Inspection on 06/06/06 for The Pines

This inspection was carried out on 6th June 2006.

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 05/12/05

The Pines 06/06/05

The Pines 09/12/04

The Pines 28/06/04

The Pines 24/02/04

The Pines 14/04/03

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Pines The Pines Hostel Mayfield Road Orrell Wigan Lancashire WN5 0HZ Lead Inspector Lindsey Withers Key Unannounced Inspection 6th June 2006 07:50 The Pines DS0000032683.V294343.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 DS0000032683.V294343.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 DS0000032683.V294343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Pines Address 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) The Pines Hostel Mayfield Road Orrell Wigan Lancashire WN5 0HZ 01942 760015 01942 621320 Wigan Council Social Services Department Mrs Ellen Prescott Care Home 29 Category(ies) of Learning disability (29), Learning disability over registration, with number 65 years of age (6) of places The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Within the maximum numbers registered there can be up to 29 LD and up to 6 LD(E) The service should at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Staffing levels are to be calculated in accordance with a Residential Forum Staffing Guidance (Older People) by 1 April 2004. The matters detailed in the attached schedule of requirements must be completed within the stated timescales. 5th December 2005 Date of last inspection Brief Description of the Service: The Pines is a local authority residential care home, registered to provide care for up to 29 residents of either sex who are over the age of 18 and who have a learning disability. Six residents may be over the age of 65 years. Of the 29 places, 5 are currently used to provide short term care, though this is currently under review. The Pines is a two storey building. Each resident has a single bedroom. There is a large lounge/dining room and a smaller lounge area. At the rear of the premises, there is courtyard garden with a paved patio. Garden furniture is provided which residents enjoy using in the better weather. The fees for this home are based on individual assessment and may differ from one person to another. Any charges made are determined in accordance with the local authority’s charging policy for residential care services. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was to look at the main “key” standards in order to assess the level to which The Pines meets the needs and expectations of residents. Part of this inspection involved an unannounced site visit to the home on 6th June 2006 from 7.50 a.m. to 1 p.m. and a further visit on 8th June 2006 from 2 p.m. to 5 p.m. This was in order to meet with as many residents as possible before or after they went out to the day’s activity. Part of the time was spent looking at the paperwork that the home needs to keep to show that it is being run and managed properly, and part of the time looking around the home and watching how people are cared for. In order to get a wider view of life at The Pines, as well as speaking to residents and staff at the home during these site visits, the inspector has taken account of comments cards that had been returned to CSCI from residents, relatives, and people who visit the home, like nurses and doctors. In making the judgements contained in this report, the Inspector has also considered previous inspection reports, and any other visits that were made to the home. What the service does well: What has improved since the last inspection? Since the last inspection at The Pines on 5th December 2005, there have been some improvements to the premises. Some bedrooms have been decorated, and some were in the process of being decorated on 6th and 8th June 2006. There are plans to recarpet and paint corridors, and to attend to the roof. Improvements have been made to the plans that set out the needs of residents, information on the home’s confidentiality policy is more widely available, and bereavement training for staff is being planned. The Pines DS0000032683.V294343.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 Pines DS0000032683.V294343.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 DS0000032683.V294343.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Prospective users of the service provided by The Pines can be assured their needs and aspirations will be assessed prior to a placement being arranged. EVIDENCE: Records for four people were looked at, including those for one person taking a short term break at the home, and one recently admitted person. A full history had been collected as part of the pre-admission assessment process, so that the persons life could be tracked through their involvement with health and social services. Copies of care management plans prepared by social services officers were held on file. The specialist needs and any potential risks to the individual had been identified and the action taken recorded. Copies of e-mails between social services and other offices had also been put on file to demonstrate continuity of information. Details of all important contacts were recorded. There was evidence that the contacts page is reviewed and amended, for example, for those accessing regular respite care. There was also evidence that an individual’s needs and aspirations had been discussed and agreed with the prospective service user and/or their representative. For example, the records showed that one person had regular access to short breaks throughout the year. Help