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Inspection on 17/01/06 for The Pines Nursing Home

Also see our care home review for The Pines Nursing Home for more information

This inspection was carried out on 17th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff reported that residents feel at home at The Pines because staff pay close attention to meeting individual needs. Residents themselves said that they enjoyed living at The Pines and were satisfied with the quality of care they received. Three residents stated that they found the staff helpful, supportive and approachable. Staff stated that they worked well together as a team and were supported by management. Two staff spoke positively of the training in place in the home, which they felt was comprehensive and encouraged good practices. Staff reported that their primary aim was to ensure that the residents are well looked after and are content. The environment is homely, well maintained and clean. Throughout the inspection the inspector observed positive interaction between staff and residents.

What has improved since the last inspection?

The system for monitoring training needs of staff continues to improve with clear records being available. New curtains have been put up in the lounge and the staff room had been decorated. The home has been awarded the investors in people award.

CARE HOMES FOR OLDER PEOPLE Pines Nursing Home, The 104 West Hill Putney London SW15 2UQ Lead Inspector Davina McLaverty 17 & 27 th th Unannounced Inspection January 2006 10.15 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 Pines Nursing Home, The DS0000019114.V277316.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. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Pines Nursing Home, The Address 104 West Hill Putney London SW15 2UQ 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) 020 8877 1951 020 8877 0916 South London Nursing Homes Limited Ms Annette Huskisson Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named female resident aged 59 years until she reaches the age of 60 years. 17TH & 29th June 2005 Date of last inspection Brief Description of the Service: The Pines is situated in Putney on the main A3 road. It is an Edwardian building with additional purpose built areas. There is a large garden for service users to use. Service users can access a local library, shops and cinema. The home is able to provide transport assistance if required. The home currently has forty-nine service users who have nursing needs. Accommodation is primarily offered in single rooms with en suite facilities. There is the option of seven shared rooms. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection over seven hours, starting at 10.15am. The inspection consisted of the examination of records, inspection of communal areas of the home, talking to six residents, six staff, one visitor and the deputy manager. What the service does well: What has improved since the last inspection? What they could do better: Residents care documentation needs to be completed fully and care plans reviewed monthly. CRB checks must be carried out on all staff employed within the home. Health and safety checks must be carried out consistently and a record maintained. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 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. Pines Nursing Home, The DS0000019114.V277316.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 Pines Nursing Home, The DS0000019114.V277316.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): 1,3, 4 & 5 Prospective residents continue to have the information they need to make an informed choice regarding moving into the home. Resident’s needs are assessed prior to admission, ensuring the home is appropriate and that their individual needs will be met. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which contain relevant information about the home and its operation. The Statement of Purpose still requires updating, in particular, the section on staff. The deputy stated that all residents receive a copy of the service user guide. Two residents confirmed that they had been given a copy. In discussion with the deputy, she stated that the assessments of residents took place prior to admission, but a full assessment of need took place on admission to the home. The initial assessment endeavours to ensure that the person’s needs could be met and that appropriate equipment would be available if they decided to take up the place. The majority of residents are self – funding, although the home does consider NHS residents. Three files were Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 9 examined and initial assessments were seen, as well as the care needs assessment following admission. However, files still failed to demonstrate that there had been appropriate consultation regarding the assessment with the resident, their representative, or other professionals involved with the resident. The information on resident’s long-term needs assessment was not fully completed, making it difficult to know whether resident’s needs could be fully met. The deputy stated that where possible, potential residents and or their representative are invited to the home before they make a decision to apply to live in the home. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 10 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): 7,8,10 & 11. Care plans were seen on two of the three files examined. Care plans seen required further input, to show how all identified needs are to be met. Residents or their representative should be involved in this process. Care plans must be reviewed by care staff on a monthly basis to reflect residents changing needs. The healthcare needs of residents are satisfactorily met. EVIDENCE: Three residents details were examined. Care plans were seen on two of the files. It was not clear why there was no plan for one of the residents. Information in the files was not consistent. The cardex system is used to record information. The information failed to evidence resident/advocates involvement. Care plans were signed by the staff member only. There was no written evidence that care plans are reviewed monthly as required in the standard. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 11 As stated at the previous inspection care plans must be developed further to address social and emotional needs including aims and objectives for individual residents. On admission to the home residents are registered with a local General Practitioner. The health needs of residents was seen to be monitored and evidence was seen in residents files of other health professionals involvement e.g. GP, dentist, optician, occupational and physiotherapists. Residents did not raise issues regarding privacy and dignity. Staff confirmed that they assist residents with care in bedrooms and bathrooms and doors would always be closed. This was observed to be the case. Residents have access to a telephone in their room and receive their mail unopened. The requirement made at the previous inspection regarding a record being made of the fridge temperature where medication is stored was still found to be inconsistent and therefore the requirement made at the previous inspection has been restated. The home has an appropriate policy in place regarding the death of a resident and notifications of death are sent to the Commission. The policy includes guidance for staff in the event of death, which preserves the privacy and dignity of the deceased. Details of resident’s final wishes if known, are recorded on their files. This was seen on one of the files examined. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 12 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 & 15 Residents are able to join in with a range of organised activities and are supported to maintain their independence and organise their own activities if they wish. Visitors are made welcome at the home and contact with significant others is encouraged. Dietary needs of residents are well catered for. Residents gave positive comments on the quality of food on offer. EVIDENCE: The home employs two (one full time and part time) activity co-ordinators, one of whom the inspector spoke to. A variety of activities ranging from arts and crafts to discussion groups take place. Guest pianists and singers are regularly in the home. Trips away from the home are also organised. However, records must be maintained of activities. Five residents were seen to be playing scrabble with the coordinators during the inspection visit. Residents are supported to use local community facilities and shops when they wish to. A visiting library comes monthly and large print books are available. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 13 The home has its own extensive selection of books, music tapes, videos and games. Church ministers visit the home regularly, where communion is offered. Residents spoken with said that they enjoyed the activities available to them. The menu seen was varied and residents confirmed that they are consulted and that a choice is always offered. Residents made positive comment on the quality and quantity of the food provided in the home. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 14 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 & 18 There is an appropriate complaints procedure, which is available to residents and their visitors. Organisational policies and procedures are available to protect residents from abuse. EVIDENCE: There is an appropriate complaints procedure detailing timescales and how to contact the Commission for Social Care Inspection. The deputy stated that all residents are issued with a copy of the procedure. The complaints book was seen and there had been no complaints since the last inspection. The home maintains a record of all staff that have received training in Protection of Vulnerable Adults (POVA). The records show that the training is updated for all staff. There are additional procedures on whistle - blowing. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 15 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): 19,20,21,22,24,25 & 26. Residents at the Pines enjoy a very attractive and comfortable living environment, to which with the high standard of cleanliness and hygiene, adds considerably to their quality of life. EVIDENCE: A tour of the communal areas was carried out and the home was found to be tastefully decorated and furnished throughout. Three residents bedrooms were seen and again they were appropriately decorated, personalised and homely. All three residents stated that they were very happy with their accommodation and had been encouraged to bring their own possessions. There is an on-going programme of decoration and general improvements to the environment. The organisation is currently looking at refurbishing the kitchen and removing steps and providing a ramp to lead to room 15, which will make it easier for residents to access the room. New curtains had been put up in the main lounge; the staff room had also been decorated. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 16 The inspector noted that the stair carpet is wearing and consideration will need to be given to replacing it before it becomes a safety hazard. The home is aware of this and is budgeting for its replacement in the near future. There are adequate numbers of bathrooms and toilets for resident’s use, which are situated near bedrooms and communal areas. Appropriate support aids were seen in the bathrooms and toilets e.g. hoists, grab rails and raised toilet seats. The home was clean throughout on the day of the inspection. There are appropriate procedures on infection control, clinical waste and Control of Substances Hazardous to Health. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 17 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, 29 & 30 Residents benefit from a committed and experienced team of staff at the home who have the skills and training to meet their needs. Recruitment practices do not fully protect service users as not all the required checks had been carried out. EVIDENCE: The published rota indicated that there were sufficient numbers of staff available to meet service users needs. Staffing levels at night remain under review as the dependency levels within the home is increasing. Since the last inspection, one new care and support staff has been employed. The inspector saw the recruitment records for the newly employed member of staff, as well as the records for five other staff members. The inspector found that CRB checks had not been carried out for three long - term members of the staff whose files were examined. Two files had no staff photographs and two files did not have any details on the staff health. Staff at the home have undertaken a range of training. Training within the home is on -going for all staff. A comprehensive induction programme is in place. Recent training includes food hygiene, infection control, supporting people with dementia, medication and the protection of vulnerable adults. A good deal of positive feedback about staff at the home was received from residents. Words used to describe staff included the following “kind”, “helpful” Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 18 and “good”. As a result, the residents experience of the home, is of a caring environment where they feel they are being supported and looked after. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 19 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): 35 36 & 38 Systems are in place to ensure that resident’s financial interests are safeguarded. Improvement was noted in respect of supervision, however, shortfalls were still noted. Systems are in place to protect the health, safety and welfare of residents, however, these systems were found not always to be maintained. EVIDENCE: The organisation had adequate systems in place in respect to managing resident’s money. Records for three residents were examined and found to be satisfactory. A supervision structure is in place, although records indicate that not all staff receive supervision at the required intervals. This does not allow for staff Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 20 members individual development, or the opportunity for the management checks on care practices at the home. It is noted however, that improvements have been made. Staff records indicated that appraisal of staff take place. The fire records were examined and shortfalls were noted resulting in an immediate requirement being made. The home had failed to test the fire alarm system weekly as required. This was a requirement of the previous inspection and although further tests had been carried out, tests were not consistent, potentially putting residents safety at risk. The testing of the alarm must take place weekly and the record maintained. Written confirmation was received within 24 hours of leaving the immediate requirement that the fire alarms had been tested and found to be in good working order. The home must also notify the Commission of all accidents and incidents. Minor shortfalls were noted in that the Commission was not always being notified when residents were admitted to hospital. Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 21 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 2 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 2 X 2 Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6(a) Requirement The Registered Persons must update the Statement of purpose. Previous timescale of the 30/09/05 not fully met. The Registered Persons must ensure that all care plans contain specific detail to enable care to be given. There must be evidence in the care plans of service user or representative involvement. The care plans must be reviewed on a monthly basis. Previous timescale of the 30/07/05 not fully met. The Registered Person must ensure that the fridge temperature is taken regularly calibrated and that a system is put is place to address action to be taken where the temperature is over the recommended limit. Previous timescale of the 30/6/05 not fully met. The Registered Persons must keep more detailed records regarding activities provided to residents. The Registered Persons must DS0000019114.V277316.R01.S.doc Timescale for action 28/02/06 2. OP7 15(2) (b) 30/03/06 3. OP9 13(2) 30/01/06 4. OP12 16(2) (m) 28/02/06 5 OP29 Schedule 28/02/06 Page 23 Pines Nursing Home, The Version 5.1 2 &19(1) 6. OP36 18 (2) 7. OP38 13(1) (4) 8 OP 38OP38 37(1) ensure that CRB checks, health details and photographs are available on all staff employed. The Registered Person must ensure that staff receive formal supervision at least six times a year. The Registered Person must ensure that weekly testing of the alarm system take place. Previous timescale of the 29/06/05 not fully met. The Registered Persons must ensure that the Commission is notified of the occurrences as detailed under regulation 37. 29/06/06 22/01/06 22/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Pines Nursing Home, The DS0000019114.V277316.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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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