the service users was compromised by not having adequate number of staff at mealtimes. Quality in this outcome area is Adequate. The judgement has been made using available evidence including a visit to the service. EVIDENCE: Staff interviewed said that the managers are approachable and supportive. Staff have regular supervision. Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 19 The registered manager is currently reviewing the client groups in all the four units and hopes to retain all dementia cases in the two units on the lower floor rather than having a mixed unit. In this way, the needs of all client groups can be met appropriately and efficiently. All records for the protection of the service users have been maintained and kept up to date. However, all the care plan files were kept in an unlocked cabinet by the staff workstation in the corridor. The registered manager must ensure that all records (for the protection of service users) are secure and used in accordance with the Data Protection Act 1998. The home has an effective quality monitoring system and there is a business and financial plan that is reviewed annually. The registered manager and the deputy manager have cooperated and have rectified any shortfalls raised to ensure service users are kept safe at all times. (See Statutory Requirements) Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 20 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 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 2 2 Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 21 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 OP27 OP38 Regulation 18(1)(a) Requirement The staffing level must be increased from 2 to 3 during mealtimes to ensure that service users are supervised appropriately. (Rectified) The registered manager must ensure that all records for the protection of service users, including care plan files, are secure and used in accordance with the Data Protection Act 1998. (Rectified) Timescale for action 21/07/06 2. OP37 17(1)(b) 21/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Pinewood Lodge DS0000019496.V305602.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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