CARE HOMES FOR OLDER PEOPLE
Pinewood Nursing Home 33 Victoria Place Budleigh Salterton Devon EX9 6JP Lead Inspector
Anita Sutcliffe Announced 11 July 2005
th 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 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 Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Pinewood Nursing Home Address 33 Victoria Place Budleigh Salterton EX9 6JP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01395 446309 01395 443096 Elmwood Nursing Home Ltd Eileen Enever CRH PC Care Home providing Personal Care 28 Category(ies) of OP Old Age [28] registration, with number of places Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This variation allows admission of one named person, outside the categories of registration as detailed in the notice dated 13 July 2004 2. The maximum number of persons accommodated at the home, including the named service user will remain at 28. 3. On the termination of the placement of the named service user, or when he attains his 65th birthday, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those normally held. 4. The manager must obtain the Registered Manager’s Award by September 2006. Date of last inspection 6th October 2004 Brief Description of the Service: Pinewood Nursing Home provides 24-hour care and accommodation for up to 28 older people with nursing care needs. It is owned by Elmwood Nursing Home Ltd. and managed by a registered nurse manager. The Home (previously Links Pinewood Nursing Home) is a detached property standing in its own grounds, approached by way of a steep hill, situated in a residential area close to Budleigh Salterton town centre and the sea front. It is currently undergoing refurbishment and enlargement. The home is sited on four floors with lift access to each. 12 of the rooms have en suite facilities. There is a main lounge, a second ‘quiet’ lounge and a dining room. There are grounds and gardens, with areas that are easily accessible to service users. The home employs a physical therapist and has shared use of a mini bus. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place over two days and took seven and a half hours in total. A pre inspection questionnaire had been received, and residents or their family representatives had provided comments about the home. The care of 3 of the 19 residents was examined. This involved reading records, meeting them, visiting their room and talking to nursing and care staff. The dining room, lounge, new ‘quiet’ lounge, bedrooms, and laundry were visited. Recruitment records and some policies and procedures were examined, and the home’s medication arrangements were inspected. Residents were met and 2 nurses and 3 care staff interviewed. The newly registered manager, Mrs. Eileen Enever, and the company representative, Mr. Philip Sadeghi, were involved in the inspection. Contacts details about the Commission and its work were left around the home. What the service does well: What has improved since the last inspection?
Residents are protected by improved recruitment practice. A quality assurance system has been started. This will be an ongoing process, with the aim of making improvements to the benefit of residents. So far there has been a survey of opinion about the home, but the management are looking at the best of way of receiving honest feedback about the service they provide. The manager has now been registered and the home is more settled. The additional post of activities coordinator will also benefit residents through the group and individual events planned. This will include the use of the mini bus. Environmentally residents will benefit from a new ‘nurse’ call system, although during the inspection staff were still getting to grips with it. There is also a small ‘quiet’ lounge, as yet underused, but which gives the opportunity to meet
Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 6 socially away from the main lounge. This should be developed. The 2 new rooms are attractive and a larger lift will be operational very soon. The laundry has been rearranged to better divide dirty from clean laundry. 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. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 8 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 standard(s) 2 & 6 The home provides clear contractual information. The home does not provide Intermediate Care, so this standard does not apply to Pinewood Nursing Home. EVIDENCE: The home’s Statement of Purpose and Service User’s Guide, which are produced to inform potential service users about the services provided at the home, contain clear terms and conditions and a contract which is balanced and easy to understand. These have recently been updated by the home. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8 & 9 Individual health and care needs are planned and met by experienced staff who care about their residents. Medication practice at the home does not fully protect residents. EVIDENCE: The care of 3 residents was examined and many other residents were asked their opinion on the care provided at the home. Without exception the responses were positive and include: “You get individualised care. They take the time to make sure everything is right”, and “You get loving care and attention”. Nursing staff were very complimentary about the professional standard of care delivered by the care staff they work with, and carers voiced confidence in the nurses. Records showed that each person is recognised as having individual needs and wishes. The care of very frail residents was of a high standard, and input from other health care professionals, such as G.P. and wound care specialist, are sought as appropriate. In February of this year the home had an additional visit from a Pharmacist Inspector who made requirements and recommendations toward better
Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 10 medicine management. Whilst at this inspection improvements were evident, there were still failings which need to be dealt with promptly. These were in the main through poor practice. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 11 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 standard(s) These standards were not inspected on this occasion. EVIDENCE: Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18 Residents are protected from abuse. EVIDENCE: Staff have received training in the protection of vulnerable adults and they understood how to recognise abuse and what they should do if they have concerns. The whistle blowing policy still needs attention, as it lacked both clear instructions on how to respond to concerns, and local adult protection contact details. However, the home has training material, guidance information, and the manager, senior nurse and care staff understand their role and responsibilities. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 24 & 26 Bedrooms were comfortable and safe. Hygiene is well managed in a less than perfect circumstance. EVIDENCE: Rooms are comfortable, personalised and safely maintained. There is an ongoing recommendation that all residents should be able to lock their room door should they wish. Newly refurbished rooms do have this option, but at present most rooms do not. An improved laundry is planned in the new extension. For the time being the home is managing well with a laundry which has been adapted to meet the good practice of separating clean from dirty laundry, but which is not in itself easy to clean, due to worn surfaces and its shape. Measures have been taken to minimise risk and hygienic practice is being maintained. Training has been planned for the autumn. The home is clean and fresh. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28,29 & 30 The quality of staff and the home’s safe recruitment practice and training ensure that residents are in safe hands. However, induction training for new staff is insufficient. EVIDENCE: Through NVQ training and the employment of nurses as care assistants the home has achieved 50 staff qualified to NVQ level 2 or equivalent, which is a recognition of their experience and knowledge. Residents spoke of their confidence in the care they receive and the professionalism of the staff and this was observed during the inspection. However, the induction of 2 staff members appears to have been abandoned, with insufficient records completed after many months. Some training needs identified have not been met, but reasons have been in part outside the home’s control. Other training has taken place which updates staff knowledge and skills. Recruitment records for the last nurse, carer and the handyman employed were examined; the recruitment was found to be thorough and robust. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36 & 37 A competent manager is running the home. Policies and procedures need review and update, but records are now managed appropriately and residents should soon benefit from the quality assurance system currently being fine-tuned. EVIDENCE: In May of this year the manager successfully completed the process to be registered. She demonstrated her knowledge in the nursing care of older people and an understanding of her responsibilities as manager. She continues to update her level of knowledge and encourages others to do the same. Residents and staff say they are happy with the way the home is managed. Records at the home, needed in the best interest of residents but which have been previously lacking, are now in place.
Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 16 The first steps have been taken toward a way of monitoring quality at the home; it is expected that this will be developed further. Some of the home’s policies and procedures were of limited use and need to be reviewed and updated so as to ensure safety and consistency at the home by providing information for staff. This process has already started with emphasis on health, safety and welfare as the priority. The new medicines policy is clear and informative. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x 2 x 2 STAFFING Standard No Score 27 x 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x 3 x x 3 2 x Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 18 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Timescale for action The registered person shall make 31 July arrangements for the recording, 2005 handling, safekeeping, safe administration and disposal of medicines received into the care home. [This refers to: inaccurate recording of medication given handwritten entries not being checked and signed by a second person lack of clarity concerning some medicine record entries a staff signature safety record not completed unrecorded medicines in a residents room (Previous requirement not met) 2. Requirement Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 24 26 26 30 37 Good Practice Recommendations Doors to residents rooms should be fitted with locks suitable to resident capabilities and accessible to staff in emergencies. Staff should receive training in Infection Control. It is recommended that the new laundry facillity meets current Department of Health Guidelines on Infection Control in Care and Nursing Homes. New staff should receive a full induction to National Training Organisation workforce training targets completed within 6 weeks of starting employment. The homes policies and procedures should be reviewed and updated. Pinewood Nursing Home D54 D06 S58891 Pinewood V224612 110705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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