Inspection on 27/04/07 for The Pines

This inspection was carried out on 27th April 2007.

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

The inspector 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 19/07/06

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 The Pines 2 Flint Cottages Culford Road Fornham St Martin Suffolk IP28 6TN Lead Inspector Jane Offord Unannounced Inspection 27th April 2007 13.30 The Pines DS0000067369.V333810.R01.S.doc Version 5.2 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 The Pines DS0000067369.V333810.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 Adults 18-65. 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. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Pines Address 2 Flint Cottages Culford Road Fornham St Martin Suffolk IP28 6TN 01284 705062 F/P 01284 705062 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.concensusupport.com Caring Homes Healthcare Group Ltd Matthew Philip Dale Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2006 Brief Description of the Service: Flint Cottages is set in a rural position in a small village outside Bury St Edmunds. It comprises of two buildings: Pines House and Pines House Annex. Pines House provides purpose built ground floor accommodation for 6 residents in single bedrooms, one of which has en suite facilities. Communal space comprises of an open plan sitting and dining area. The first floor flat is at present vacant and there are plans to refurbish it to provide accommodation for a further three residents. The Annex is attached to Pines house and had an interconnecting door, however, this is rarely used and the two facilities are viewed as separate homes. The Annex caters for residents who are relatively independent and provides four single bedrooms all with ensuite. Communal space is a lounge/diner and a large galley kitchen. The garden is well kept and mainly lawn with a mixture of mature and newly planted trees, flowerbeds and patio areas next to the buildings. There is ample parking for staff and visitors in front of the Annex. Fees for this home currently range from £515 to £675. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection looking at the core standards for care of adults took place on a weekday between 13.30 and 17.00. The manager had a day off but the two team leaders were helpful and informative during the inspection. This inspection follows a random inspection undertaken in January 2007 to follow up requirements left at the key inspection done in July 2006. Five further requirements were left as a result of the random inspection. This report is compiled from information available and evidence found at the inspection. The files and care plans of two residents were seen as well as a number of other documents and records. A tour of both parts of the home was undertaken and a number of staff and residents were spoken with in the course of the visit. Interactions between staff and residents were observed. On the day of inspection the weather was sunny and warm and residents were taking advantage of it with doors and windows open to let any breeze into the house. They were using all areas of the home and appeared relaxed and comfortable. The home was clean and tidy. What the service does well: What has improved since the last inspection? Two requirements were left at the last inspection with regard to repairs needed in the house. Both these have been actioned and the repairs taken place. Regular residents’ meetings take place in both the Pines and the Annexe. Wide discussion is held and minutes are made available. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 6 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 summary of this inspection report can be made available in other formats on request. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Pines DS0000067369.V333810.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4. Quality in this outcome area is good. People who use this service can expect to have an assessment of need before admission and the opportunity to ‘test drive’ the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents files were seen. One was for a resident who has lived at the Pines for a number of years and one for a recently admitted resident. In the file for the recently admitted resident there was a full pre-admission assessment of need. The resident had stayed three days in the home and the manager had made the assessment during that time. It was recorded that the resident understood that they were visiting the Pines to ‘try it out’. The assessment covered areas of health need that the resident may need support with such as personal care, mobility, diet and communication. There was also evidence of information about the resident’s preferred activities, relationships, behaviour and financial management. Since being taken over by Caring Homes Ltd. a new Statement of Purpose has been produced and a Service Users Guide that contains pictorial information is available to prospective residents and their representatives. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. People who use this service can expect to have a plan of care in place to help staff support them to make their own decisions about their individual lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both files seen contained a plan of care that covered areas of daily living that the resident required support in. The plans were signed by the resident and there was evidence that they were reviewed with the resident on a regular basis. Areas covered included continence, managing medication, mobility and personal hygiene. The interventions were worded to maintain independence as much as possible, and dignity during personal needs. The interventions for daily living activities covered support to access community activities, managing household tasks such as changing bed linen and cooking, building on life skills like literacy, numeracy and managing money. One intervention said, ‘XXXX can recognise some coins but does not understand their value. Will need support with shopping’. