Inspection on 25/10/05 for The Pines

This inspection was carried out on 25th October 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 1 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 23/05/05

The Pines 27/01/05

The Pines 14/05/04

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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 Paul Stibbons Announced 25 October 2005 10:30 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 V247659 251005 Stage 4.doc Version 1.40 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 CRH Care Home 24 Category(ies) of Learning disability (24) registration, with number of places The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care of 2 service users who are over 65 years of age is restricted to two persons whose date of births are 05/11/23 and 03/03/20. Date of last inspection 23 May 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. Avenues Trust have applied for a variation to the registration to be a care home for younger adults without nursing. The Pines comprises of four detached bungalows set in a 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. Accomodation is on the ground floor with eight single rooms and eight double rooms. There is a lounge/dining room, separate kitchen and bathrooms in each bungalow. All staff work on a shift roster which includes a waking night. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulatory Inspector Paul Stibbons carried out this announced inspection. Time was spent with the Site Manager and Service Manager discussing responses to comment cards received back from relatives and other Health care professionals. 11 comment cards were received from relatives who all stated they were satisfied with the overall care provided, however, 5 did state that in their opinion there was not always sufficient numbers of staff on duty. Only 1 comment card was received back from a Health and Social Care professional and this was a very negative response, stating that the home often fails to keep appointments without informing them and that service users are usually accompanied by agency staff who are unable to agree to decisions. The Pre-Inspection questionnaire and Providers self-audit was received from the Site Manager prior to the inspection. A tour of the buildings was conducted accompanied by the Site Manager. Due to the communication disabilities of some service users it is difficult to reliably incorporate accurate reflections of the service users in the report. Some judgements about their quality of life and choices were taken from direct conversation with and observations of service users, followed by discussions with staff and a review of records held in the home. What the service does well: What has improved since the last inspection? Since the last inspection interviews for more staff have taken place. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 6 The service has purchased a new fridge/freezer and some garden furniture, also a three-piece suite and curtains have been ordered for one bungalow. A garden fence has been erected to protect the privacy of neighbours and service users. More lockable files have been purchased to store confidential files. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 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 V247659 251005 Stage 4.doc Version 1.40 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) 2, 3, 5 Service users know that their needs have been assessed and that the home is able to meet those needs within the terms of an agreed written contract. EVIDENCE: Service users have a comprehensive assessment of their needs covering all aspects of their lives and includes their social, physical and emotional needs. Care plans viewed evidenced assessments by Health and Social care professionals and support plans guided staff on the delivery of care and the use of specialised equipment where relevant. Staff spoken with demonstrated a good understanding of the individual and joint needs of service users. Contracts for individual service users were in place stating terms and conditions; these were signed by a representative of the service, but not all of them by the service user or their representative. It is recommended that the contracts are reviewed and signed. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 9 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, 9, 10 Individual care plans reflect service users’ assessed needs and personal goals within a risk assessed framework. There is room for improvement in maintaining confidentiality of service users’ information. EVIDENCE: The home uses person centred planning to gain a holistic view of service users’ needs and personal goals. Through their designated keyworker and the use of signs, pictures and photographs, service users are involved as far as possible in expressing their wishes. Care plans detailed activities, likes and dislikes and associated risk assessments. The bungalows have small office areas with lockable filing cabinets for some personal records but not lockable doors on the offices. The inspector is concerned that documents in use could have open access if the office is left unattended at any time. It is acknowledged that future building plans are to address this issue but in the meantime it is recommended that procedures such as a “clear desk” policy should in place for security of information when left unattended. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 10 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) 12, 13, 14, 15, 16 Service users are supported in maintaining their independence and areas of personal development. They have the opportunity to participate in a range of activities on site and in the community where they can develop friendships. Family contacts are actively promoted. EVIDENCE: Service users have access to on-site day centre facilities for a variety of activities such as music, art and crafts and some of their work was displayed in the home. The manager stated that all service users have an annual holiday and leisure opportunities include horse riding, swimming, visits to local parks and restaurants. Visits to social clubs and public houses afford the opportunity to develop friendships within the community. Staff were seen to treat service users with respect and meaningful interaction was observed. One keyworker showed the inspector, through various records, how they monitored participation and encouraged decision making by service users. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 11 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) 19, 20, 21 Service users’ health needs are fully met and monitored by the multidisciplinary team. They are unable to administer their own medication and are supported by competent staff using safe procedures. Their wishes in respect of illness, ageing and death are respected. EVIDENCE: Care plans evidenced various charts for monitoring health and referrals to relevant health professionals where appropriate. Service users are supported to attend appointments and for treatment, however, one comment card received back from a health care professional did state that often appointments were not kept and the service failed to inform them in advance. None of the service users are able to administer their own medication and are supported by staff who have received training and have been assessed as competent. Medication procedures were inspected and seen to be stored, administered and recorded in line with Royal Pharmaceutical Society guidance for the safety of service users. The wishes of service users and their familes, in respect of death, are detailed in a document called “When I die”. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 12 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 Service users and their relatives are provided with a copy of the home’s complaints procedures. EVIDENCE: The home’s complaints procedure is prominently displayed in each bungalow in a pictorial format and also available on audiotape. The manager stated that there had been no complaints since the last inspection. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 13 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, 28, 29, 30 Service users generally live in a homely, clean and comfortable environment; however, some areas of the bungalows are in need of repair and redecoration. Not all of the bedrooms meet the needs of service users. EVIDENCE: The exterior of the buildings require maintenance as the guttering has vegetation growing in it that will result in longer term damage if not removed. A new fence has been erected in the gardens to protect the privacy of neighbours and service users and new garden furniture has been purchased. Some redecoration of the homes has taken place but there are still areas that require attention. Tiles are missing from the bathroom in bungalow 1 and in bungalow 4, one service user’s bedroom has damaged walls and furniture. The manager stated that she has submitted a maintenance and renewal plan to the Provider to address these issues; it remains a requirement to implement the plan. A new three-piece suite and curtains are on order and a new fridge/freezer has been purchased. Not all of the service users have a bedroom that meets their needs; two ladies sharing a double room disturb each other during the night and early morning, another service users room is too small to accommodate a hoist that is required to transfer him from The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 14 wheelchair to bed. It is recommended that accommodation for these particular service users be reviewed. Bedrooms were adequately furnished and decorated to the preferences of service users and personal possessions were displayed reflecting the personalities and lifestyles of service users. Specialist equipment in the form of assisted baths, hoists are regularly serviced annually. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 15 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) 32, 33, 35 Service users are supported by a competent and qualified staff team but staffing levels are only maintained through a high level of use of bank and agency staff. The staff team have the skills to meet the individual and joint needs of service users. EVIDENCE: Currently the home has three members of staff with an NVQ level 2 qualification, five with an NVQ level 3, one with an NVQ level 4 and two who have NVQ assessor qualifications. In addition a further two staff are working towards NVQ level 3, two who are working towards the Registered Manager’s Award and one towards the NVQ assessor’s award. Of eleven comment cards received by the Commission from relatives, five were of the opinion that there were insufficient numbers of staff on duty. The manager stated that staffing levels were never allowed to fall below agreed levels but conceded this could only be achieved by using high levels of bank and agency staff. The majority of bank and agency staff used are regular and therefore familiar with the service users. Efforts to recruit permanent members of staff is ongoing and it is a recommended that these efforts continue. Interaction observed between staff and service users demonstrated a good understanding of service users’ needs. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 16 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, 39, 42 Service users benefit from living in a home that is run by a qualified, approachable and competent manager who is currently unregistered by the Commission. There is some dispute as to whether service user representative’s views are part of any development by the home. EVIDENCE: The site manager has GNVQ level 4 in Health and Social Care, The Diploma in Welfare Studies and is currently completing the Registered Manager’s Award. House managers spoken to said the manager was approachable and that improvements had taken place since her appointment. The home intends to de-register as a nursing home and correspondence forwarded to the commission from “Parents, Relatives and Friends of The Pines” group alleges that a lack of consultation had taken place between the Provider and the service users’ representatives. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 17 The health, safety and welfare of service users is promoted through staff training, monthly audits and policies and procedures in place. The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 18 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 x 3 3 x 2 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 2 x 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x 3 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Pines Score x 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 19 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 YA24 Regulation 23(2)b.d. Timescale for action The home should be kept in a By good state of repair externally February and internally and all parts of the 2006 home kept clean and reasonably decorated. This refers to external guttering and internal tiling and decoration. Requirement 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. Refer to Standard YA5 YA10 YA25 YA26 Good Practice Recommendations Service users contracts should be signed by the service user or their representative. Procedures should be in place to ensure confidentiality of information when left unattended. A review of accomodation for service users in a shared room where not compatable should take place. Service users who require the use of equipment in their rooms should be accomodated in a room capable of taking that equipment. Recruitment of staff should continue to reduce the reliance on bank and agency staff. 4. YA33 The Pines H56-H06 S26197 The Pines V247659 251005 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 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 V247659 251005 Stage 4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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