CARE HOMES FOR OLDER PEOPLE
The Pines Nursing Home Bongate Appleby-in-westmorland Cumbria CA16 6HN Lead Inspector
Jenny Donnelly Unannounced Inspection 15th March 2006 11:30 X10015.doc Version 1.40 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 Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Pines Nursing Home Address Bongate Appleby-in-westmorland Cumbria CA16 6HN 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) 017683 51503 017683 52827 J.L.Robson and R.M.Johnson Partnership Mrs Barbara Mary Goad Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21), Physical disability (1) of places The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 21 service users to include: up to 21 service users in the category of OP (Old age, not falling within any other category) 1 named service user in the category of PD (Physical disabilities under 65 years of age) may be accommodated within the overall number of registered places. 23rd November 2005 Date of last inspection Brief Description of the Service: The Pines Nursing Home is situated in the town of Appleby. It is a converted house with a new extension added. Accommodation is on the ground floor only, with the first floor used as office and staff space. There are 19 single bedrooms and 1 double (although this is currently used singly). All bedrooms have an en-suite toilet. There are two comfortable lounges, a conservatory and a dining room. The Pines has mature gardens, with a paved area for seating. There is ramped access and a small car park. The Robson and Johnson Partnership own the home. Mrs Barbara Goad is the registered manager. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 15 March 2006 from late morning until early afternoon. The manager was not present, so certain confidential records could be accessed. I spoke with residents, visitors and staff, in groups as well as in private. I looked at care records and staff rotas. I toured the building and observed lunch being served. There were 20 residents in occupancy, with no vacancies. Any key standards not reported on here, were inspected and found satisfactory at the last inspection in November 2005. A second, announced visit was made on 21 March 2006 when the manager and the owner were present, to view records that were not available on the unannounced visit. What the service does well: What has improved since the last inspection?
One recommendation was made at the last inspection for the home to formally seek residents’ views of the service at The Pines. Since then the manager had increased her administrative hours, enabling her to spend more time on the management tasks of supervising and training staff, and undertaking quality checks. She also continues to work some “hands on” nursing shifts. The format for staff appraisals and supervision had been drawn up, and clinical skills audits and supervision meetings had taken place with some staff. Work was in progress on developing the quality assurance system to include satisfaction surveys for residents/relatives, which will be distributed later in the year.
The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 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 Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards in this section were assessed. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Staff were giving a high standard of nursing care and promoting and managing residents’ health needs very well. Personal and social care needs were being met to the residents’ satisfaction. Residents felt they were treated with dignity and respect. EVIDENCE: Care plans were very good at the last inspection, so only two were examined on this occasion. There were clear and detailed records for all nursing care, and this information had been kept updated. The instructions for the care of specialist needs such as the management of tube feeds and wound dressings had been clearly recorded. Any changes in a residents’ condition had been noted so it was easy to follow any improvements or deterioration. There was also clear evidence that the resident’s doctor or other specialists had been kept informed of any changes in their condition. Staff were particularly good at noticing, recording and passing on information about relevant changes in residents health status. There was evidence of liaison with, and visits to the home by doctors, chiropodists, physiotherapists,
The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 10 and speech and language therapists. Visitors said they were kept well informed about any changes in their relatives’ condition and care. Each resident was allocated a “primary nurse” responsible for planning and overseeing their care, and keeping their care plan up to date. Care assistants were knowledgeable about residents needs, and reported any changes or concerns to the nurse on duty for action. Residents were seen smartly dressed in clean clothing, and had all their personal hygiene needs attended to. Residents said they were offered a bath or shower once or twice a week, either in the morning or the evening. There was evidence that continence, skin care and mouth hygiene was performed very regularly to the most needy residents. Residents felt very well cared for and said, “you couldn’t come to a better place”, “we are so well looked after here, everything is perfect” and, “the staff will do anything for you”. The Pines was well equipped with special mattresses and seat cushions for anyone at risk of pressure sores. Other individual specialist equipment had been ordered and obtained for residents as necessary. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 Residents were able to maintain social and religious links with the local community, and enjoyed visits from their friends and family. Residents said the provision of meals was excellent, and that their special requirements dietary were catered for. EVIDENCE: Most residents were local people and as such enjoyed many visits from friends and family. There were more formal links with the local community through the monthly religious service in the home, and through the local parish newsletter, and visiting library van. Visitors said they were made welcome in the home, knew all the staff and were kept well informed of any changes. Visitors were involved with and supportive of the homes’ fund raising raffles and other activities. Residents enjoyed their meals at The Pines, saying the quality of the food was excellent. Breakfast was available throughout the morning, with a wide choice of options. Lunch was the main meal of the day, and although this was a set dish, residents stated they were never offered anything they didn’t want and said the cook knew their particular preferences and catered individually for them at times. The daily menu was on display. The cook confirmed that she knew residents’ likes and dislikes and worked these into her menu planning.