notes were reviewed at each admission. For other residents, the extent of access to, and involvement with, families and other supporters had been recorded and planned for. The inspector saw the The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 9 arrangements that are put in place when a person is admitted for respite care, for example, the preparation for receipt of possessions, medication, etc. There had been no referrals from anyone from an ethnic minority. Discussing this with the Manager, she said that a persons social or cultural background had no effect on the standard of care provided. Each person is assessed on his or her individual needs, and the care package is devised specifically for them i.e. focussing on the individual (known as “person-centred”). In the event of a referral from a person from an ethnic minority, the Manager said she would seek assistance from that persons community. However, she said this was much the same as she would do for any prospective resident. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents can expect to be involved in developing their plan of care, which will take account of their needs and aspirations. Residents are able to make decisions about their lives, and will receive assistance where it is needed. As part of an independent lifestyle, residents are able to take risks and are supported appropriately. EVIDENCE: Four care plans were looked at. All had been generated from the initial assessment. The records contained highly detailed information, emphasising the persons skills and identifying where help is needed. Individual aspirations and needs had been recorded, together with the support that the person would need in order to achieve his or her goals. Individualised procedures were on file. These focussed on positive ability and encouraging co-operation. Any unusual behaviour was dealt with quickly and with respect, so that the persons dignity was maintained. Each resident has a keyworker who will have had appropriate specialist training in order to have full involvement with the resident. There was evidence that the care plans had been reviewed six The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 11 monthly. For example, one person had had a Six Monthly Review Meeting in May, the record for which clearly indicated the extent of the resident’s involvement in the review. The Review document has more pictures than words and has been introduced recently. The document had been an objective of a senior carer to achieve, and formed part of the person’s training and development programme. As with the care plan, the review documents are written in the first person and so focus on the individual. Comments in the resident’s review included: happy with accommodation and support”. Hopes and expectations had been expressed, were recorded, and an action plan devised. With this and a second example that were looked at, there was strong evidence to confirm that the resident had been included and involved. There was good evidence to show what planning was being done for people moving to more independent living. Reviews were being conducted regularly with the multi-disciplinary team helping the resident to plan the move. However, the outcome of these reviews are not linking back to the homes care plan. A recommendation is made that this be done, so that complete information is maintained. Two people took time to speak to the Inspector, one of whom would be moving soon and one who was in the early stages of preparation. Both were practising domestic skills (under supervision from staff) that would prove useful in the future. The inspector saw evidence of staff respecting residents’ right to make decisions: e.g. whether or not to attend the day centre. There was evidence in care plans where a resident has changed how they want to do something e.g. college attendance, and there was evidence in care plans where decisions have been made on behalf of the resident e.g. for a person who has limited ability to make choices for themself. Decisions appear to have been made in the best interest of the resident. The inspector saw how residents manage their own finances, for example, one person going to the shop. The Manager said that residents buy their own sweets and snacks; one person had been for a new top. One person spoke about having money that was kept safely for them. The person knew where it was kept and how to get it. Any appointee arrangements are clearly documented in care plans. Care plans record assessed areas of risk, for example, in relation to bathing, showering, and going out alone, and there is good information on file to confirm how these risks have been identified. Aids and adaptations are arranged to help residents remain independent but within safe boundaries. This might involve speaking to a health professional, such as an occupational therapist. Risk assessments also record the extent of staff support required, for example, two carers to assist or support one resident. One person said they were left to their own devices within The Pines: the person could go out to the shop, or run errands, so long as staff were told. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 12 4 comment cards were received by CSCI from residents. Two people said staff were “always” available when you need them, and two people said “sometimes”. One person said that if staff were busy “theyll tell you 1 minute. 3 comment cards were received by CSCI from relatives. One person felt they were not kept informed of important matters affecting their relative, but two did. One person felt they were not consulted with, but two did. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents can be assured that they will be helped to live as full and as active a life as they would wish, and that their right to independence and dignity will be upheld. EVIDENCE: Of the four people whose care was being looked at during this visit, two attend college on a regular basis. One person said they very much enjoyed the classes, had learned a lot and hoped to get some paid employment eventually. One person’s classes had just been introduced but the enjoyment could not be measured as the person offered no responses to questions from the inspector. One person works three shifts per week at a local supermarket which, the person enjoyed. This person is the homes gardener and has planted up all the baskets and tubs. Staff acknowledged the residents ‘green fingers’. One person does some gardening work one day per week which they liked, because its outdoors and keeps me fit. The inspector spoke to residents returning from activities. Residents were happy to describe what they had been doing, The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 14 and were full of conversation about how they had spent their time, whether it was doing arts and crafts, singing, or doing college work. There was good evidence, therefore, that education and occupation is geared to the individual, and is appropriate to them. Residents spoke about going to the cinema (one person was going one afternoon and would have pizza – which the person later said had been enjoyed – and two other residents were going with support workers from the Pines in the evening), the gym and swimming, or shopping (either alone to a local shop or further afield with support workers). One person enjoys singing at church and is a regular attender. Events in the local community are displayed on a noticeboard, for example, some residents were thinking about going to the circus. Transport is arranged either via the local authority, public transport, or taxi. When staff from The Pines are not supporting residents, this is provided by support workers employed by the local authority. These are known to the residents. New support workers are gradually introduced. Those residents who had not been out on activities had spent time in the garden, where lots of shade was available and appreciated. The inspector saw that the majority of residents have television or music systems in their bedrooms. Two male residents spend time together playing records. There are TV and music systems in each of the lounges. Breakfast and lunch and tea were observed on the two days comprising the site visit. Breakfast was served flexibly in the dining room – with the last person eating at 9.45 a.m. Hot and cold options were available, with as much or as little as each person wanted. Lots of hot and cold drinks were available throughout the day. Some residents going out for the day took a packed lunch, prepared to their choice by the cook. At lunch-time a good variety of food was available, with hot and cold options. Sandwiches were prepared using different breads and fillings, jacket potatoes, home made soup, and omelettes. A number of residents who go out for the day have a full meal at lunch-time (for example, in the day centre) so do not want a full meal at teatime. However, full range of tea-time options were offered, including light meals and snacks. Tea on the 8th June was a “grand buffet” requested by residents due to very hot weather. A selection of hot and cold options were available, and it was seen that residents had substantial plate-fulls. It was noted some residents had food served in large pasta bowls to help them eat independently. There was lots of conversation between residents, and between staff and residents creating a convivial and relaxed atmosphere. At least one member of staff sat down at each table. The inspector heard residents reminding staff that X didnt like such and such, and saw residents helping each other – for example, getting a knife and fork, ordering a cold drink. Staff used different communication techniques to determine what choice the resident wished to make. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 15 The Cook said that residents get involved in the planning meals. There are three visits per week to the supermarket, with residents, where they have exposure to all the different foods available, including those that are in season. Residents are encouraged to try new foods: a current favourite is cous-cous. The cook said a curry will be made from good, basic ingredients, including herbs and spices. He said he felt it was important for residents to understand what ingredients went into making a meal and how it was prepared. Although residents did not use the main kitchen, if they wished to cook or bake something, they could be supported to do this using the domestic kitchen in the flat. The inspector saw residents speaking directly with cooks to request their meals and drinks. Each of the cooks checked to see what was eaten and whether more was wanted. Aids and adaptations were available for those residents who needed assistance, plus individual 1:1 support for those who could not eat independently. One person was provided with a pureed diet and two residents were offered thickened drinks that would be nourishing and easier to drink for someone who had swallowing difficulties. Nutritional needs are recorded in the care plan, for example, eating disorders or food intolerances, and several residents are diabetic and take a special diet. Staff were familiar with individual