Inspection on 23/05/05 for The Pines

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Pines 10/07/07

The Pines 25/05/06

The Pines 25/10/05

The Pines 27/01/05

The Pines 14/05/04

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Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Pines Sherwood Park Pembury Road Tunbridge Wells Kent TN2 3QE Lead Inspector Fiona Holdaway Unannounced 23 May 2005 10:00 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Pines Address Sherwood Park Pembury Road Tunbridge Wells Kent TN2 3QE 01892 526274 01892 615800 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) The Avenues Trust Limited Care Home with Nursing 24 Category(ies) of Learning disability (24) registration, with number of places The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27 January 2005 Brief Description of the Service: The Pines is managed by The Avenues Trust and is a care home with nursing it is currently registered for twenty-four service users, a variation to the registration has been applied for to be a care home for younger adults without nursing. The Pines comprises of four detached bungalows set in partly secluded wooded area next to a resource centre run jointly with the Local Authority Social Services and the Health Authority.The property is located off the main Pembury Road in Tunbridge Wells, Kent. It has a large driveway with some parking adjacent to the building. The bungalows were purpose built and are designed to support individuals with physical and learning disabilities. Accommodation is on the ground floor with eight single rooms and eight double rooms. There is a lounge/dining room and separate kitchen in each bungalow. There are communal gardens around the bungalows. All staff work on a shift roster, which includes waking night staff. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Inspection was carried out by Fiona Holdaway. A tour of the home took place and the Inspector met with service users and staff. Care records and files were inspected. There have been no complaints received by CSCI about this home. What the service does well: What has improved since the last inspection? What they could do better: Service users would benefit from the plans for future developments to the bungalows being implemented. These include adequate lockable office space, a visitors’ room and converting double rooms to singles. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 6 It remains a requirement that personal records should be stored securely. Some areas of the bungalows remain shabby and in need of repair or redecoration to make a more pleasant environment for service users. Staff vacancies need to be filled. Service users do not have the benefit of a fully staffed, permanent team of carers working together to provide a consistent care service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,5 Information is available for prospective service users to make a choice about the home. Service users needs are fully assessed to ensure that the home can meet their needs. Service users have access to specialist services if they need them. Service users have a contract with the home, which details their rights and responsibilities. EVIDENCE: There have been no recent admissions to the home, however the service users guide and the statement of purpose provide the information required for any prospective service users. The service users guide is provided in a language and format that is suitable for the intended residents and is also provided in a pictorial format and on audio tape. Updated versions have been provided to support the homes application for a variation from nursing care to residential care. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 9 All the present service users have had assessments by Health Care workers and Care Managers from Social Services and do not require nursing care. Some service users are over the age of 65 and therefore the manager must submit an application for a variation for those service users to be included in the registration. This is an outstanding requirement from the previous inspection in January 05. Contracts for service users were in place these had been signed by the service users next of kin where possible. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 Service users care plans reflect their assessed and changing needs. Service users are encouraged to make choices and decisions about their lives and the daily activities in the home, areas of risk are assessed. Information about service users is not held securely which does not protect service users rights to have information kept private and confidential. EVIDENCE: The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 11 Each service user has a designated key worker. The home uses person centred care plans. The service user is involved as far as possible in setting up the care plan and much of the information about the service user had been put together using signs, pictures and photographs. Care plans sampled were in good detail and included risk assessment, activity plans, likes and dislikes. Care plans included individual procedures in relation to challenging behaviours. The records evidenced that reviews were generally taking place on time. The individual daily records for service users included participation in the daily running of the home as far as their abilities allow. It was evident that in bungalow 1 service users were being actively encouraged to participate in the home, this was an improvement from the last inspection. Risk assessments were in place for all areas of identified risk and steps had been taken to reduce risk where possible, clear guidance was given for staff. The bungalows have small office areas with lockable filing cabinets for some personal records but not lockable doors on the offices. Building plans to improve the homes include adequate office space with lockable doors. It will remain a requirement that personal records should be stored securely. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14 and 17 Service users are supported in maintaining their independence and in areas of personal development according to their needs and wishes. Service users are engaged in community life in so far as their abilities allow and enjoy a range of leisure activities. Service users enjoy a varied and nutritional diet. EVIDENCE: Service users have opportunities for personal development as documented in care plans and records of daily participation in the home. Service users had access to a speech therapist, as required. Service users have access to the day centre for various activities such as music, art and crafts and some community based activities and social clubs suited to their needs. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 13 Service users at the Pines have access to their local community. In general leisure facilities such as social clubs, horse riding, hydrotherapy, pubs, cafes and parks were accessed. It was noted that activities and outings in one bungalow had been significantly increased since the last inspection. The Home has 3 mini buses and an estate car for the benefit of service users. The homes menu records showed that service users are supported in choosing meals that are varied and healthy. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 and 21 Service users personal, physical and emotional health care is provided according to service users needs and wishes. The systems for medication administration are good with clear arrangements in place to ensure service users medication needs are met. Service users and their families’ wishes in respect of illness, ageing and death are respected. EVIDENCE: Care plans sampled were in good detail and provide staff with clear guidance to support service users with personal and health care needs. Individual preferences in respect of personal care were documented and staff confirmed that service users choices over clothing, hairstyle and general appearance were observed and personal support is provided in private. All service users have a designated key worker. Service users are supported to attend appointments and with treatment. Care records showed that service users health is monitored and prompt referrals are made. Staff were knowledgeable about medication procedures and the homes medication records were properly kept. Evidence was seen that the wishes of service users and their families in respect of illness and death are sought (where possible) and recorded. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 15 The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Service users and their relatives are provided with a copy of the complaints procedure. The homes policies and procedures protect service users from potential abuse. EVIDENCE: The homes complaints procedure was prominently displayed in each bungalow in a pictorial format, it was also available on audio tape. There had been no complaints made since the last inspection. Staff demonstrated knowledge of adult protection procedures and ‘whistleblowing’. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28 29 and 30. Service users generally have a homely, clean and comfortable environment. Some improvements in bungalow 1 have been made, however some areas of the bungalows remain shabby and in need of repair or redecoration which does not make a pleasant and pleasing environment. EVIDENCE: The Pines comprises of four detached bungalows set in partly secluded wooded area next to a resource centre. Accommodation is on the ground floor with eight single rooms and eight double rooms. The home does not meet the standards required for room sizes for some rooms. There is a lounge / dining room and separate kitchen in each bungalow these were decorated and furnished to an acceptable standard. There are communal gardens around the bungalows. There are no designated room for private conversations or meetings. The Inspector is aware that there are plans for future developments to the home to include adequate office space, a visitors’ room and to convert double rooms to singles. In general the bungalows presented as homely and comfortable. As highlighted in previous reports there are some concerns about the general maintenance of The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 18 the buildings. Work on repairing damaged plaster has been outstanding for over a year now in bungalow 2. The general décor in the corridors of bungalow 4 were very shabby, doorframes, skirting boards and doors have been badly damaged by wheelchairs. All of the toilets are sited in the bath/shower rooms, there are no designated toilets for staff. Assisted baths were in place and other bathing aids / equipment were seen. In bungalow one the shower room has paint peeling off the walls and the tile grout needed replacing. There was no toilet paper in either bathrooms and the toilet seat lid was stuck with packing tape. Bedrooms in all bungalows were found to be clean and furnished according to the needs of the service user they were decorated according to the needs and wishes of the occupant. Bedrooms were highly personalised with pictures, ornaments and in some rooms sensory lights and mobiles. It remains an outstanding requirement that the maintenance of the buildings be improved and be made comfortable and homely. There have been good improvements to the décor, cleanliness and furnishings of bungalow 1. These include curtains or blinds in service users rooms, new dining room furniture and a wash hand basin in the laundry. Clinical waste bins in all bungalows are now appropriately situated to prevent the risk of cross contamination. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 33 Service users do not have the benefit of a fully staffed, permanent team of carers working together to provide a consistent care service. Only limited progress has been made in addressing staffing shortages. In spite of this the staff have a good understanding of service users needs it was evident that positive relationships had formed between members of staff and service users. EVIDENCE: The staff duty rotas were viewed a high number of agency and bank staff are covering the vacancies to provide the level of care needed. Although every effort is made to ensure that the same agency or bank staff are used to provide as much continuity as possible service users do not benefit from a team of permanent staff. The manager stated that efforts to recruit were continuing and she hoped that when the home is not registered for nursing care there will be more success in filling vacancies. Staff were observed to respect service users and are accessible and approachable for service users. Staff demonstrated that they have the necessary skills and knowledge to meet individual needs of service users, including being good listeners and communicators, and able to deal with and anticipate problem behaviours. Service users benefited from permanent staff and agency staff having a clear understanding of their roles and the roles of others in the bungalows and the organisation. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 20 The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 Service users have benefited from the improvements made by the present manager who has a clear vision for the home, which she has effectively communicated to service users, relatives and staff. EVIDENCE: It was evident from discussion with staff that the Manager provides clear and open leadership throughout the home. Since this inspection took place the manager has made an application to be registered for the home. The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 2 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 2 2 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 x 1 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Pines Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 23 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 YA3 Regulation CSA 24 Requirement Section 24 The service users assessed needs must be within the homes registered category. A variation is required for any service users over the age of 65. Staffing18. - (1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users - (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users;(b) ensure that the employment of any persons on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs; Fitness of Premises 23 (2) (b) & (d) The home should be well decorated and maintained internally with furniture, fixings and fittings in good repair and suitable for purpose. Timescale for action 30/06/05 2. YA33 18 Action plan with timecsales 3. YA24 23 Action plan with timescales The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 24 4. YA10 17 This remains a requirement with regards to maintenance for hallways, doors and the shower room in bungalow 1. Records 17 (1) (b) Personal records should be stored securely. Offices should be fitted with doors, which can be locked. This remains a requirement. Action plan with timescales. 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 Good Practice Recommendations The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent TN16 9NT 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 The Pines H56-H06 S26197 The Pines V227907 230505 Stage 4.doc Version 1.30 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!