The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 12 Lunch was a hot pot followed by rice pudding, which was very popular. Special diets such as diabetic and soft diets were managed very well. Where people did require a soft diet, the meat was pureed and vegetables fork mashed, and the meal nicely presented. Hot and cold drinks were available throughout the day, as well as being served around the home at regular times by the kitchen staff. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards in this section were assessed. The manager said no formal complaints had been made to the home, and none had been made to the inspector. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents were living in a warm, comfortable and safe environment. EVIDENCE: The Pines is very well suited to its use as a care home. All residents’ accommodation is on the ground floor, with ramped access outside. The older part of the building housed the communal lounges and dining room, and benefited from original features and high ceilings. The newer section of the building housed the bedrooms, which all had en-suite toilets, the bathrooms and disabled access toilets. The building was well maintained, decorated and furnished to a high standard. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Residents benefited from having a stable, caring and well-trained staff team. Recruitment procedures were sound and served to safeguard the residents. EVIDENCE: Inspection of three staff files showed that recruitment procedures were sound, and included all the necessary checks to ensure unsuitable people were not employed in the home. Staff had received training in fire safety, moving and handling, infection control, food hygiene, health and safety and elder abuse. Training was mostly delivered by the manager, with the use of training videos and work sheets. New care staff completed a Skills Council induction training. Staff had a good understanding of their role within the home. The general responsibilities and duties of the primary nurses and care assistants were clearly set out, and on display in the office. Residents spoke highly of the staff team saying, “everyone is so friendly”, and “they will do anything for you”. The home has had a very stable staff team with little change over the years, and residents feel they benefit from this. Staff were seen to spend quality time with residents. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 and 38 The health, safety and welfare of residents and staff was promoted and protected by the homes systems. Staff were supervised and supported to their jobs well. There was a quality assurance process in place, which was to take residents views into account. EVIDENCE: At the last inspection it was recommended that the homes’ quality assurance system be revised to include the views of residents. In response to this the manager was devising a satisfaction questionnaire to be given out to residents and relatives. The results of this will be seen at the next inspection. Verbal feedback from residents and visitors on the service was very good. The managers’ annual quality audit, which covers all aspects of the building, the care delivery and catering, was about to commence. Since the last inspection, the manager had moved forward with developing formal staff supervision. All the nurses had completed a detailed clinical skills
The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 17 audit, and the manager had held individual appraisal/supervision sessions with them. The manager was now looking at developing a similar tool for use with the care assistants. The health, safety and welfare of residents and staff was being protected through the homes’ regular maintenance checks and service contracts. Documentation was in place for gas safety checks, hoists and nurse call bell servicing, electrical and water safety. The fire log showed that fire safety equipment had been checked and tested regularly, both by the homes’ maintenance man and periodically by an external contractor. Staff had received training in fire safety, safe moving and handling, infection control and food hygiene. The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 X 3 The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Pines Nursing Home DS0000010099.V283528.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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