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 10 Residents were encouraged to identify personal goals they wished to achieve. One record showed the resident had had a special diet prescribed by the GP to help with weight loss and the goal identified by the resident was to, ‘maintain my diet and remain fit and mobile’. Another record showed the resident’s goals were to enrol on a college course and maintain contact with their family. Daily records were informative about the activities the residents had done but also included details of moods and behaviour. One record noted, ‘tearful today as worried about whether they will stay in the home. Reassured by staff’. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. People who use this service can expect to be encouraged to maintain contact with family and friends, to participate in activities in the community and to receive a balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has a weekly plan of the various day services or work placements they attend. Day services available locally to people with a learning disability include Wood ‘n Stuff, community resource units and Nowton park. Work opportunities are available in some charity shops. Social contact is maintained by accessing a variety of clubs such as Gateway, the befrienders club, the Causeway and a cinema club. Some residents enjoy sports and swimming and access a local sports club. The weekly plan for one resident included bowling but also left time for domestic tasks such as tidying their room. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 12 Files contained details of a resident’s religious persuasion and whether they wished to attend the local church services. Each file seen had details of the next of kin and how to contact them. One file recorded that there was family contact weekly with the resident and all files seen had a life history with details of family members such as brothers, sisters, parents and cousins. Individual rooms seen frequently had family photographs on display. Among the residents in the home on the day of inspection there was discussion about a walk that one resident had taken during the morning to visit a friend and see their cats and pet rat. Others talked about a holiday that was planned in a few weeks time to spend a week in a caravan near the seaside. One resident wanted a new swimsuit bought in preparation. Menus were seen that had pictures of prepared meals to help residents choose the meals they liked. The residents decided meals and they took turns to go to the local supermarket to shop for the ingredients. The timing of this inspection meant that a mealtime was not observed but residents were offered cups of tea or cold drinks during the afternoon. The food stores were seen and showed a good selection of fresh food. Food stored in refrigerators was labelled and the temperature records showed that the refrigerators were functioning at safe levels for food storage. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. People who use this service can expect to have their health needs met and be protected by the medication administration practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each file seen contained contact details for health professionals involved with the resident’s care for example GP, dentist, psychiatrist and optician. There was information about past medical history, an assessment of overall health and details of the medication the resident was taking. Records were kept of visits to health professionals and hospital appointments. There was evidence that age and gender specific routine screenings had been carried out. Practice observed on the day showed staff listened to residents and responded to requests for support or help. One resident was given a cup of tea but asked if some could be poured away as they could not safely manage such a full cup. The carer willingly did so and the resident enjoyed their tea. Residents spoken with said staff were, ‘nice and fun’. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 14 The home has a monitored dosage system (MDS) to manage medication. Blister packs are prepared by a local pharmacy following the residents’ prescriptions and delivered monthly to the home. Staff spoken with said the service was good and they were always able to get a new prescription filled quickly. Medication administration records (MAR sheets) were seen and found to be correctly completed with codes appropriately used if medication was not administered for any reason. An audit trail for individual medicines was in place. The home has a comprehensive medication policy covering storing, administering and disposing of medicines. Staff spoken with confirmed they had received recent training in medication management. A training pack was seen that enabled senior staff to train new staff and assess their competency before allowing them to administer medication. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. People who use this service can expect to be protected from abuse but cannot be assured that records of investigations and outcomes of complaints will be completed fully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints log was seen and showed that the complaint that had previously not been recorded was now there but the evidence of investigation and the outcome was very sparse. This issue had been raised during the random inspection done in January 2007 and is not yet resolved. The copy of the complaints policy seen contained the address of the CSCI office in Shrewsbury not the local office in Ipswich. Staff spoken with confirmed that POVA was covered in their induction programme and they had had leaflets and seen a video on the subject. POVA is also covered during NVQ study and the present staff team all hold an NVQ qualification. Staff spoken with were clear about their duty of care. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. People who use this service can expect to live in a clean, homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the Pines and the Annexe was undertaken and everywhere was clean and tidy. The rooms all had plenty of natural light and felt spacious. Residents’ individual rooms were personalised with different soft furnishings, pictures and photographs and evidence of the resident’s particular interests. The rooms all had views over the garden that went around the house. There were no unpleasant odours noted. Hand washing facilities and protective clothing were supplied to prevent cross infection. The toilet seat in the front toilet in the Annexe was broken and had been removed from the toilet and left propped against the wall. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 17 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is adequate. People who use this service can expect to be supported by adequate numbers of staff but cannot be assured that evidence of all the correct recruitment checks will be available or that the organisation has given updated training to the team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous key inspection had identified that the dependency of the residents did not balance with the numbers of staff rostered to meet those needs and an immediate requirement was left to re-assess needs and roster staffing levels to meet them. During the random inspection evidence was seen that staffing levels had been adjusted to match the residents’ assessed needs. During this inspection the duty rotas showed that there were two staff on duty every day between 8.00 and 22.00. The manager is on call at all times and works some administrative shifts and does some care shifts. A sleeping-in person covers nighttime. Staff spoken with said the mornings were the busiest shifts but two staff were sufficient to support the residents. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 18 The present staff team members currently hold or are training for an NVQ level 2 or 3 qualification. All mandatory training is covered by the studies for the NVQ but training records showed that no in-house training has been given to the staff team recently. Staff spoken with confirmed this but said the organisation was planning to offer a comprehensive training package delivered by their own trainer to be commenced in the next month. The file of a new member of staff was inspected and it contained two references, the notes from the interview and a full work history. There was a recent photograph of the person and evidence that a CRB check had been applied for. The file did not contain any copies of the documents used for identification purposes to complete the CRB request and evidence that a POVA 1st check had been done prior to commencing in post was not seen during the inspection but later supplied to the CSCI office. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 19 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate. People who use this service can expect to be consulted about the service but cannot be assured that their welfare will be protected at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post nearly a year but has several years experience at a senior level of management in care homes for people with learning disabilities. They have achieved an NVQ level 4 and the registered managers award. The minutes of residents’ meetings were seen. Meetings are held every two months, one for the Pines’ residents and one for the Annexe. The minutes showed a wide range of issues was discussed. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 20 The residents talked about outings and planned for their holidays away. There was a discussion about meal planning and the shopping for food. A new way of managing the activity was proposed and agreement was reached to try it out. Residents raised awareness of any repairs required in the home and requested that a sign be made for the front drive so people visiting the home could identify that it was the Pines. They said taxi drivers often could not find the home, as there was no name or number evident and a tall hedge hiding the house. Observation of interactions between staff and residents showed that staff valued and respected residents’ choices and opinions. Certificates and records seen showed that an external engineer had checked the fire alarms and emergency lighting on 17/4/07 and passed them all. The gas safety certificate was valid until September 2007. Water temperature records showed hot water was delivered on or near 43 degrees the recommended safe level and refrigerator temperatures were safe for food storage. A walking route check of fire equipment, flooring, furniture, general maintenance needs and windows is carried out weekly. Records show that during the check in February a fire door in the kitchen of the Annexe was not closing fully. No action had been taken and on the day of inspection the fault was still present. An immediate requirement in respect of the door was left. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 21 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 Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 1 X The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES. 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 YA22 Regulation 22 Requirement Timescale for action 27/04/07 2. YA34 19 (1) (b) (i) 3. YA42 23 (4) (c) (iv) 23 (2) (b) 4. YA42 The complaints policy must contain relevant local details and there must be full evidence of the investigation of any complaint available to make sure that residents know their concerns are taken seriously. 27/04/07 There must be full compliance with the recruitment requirements specified in Schedule 2 and the documentary evidence must be available for inspection at any time. This is to ensure residents are supported by appropriate staff. Although this requirement is not exactly the same as previously, a requirement under Regulation 19 has been made in the past. Steps must be taken to maintain 27/04/07 fire doors and equipment in good working order to protect residents. Repairs to essential facilities 31/05/07 such as toilets must be carried out urgently to maintain a safe environment for the residents. The Pines DS0000067369.V333810.R01.S.doc Version 5.2 Page 23 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 YA35 Good Practice Recommendations Plans for in-house training updates for staff should go ahead to make sure residents are supported by staff trained for the job. 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