needs. As part of the healthy lifestyle that is encouraged within the home, residents are not routinely offered snacks and biscuits, but they are available if required. For example, one person said that when her visitors come they have tea and biscuits. Fizzy drinks are the low or sugar free variety. Residents tend to purchase sweets and confectionery from their own money. Residents described the food as lovely and very good, said there were different things to eat, and that there was plenty of food. One of the Cooks has attended recent training and had a copy of the CSCIs In Focus Highlight of the Day. 4 comment cards were received by CSCI from residents. Two people said they “always” like the meals at the home, one said “usually”, and one said “sometimes”. One person thought residents who had liquidised food and those who are diabetic should have more choice. One person said there are “usually” activities arranged by the home (but sometimes the person chose not to go), one person said “sometimes” (but suggested more outdoor activities for people in wheelchairs and for people who can walk), one person said “always” (and gave examples of shopping, cinema, trips out on public transport), and one person said “sometimes” (but made no further comment). 3 comment cards were received by CSCI from relatives. One person felt that there were not always sufficient staff for outside activities but others made no comment that related to this section of the report. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 18, 19, and 20 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents receive personal and healthcare support that is appropriate to them, and which is reviewed regularly and changed when it is needed. However, care must be taken to ensure medication that is not properly administered is recorded. EVIDENCE: Observation of the way that staff went about their work showed that they were receptive to residents and the way that they wished to be helped. Staff asked, Would you like me to ..., Shall I .. Who would you like to help you? Female residents obviously enjoyed the fact that staff helped them to style their hair (bringing hair brushes and hair bands) or choose the best top for the days weather. Residents were helped to put on jewellery and reminded about wearing spectacles. Residents are encouraged to change inappropriate clothing and helped to change clothing that had become dirty. There were lots of technical aids and equipment available that residents and staff appeared to be familiar with. Two members of staff said they had received training on each piece of equipment. The records showed that occupational therapist and physiotherapists had been involved in determining the appropriateness of the aids and equipment for the individual residents. Review documentation The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 17 showed that residents had been asked their views on the help they were given and whether they found it to be satisfactory. Each resident has a designated keyworker, which can be changed if the resident wishes this. Any new support worker is gradually introduced to a resident, and an example of this phased introduction was seen on the first day of this visit to the home. One resident pointed out her keyworker to the Inspector. Two members of staff spoke about the role of the keyworker and the responsibilities they had, and which they felt strongly about fulfilling to the best of their ability. Staff said that each member of staff must read the communication briefing when coming on to shift to check up on what has been happening to residents, and alerting them to anything they should be bearing in mind. Staff must sign to confirm they have read the briefing. One member of staff thought this was really important, indicating that, “you cannt provide the right care if you dont know what is going on”. The inspector noted that all staff were reading the briefing, including domestic staff. Staff must also read care plans so that they are aware of residents mental and physical health conditions and the assistance that they require. The records showed that residents physical and emotional needs are identified and that action is taken to meet them. For example, one resident had suffered a bereavement and family contact was being maintained and encouraged for this person. Other people had had their physical needs met in different ways, for example, being seen by a dentist, chiropodist, diabetic specialist, or a speech and language therapist. A good example of how residents are helped to decide what treatment they need if they feel unwell – for example, having a lie down, seeing a GP, etc. - was observed during this site visit. Medication is dispensed by senior members of staff. The inspector saw the morning medication round in progress. Medication was administered as each person came to breakfast. Different techniques were seen that helped the residents take their medication in a way that suited them. Staff were seen to check that medication had been taken properly. A minor ommission was seen in the medication sheets where a record had not been made when a person spat out their medication. The Manager said that ordinarily this would be noted in the staff communication book or on the reverse of the MAR sheet to say that the administration had not been successful. However, the record had not been made on this occasion. The inspector saw residents being helped with inhalers so that staff could check the person had taken the full dose. Staff were quick to help one person who had breathing difficulties because of the hot weather. They responded immediately by administering the inhaler. Residents coming for short term break have their medication checked in at the time of admission. There is a set process for this, and for checking them out again when the person leaves. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 18 In 4 comment cards returned to CSCI from residents, two said they “always” received the care and support they needed, and two said “usually”. Four people said they “always” receive the medical support they needed One person said that senior care staff are very good with helping me ... when I need it. In 3 comment cards returned to CSCI from relatives: two people were satisfied with the overall care provided, but one was not. 1 comment card was returned to CSCI from a GP. All comments made on the card were positive about the care provided at The Pines. 2 comment cards were returned to CSCI from health and social care professionals: both contained positive comments throughout. One person said, I have been involved with the Pines for many years. Staff will always do their utmost to accommodate us and are excellent in emergency situations. Their care and attention to service users is very good both to permanent residents and to those using respite. The second person said, The staff at The Pines have worked hard to understand the risks associated with my clients syndrome and health needs. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The residents at The Pines are able to express their views, know that they will be listened to, and that action will be taken. However, care must be taken to show the complaint outcomes are always recorded. The home has a policy and procedure for protecting vulnerable people that staff are trained in and are familiar with. Residents can be assured they will be protected from abuse or harm. EVIDENCE: The Pines had received 5 complaints from residents, four of them from one person. There was, therefore, evidence that residents feel empowered to make a complaint. 4 of the 5 complaint forms showed that the Manager or other senior person had taken action that was satisfactory to the resident. The 5th complaint did not appear to have been finalised, though there was nothing further on file to show that the complainant was still seeking resolution. It can be assume that complaint resolved but not recorded, but not actually confirmed. A recommendation is made that all complaints are shown to have been concluded. The inspector saw that residents will speak directly to staff if they were unhappy about something, for example one person not getting the breakfast of choice. Residents told the inspector that they would speak up if they had a complaint. The staff records showed that training had been undertaken on Safeguarding Adults. Two members of staff said they have covered protection of vulnerable The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 20 adults during induction and within the Learning Disability Aware Framework (LDAF) training. Each person said they would have no hesitation in reporting any potentially abusive situation to the senior person in charge. One member of staff was of the view that if one person lets down the team, all the team members are implicated. The person felt that this was not beneficial to residents. Observation of care practice showed that staff used a variety of techniques to deflect or diffuse situations, such as heated exchanges between residents or a resident against a member of staff. This was achieved while maintaining the residents dignity. Risk assessments are in place on care plans that relate to physical intervention that may be required by staff, and the records show that this is discussed with the resident and/or their supporter. The records showed that staff receive training in the use of physical intervention and that there are regular refresher courses. In order to prevent residents being financially abused, records are maintained of all financial transactions. Residents knew they had money kept on their behalf, or where they could get money if they needed it. Residents coming back from day centres spoke with staff about the money they would need for the next day so that it would be ready for them. Staff are expected to bring receipts back for all expenditure. Staff know how much they can spend on meals and refreshments when they are out with residents - there is a set schedule. In this way, staff are prevented from benefitting from residents money. 4 comment cards were received by CSCI from residents. Generally, three people said they knew how to make a complaint and the 4th person said they had never needed to. One person said they “sometimes” know who to speak to if they were not happy (“if the person was on shift”), one said “sometimes” (but would speak to parents or senior member of staff in the office), one person said “always”, and one person said “sometimes” but made no further comment. 3 comment cards were received by CSCI from relatives: none had had to make complaints to the home, but one person had raised minor issues. