Inspection on 16/11/06 for The Pines Nursing Home

This inspection was carried out on 16th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Pines Nursing Home 15/03/06

The Pines Nursing Home 23/11/05

The Pines Nursing Home 18/02/05

The Pines Nursing Home 12/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Pines Nursing Home Bongate Appleby-in-westmorland Cumbria CA16 6HN Lead Inspector Jenny Donnelly Unannounced Inspection 16th November 2006 10:00 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.V306140.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 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.V306140.R01.S.doc Version 5.2 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 (2) of places The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 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) up to 2 service users in the category of PD (Physical disabilities under 65 years of age) 15th March 2006 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. The homes’ registered manager has retired and a new manager, Beverley Alderson, is in the process of being registered with the commission. Written information about the homes, its’ services and the fees can be gained directly from The Pines. At the time of this visit the weekly fees were approximately £498.00. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place mid morning. The homes’ new manager was present, and there were 17 residents living in the home. During the visit I toured the building, I spent time talking privately with residents and staff and I looked at care planning, management and staffing records. In the months before this visit surveys had been sent to the home for residents /relatives to complete, four of these were returned and the information supplied is included in this report. What the service does well: What has improved since the last inspection? What they could do better: Staff training had fallen behind in certain areas, such as adult protection and moving and handling. Although practice was seen to be good, there must be a training plan in place, and a requirement is made about this. A recommendation is made about the handling of residents’ money, where the home holds it for safekeeping. Whilst money is managed safely, it is not readily accessible by residents at all times. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 6 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.V306140.R01.S.doc Version 5.2 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.V306140.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Pre-admission procedures were thorough and served to ensure that only those people, whose needs could be met at The Pines, were offered a place. EVIDENCE: There was evidence that prior to being admitted to The Pines, prospective residents had undergone a detailed assessment of need. This included gathering information from other professionals, such as the social worker or hospital staff, and from family members. This was to ensure that the home only offered places to those people whose needs they could meet. The majority of residents were local people who had some knowledge or connection with The Pines prior to needing to use their service. Some of the residents spoken with had known or visited the home before they chose to move in. Others, who had been ill at the time, relied on their families to choose the home. One resident commented her family had “chosen very well”. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 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, 9 and 10 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents’ level of well being was promoted by the provision of good personal and health care. Care was provided in a way that suited residents and promoted their dignity. EVIDENCE: Each resident had an individual plan of care drawn up, and three of these were examined in detail. The care plans gave staff good information about the level of care residents needed and how they liked to be cared for. Personal preferences such as liking to be attended only by female staff or the importance of a person’s religion were included in the care plan and understood by all staff. Nursing and healthcare needs, such as wound care and tube feed regimes, were clearly set out; ensuring residents received consistent care at all times. The quality of nursing records was very good, with any changes in condition clearly stated and evidence that reviews by the doctor or other healthcare specialists were sought appropriately. There was evidence that residents had good access to everyday health checks including eye care and dentistry. Each resident was allocated a named nurse and a key worker to take a special interest in his or her care, and ensure the care plan was up to date and accurate. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 10 Residents confirmed that staff did listen to, and respect their wishes. Residents said personal care was provided in a sensitive manner, and commented “I have a lovely soak in the bath when I want”, “I’m very happy here, you just ring the bell and the staff come and help you”, and, “I didn’t want to be here, but I’m getting so much better now they are looking after me”. All levels of staff, including domestics and kitchen staff, were seen to treat residents with respect and had a high regard for maintaining individual’s dignity and privacy. The management of medicines was good. There were monthly medicine administration records, which showed the amount of medicines received, those administered and those returned or destroyed. There were also records of weekly stock checks. It was apparent that medicines administration was taken seriously and done in a professional manner. Where medicines were to be given at specific times or in alternating doses, these instructions were clearly recorded and adhered to. The storage of medicines was secure and tidy, with no evidence of over or under supply. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 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): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using the available evidence including a visit to the service. Residents were able to make choices about their daily lives at The Pines. The home enjoyed good contact with the local community, and residents were very happy with the provision of meals. EVIDENCE: The Pines was being run for the benefit of the residents who lived there, and this ethos was evident throughout my visit. Visitors were made welcome in the home and staff had good relations with residents and their families. Residents said they could spend the days as they wished and enjoyed freedom within and outside of the home. The provision of activities and organised events was fairly low key, and residents said they liked it this way. There was a weekly programme on the notice board advertising afternoon teas, hair and beauty treatments, bingo and videos. There was a weekly music and movement session that was very popular, and regular religious services covering three faiths. There were occasional outings and some entertainment was being arranged for Christmas. A number of residents preferred to occupy themselves with reading, television, and visitors. There was a library shelf, which was supplied regularly by the library van. Residents were able to use the communal rooms, go into the grounds or stay in their bedroom as they The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 12 chose. Residents’, who did not like to attend the organised activities, said they were not coerced into doing so. Residents said the provision of meals was “very good”. There was a choice of breakfast including cereals, toast and cooked breakfast. Lunch was the main meal of the day and this was a set menu. The cook said she was catering for 16 residents at present, and knew all of their likes, dislikes and food preferences. This meant the menu was planned so as to avoid residents’ dislikes, and where necessary an alternative was prepared for certain individuals. Residents said they were very happy with this arrangement, and felt the kitchen staff were most obliging to their wishes and any special food needs. The evening meal was lighter with a selection of buffet type food. Hot and cold drinks were served regularly throughout the day, and there was a good supply of home baked cakes and scones. I saw lunch served, both in the dining room and in some residents’ bedrooms. The meal was minced beef with creamed potatoes, carrots and broccoli, followed by a hot dessert. Residents were given discreet assistance where needed, by staff who sat at the dining table with them. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. The home had a complaints system that residents’ felt they could use. Residents also said they could talk to the manager or the owner about any concerns. Staff had an understanding of their role in safeguarding residents from harm, and residents said they felt safe living at The Pines. EVIDENCE: The home had a complaints procedure that was well advertised in the entrance hall. Residents said they knew the homeowner, Mr Johnson and that he visited weekly. Residents told me if they had any concerns, they would speak either to the manager or to Mr Johnson, and felt confident that any problem would be resolved. One resident said, “we have a lovely boss”. The manager stated the home had not received any complaints since the last inspection, and none had been made to the commission for social care inspection. The home had procedures in place for safeguarding vulnerable adults, and some staff had watched a training video about elderly abuse. Some staff were confident in talking about what constituted abuse, and were aware of the importance of safeguarding residents, and reporting any concerns. The home had copies of the Cumbria multi-agency guidelines on safeguarding vulnerable adults. The new manager was aware that some staff needed a training update on abuse, and intended to use the training video and questionnaire to do this. Residents said they felt safe in the home. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 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, 20, 21, 22, 23, 24, 25 and 16 Quality in this outcome area is excellent. This judgement has been made using the available evidence including a visit to the service. Residents have comfortable day rooms with period features, whilst having the benefit of modern spacious bathrooms, and single ensuite bedrooms. The home is exceptionally clean throughout, and infection procedures are very good and serve to protect residents. EVIDENCE: The Pines is an old property that has been extended and modernised to make it very suitable for a care home. The communal rooms which are two lounges, a conservatory and a dining room, are situated in the older part of the building, and as well as retaining some period features, these are very comfortable rooms. The bedrooms, bathrooms and laundry are situated in the newer single storey extension. All bedrooms are single with ensuite facilities. The bathrooms are fitted with assisted bathing equipment and the toilets are spacious and fitted with handrails. Residents have been able to bring their own possessions into the home and make their bedrooms look individual and homely. The first floor is used for office space only. The home has plenty of The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 15 storage, and corridors in the new extension are generous to allow for wheelchairs and equipment. The home is well equipped with hoists, slings and other mobility aids. Residents who need one had special pressure reducing mattresses. The heating and lighting throughout the home was good, with residents being able to make individual adjustments in their bedrooms as they wished. The grounds were well maintained and easily accessible to residents. The standard of hygiene throughout the home was excellent. The building was spotless and sweet smelling in all areas. Residents said the home was always this clean and that staff worked hard to keep it so. The management of laundry and the general infection control procedures were also very good. Staff had good access to protective equipment including gloves, aprons, clinical waste bags, hand cleansers and sanitizers. Where residents were known to have infective wounds or conditions, staff were aware of the additional precautions needed, and adhered to them. Residents were therefore protected from the risk of cross infection, and lived in a clean and pleasant environment. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 16 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Staffing levels were sufficient to meet not only the physical care needs of residents, but to allow for quality social time as well. Staff recruitment procedures were sound and ensured new staff were properly vetted and would compliment the team. Staff training needs to be reviewed. EVIDENCE: On the day of my visit there were 17 residents, supported by 1 nurse (the manager) 3 care staff, domestic and kitchen staff. This was in line with expectations. The manager worked half the week as the nurse on duty and half as management time. There was also a part time administrator. Staff and residents felt that staffing levels were sufficient to manage the work and have time to chat with residents other than when providing care. Residents spoke warmly of the staff group saying, “they are kind and helpful” and, “they do a first class job”. It was evident that all staff including kitchen and domestic staff, interacted well with residents, and chatted in a sociable friendly way. The staff team was settled with little change over the years. The atmosphere in the home was friendly and both staff and residents spoke of The Pines as being a “family unit”, where “relations are very good”. A review of staff files showed that the home adopted sound recruitment procedures. Staff had completed an application form, attended interview, and references and criminal records bureau checks had been obtained. This The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 17 system served to protect residents from having unsuitable persons working in the home. Staff training seemed to be out of date for a number of areas. Training had taken place this year on infection control and management of medicines, and fire drills had taken place. Up to date training in other areas such as moving and handling and adult protection could not be evidenced. 27 of the care staff had an NVQ in care, and the home was looking into getting funding for further NVQ training. The new manager said she would be looking at training generally and planning a training programme accordingly. This is subject to a requirement. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 18 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): 31, 33, 35, 37 and 38 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. The change of manager had not caused any disruption to residents’ lives, and management arrangements continued to be satisfactory. Residents were enabled to make their views known and were invited to contribute their ideas. The management of residents’ money was safe but needs to be more easily accessible to residents. EVIDENCE: A new home manager had been appointed and came into post 2 weeks before this visit. The commission for social care inspection had been kept informed of this change, and the manager had commenced the process of applying to be registered with the commission. Staff and residents felt the change of manager had not caused any disruption to the home. They had been kept informed of the change through staff and residents meetings, and the new manager had visited before taking up post. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 19 The home completed their own annual quality audit, which looked at all areas of the service, from residents care, to the upkeep of the building. This had been completed during the summer and the home scored highly in all areas. In addition to this, satisfaction surveys had been issued to all residents/ families. 12 out of 18 survey forms were returned and these showed very positive results, with the exception of one person who did not like the meals. The survey had asked people for any suggestions, and some had been made with regard to activities. These had been passed to the home owner for his consideration. This system allowed for residents to make their views known in a formal way, as well during their daily conversations with management and staff. The home is operated in a resident focused manner, with emphasis on the home being run for the benefit of residents, not staff. The homes’ policies and procedures were reviewed annually and updated as necessary. The home did hold spending money for safe keeping on behalf of some residents. This could not be checked, as the administrator was the only key holder to the money, and she works only two days a week. The manager needs to review this arrangement, as residents must be able to access their money without prior booking. Written information had been supplied to the commission, by the previous manager to confirm the service arrangements for the building and equipment were up to date. A check of the fire log confirmed this. As recorded in the staffing section of this report, some staff training in relation to health and safety was due to be updated. The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 20 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 4 3 3 3 3 4 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X 3 2 The Pines Nursing Home DS0000010099.V306140.R01.S.doc Version 5.2 Page 21 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. 1 Standard OP30 Regulation 18(1)c Requirement The home must have a staff training and development programme in place, to ensure all staff receive updated training in key areas. Timescale for action 31/03/07 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 OP35 Good Practice Recommendations It is recommended that the arrangements for residents’ money held by the home be reviewed to allow easier access. 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