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 21 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The standard of decoration and presentation of the home is improving, which is making the home a more pleasing place in which to live. However, the improvement plan for the building should not be allowed to slip. Residents can be assured that they will live in a home that is clean and where the spread of infection is controlled. EVIDENCE: The inspector made a tour of premises and found that the home was kept clean and tidy throughout. Keeping the home tidy can be difficult as residents will leave their belongings where they drop them. However, the inspector saw that staff pick up as they walk around and return items to residents rooms. There was evidence of some financial investment into the premises: several bedrooms have been redecorated in a modern, fresh style which has been the residents choosing. A variety of flooring was seen: ‘Flotex’, carpet, and timber-effect. Designs of the flooring are different according to the wish of the resident. New furniture was in evidence, including good sized wardrobes and The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 22 drawers. Some bedrooms are limited in size but effort has been made to provide storage. One person is accommodated in a large room but has oversized bed, commode and wheelchair and assistance of two staff so this additional space is valuable to the resident. Several rooms were in the process of being redecorated. As part of the five year improvement plan for the building, carpets are being replaced in corridors, and corridors are being repainted. Workmen were making improvements to the offices and a plumber called to effect a repair in a bedroom on 6/6/06. On 8/6/06 contractors called to look at the drains and to repair the outside washing line. The Manager said that the roof of the building was going to be replaced at a cost of £15,000. There was good evidence, therefore, to show that the home is being maintained and that arrangements are made to repair or replace, as needed. Both visits to the home were carried out on very bright sunny days so all windows and doors open for ventilation. The home appeared bright and cheerful. Access into and out of the home is good – the inspector saw residents using wheelchairs and zimmer frames independently and without difficulty. Observation of staff practice in relation to infection control and hygiene confirmed that care is taken to minimise the risk of cross infection. Domestics have different equipment for different areas of the home – on the first day of the site visit the domestic made a thorough cleaning of dining room and lounge observed including window sills and skirting boards. One resident had been unwell overnight. Staff had stripped the room and were deep cleaning it. The laundry is situated away from any kitchen facility. It contains large, commercial equipment which was in working order. One resident helped staff to peg out . One resident chooses to wipe over the dining tables (supervised by staff). Another resident likes to do dusting and polishing. Protective aprons are made available for staff and were seen to be used by those who entered the kitchen and when serving meals. As part of their occupational therapy, some residents do their own laundry in the flat. Residents are supervised by a support worker. 4 comment cards were received by CSCI from residents: All said that the home is “always” clean and fresh though one person commented that there were “sometimes odours in toilets in warm weather”. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home has a recruitment process that makes sure only suitable people are employed. Staff receive training so they are competent to do the work they are employed to do. EVIDENCE: The inspector discussed recruitment with the home’s Manager in relation to the vacant assistant accommodation manager post. Recruitment was following the local authoritys procedure, with an emphasis on equality of opportunity for all applicants. Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) list checks are undertaken before employment is confirmed. References and other confidential documentation is kept centrally at the local authority. Staff files at the home show the CRB disclosure number. The Manager said that looking at a persons core values was essential to determine whether he or she would be suitable to work at The Pines. She said that training and development can be put in place, as necessary, but a person must express empathy and respect in relation to the residents. A project is in progress within the local authoritys Workforce Planning Group that relates to the involvement of residents in the recruitment, selection, and induction of new staff. The group is currently looking at the training that residents would need in order for them to contribute effectively to the process. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 24 Three staff files were checked. All were satisfactory, tidy and well-maintained. The majority of staff had attended a recent team building session, where concentrated effort had been placed on the role of the care team, following the code of conduct set by the General Social Care Council (GSCC). Two members of staff said they had really enjoyed the session. Their conversation showed that they had understood the ethos of working within a team. They were able to describe the benefits to residents when staff work together. Another member of staff also thought the session had been beneficial. More are planned, including an awayday. Each member of staff has a learning and development plan that is individual to them. This is based on the work the member of staff is required to do as well as taking into account areas of particular interest to them. The plan is reviewed annually. The training records showed that staff had attended training specific to the role they were employed to do, as well as developmental opportunities in subjects that would expand and stretch their knowledge and abilities. Two members of staff spoke about the Learning Disability Award Framework (LDAF) training they had been on, which they said was really good because they could use the learning from the course straight away. Both had done basic food hygiene training, and were were waiting to do a first aid course. Both people said they like to do training so they can be better at their jobs. The Manager said that bereavement training for staff is being commissioned by the local authority – a training plan is being developed which will be delivered, possibly, by the local hospice. 4 comment cards were received by CSCI from residents: all thought there was generally enough staff on duty because they were not kept waiting. 3 comment cards were received by CSCI from relatives: all thought there were “always” sufficient numbers of staff on duty, but one person thought more were needed for outside activities. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The Pines is managed by a competent person who ensures that the needs of residents are met. However, monitoring of the service by a senior person from outside the home must improve and become more regular. The working practices adopted by the home keep residents and staff safe. EVIDENCE: The Manager said she no longer organises staff meetings. Staff do this and she attends if asked. The onus, therefore, is on staff – and the Manager sees this as a way to create more effective team-working. Staff said they have team meetings every other month and that they were well attended. Consumer meetings are held when called for by residents and are held at a time that suits them. The Chair for the consumer group is currently vacant. The last consumer meeting was held in Feb 2006, and 14 residents attended. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 26 Topics for discussion included: holidays, activities, decorating, interviews, and pictorial books. Assessment of the home by a senior officer from outside of The Pines (known as a ‘Regulation 26 visit’) are carried out, but not regularly enough. The assessment on 1/2/06 focussed on residents financial accounts. The report was brief and was not recorded in the appropriate format. The Manager said that the most recent Regulation 26 visit was on 4/5/06 but the records were not yet available (because they had not done yet by the senior manager). The inspector noted that previous to February 2006 Regulation 26 visits have been recorded and were in an appropriate format. There was insufficient evidence now, however, to confirm that Regulation 26 visits are being conducted in line with the regulation, i.e. monthly and unannounced. A requirement is made for the Regulation 26 reports for May, June and July 2006 to be sent to CSCI for review. There was evidence of regular self-monitoring of the home (observed in written documentation, for example, care plans), following the local authoritys quality assurance system. The home conducts reviews with residents every six months. At the same time, residents complete a quality review form to express their views on the home and the standard of care that they receive. This is a pictorial document which is easier for residents to understand. Comments from residents included I like living at The Pines, I would like my room decorated., I would like to go on holiday somewhere in the country., and I would like to go on more activities. Information about the homes policies and procedures were provided to CSCI in the pre-inspection questionnaire and showed that they are reviewed and updated. Staff have attended training and refresher courses in relation to safe working practices, including moving and handling, first aid, and food hygiene. Water checks are made by the local authority on a regular basis to make sure that temperatures are kept within safe boundaries. There was evidence of laundry equipment being serviced and repaired. Pathways were clear and free from debris. Health and safety procedures were in place. Risk to a person’s safety had been identified and assessments recorded to minimise the risk. Safety notices were displayed in suitable formats. Accidents and injuries are recorded and reported appropriately. The file was available to look at and was in order. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 27 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 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 3 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 2 X X X 3 The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 28 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 YA43 Regulation 26 Requirement A senior manager should carry out Regulation 26 visits on a monthly, unannounced basis. Reports of the visit must be written in a suitable format. Copies of the Regulation 26 visit reports must be provided to CSCI for May, June and July 2006. PREVIOUS TIMESCALE OF 31/12/05 NOT MET. Timescale for action 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA20 Good Practice Recommendations Information gained from reviews by health and social care professionals external to the home should be recorded in the person’s care plan. When medication is not successfully administered, a record should be kept. DS0000032683.V294343.R01.S.doc Version 5.2 Page 29 The Pines 3. 4. YA22 YA24 Outcomes of any complaint investigation should be recorded routinely. The Provider and Manager should ensure that the improvement plan for the home continues, and that any slippage is minimised. The Pines DS0000032683.V294343.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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. 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