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Inspection on 17/06/05 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 June 2005.

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

The home provides a high standard of care by a committed team of staff. Throughout the inspection the inspector observed positive interaction between staff and service users, which demonstrated their commitment to involving the service users in making decisions about their daily lives. All ten residents spoken to said that they enjoyed living at `The Pines` and were very happy with the quality of care they received. Comments included " it`s a nice home", "the staff are all very helpful", and "my friends are made to feel welcome".

What has improved since the last inspection?

The system for monitoring training needs of staff has been improved with all staff being encouraged to participate in the training offered. A record is also maintained. A further improvement was seen in regards to medication, in that the Medication Administration sheets were all completed, photographs of residents were on all files examined.

What the care home could do better:

Residents care documentation needs to be completed fully and accurately, to ensure care needs are identified and met.Staff supervision needs to take place on a one to one basis at least six times a year to meet National Minimum Standards. This is to ensure that staff have the support and direction to carry out their jobs safely and efficiently. Health and safety checks must clearly identify action taken when problems are identified.

CARE HOMES FOR OLDER PEOPLE The Pines Nursing Home 104 West Hill Putney London SW15 2UQ Lead Inspector Davina McLaverty Unannounced Friday 17th & 29th June 2005 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 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 G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Pines Nursing Home Address 104 West Hill Putney London SW15 2UQ 020 8877 1951 020 8877 0916 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) South London Nursing Homes Limited Ms Annette Huskisson ( subject to CSCI approval) CRH Care Home Care Home with Nursing 50 Category(ies) of OP Old Age (50) registration, with number of places The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: To include one named female resident aged 59 years until she reaches the age of 60 years. Date of last inspection 7TH & 10TH September 2004 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 The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out unannounced, by one inspector over two days and a total of 10 hours was spent in the home. A variety of records, including care plans, staff files and health and safety documents, were looked at. A tour of the communal areas of the home was undertaken. During the course of the inspection the inspector spoke to the manager, deputy manager, two support staff, two nurses, the activity co-ordinator, the chef, the registered nurse trainer, the house keeping manager, three relatives and ten residents 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 accurately, to ensure care needs are identified and met. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 6 Staff supervision needs to take place on a one to one basis at least six times a year to meet National Minimum Standards. This is to ensure that staff have the support and direction to carry out their jobs safely and efficiently. Health and safety checks must clearly identify action taken when problems are identified. 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 G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 standard(s) 1 & 3 Prospective residents have the information they need to make an informed choice regarding moving into the home. However, resident’s needs must be assessed prior to admission, this was found not always to be the case, which could result in placements failing as the home is unable to meet the residents needs. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which contain relevant information about the home and its operation. However, both documents require updating in view of staff changes within the home. In discussion with the manager, assessments of residents did not always take place prior to admission. The majority of residents are self -funding and brief information is taken on referral. However, a full needs assessment must take place to ensure that the individual needs of the resident can be met in the home. The six files examined evidenced the lack of full assessments. Files failed to demonstrate that there had been appropriate consultation regarding the assessment with the resident, their representative of the resident or other professionals. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 9 The manager stated that care plans are normally developed within the few weeks of admission to the home, although one of the four files examined had no care plan in place, this was pointed out for the manager to address. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 standard(s) 7, 8 & 9 Care plans were seen on five of the six plans 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 health needs of residents are adequately met and there is evidence of multi –disciplinary working with health care professionals. The home has appropriate systems in place for the ordering, and recording of medication. EVIDENCE: Care plans seen lacked detail and did not demonstrate how the long term needs of the residents were to be met. There was no evidence of any goals on the plans examined. Monthly reviews of residents needs were not seen to be consistently taking place. There was no evidence of residents or their representatives being consulted during the care planning process, although three relatives spoken to stated that they were very happy with the home and the care their relative received. They felt consulted and included in their relatives care by staff in the home. This however was not evident in the care plans seen. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 11 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. One of the care plans examined showed an incomplete nutritional risk assessment. Requirements made following the previous inspection regarding medication, and its administration were found to be in place. Medication administration sheets examined were found to be appropriately completed. The record of the temperature of the fridge where medication is stored was found to be outside the recommended level. This was discussed with the nurse responsible for medication and the manager. It was agreed that the fridge must be calibrated. It is important that the home develops a system, which addresses action to be taken when temperatures are above the required level, it showed that it was in excess of the acceptable range for a number of days with no action being taken, just a record being made. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 standard(s) 13, 14 & 15 Residents are offered a choice of appropriate and varied activities, which enhances their daily living. Contact with significant others is encouraged and welcomed. Dietary needs are well catered for with a balanced and varied menu (including special diets) available. Residents are asked on a daily basis about their wishes in relation to meals. EVIDENCE: The home employs two full time activity co-odinators and a variety of activities ranging from arts and crafts to discussion groups take place. Guest’s pianists and singers are regularly in the home. A list of activities is displayed on the notice board. Residents can choose whether to participate or not. The coordinators are also responsible for co-ordinating the residents committee meetings, which take place quarterly. Minutes of these meetings were seen. Issues discussed at this meeting covers activities/outings, meals, staffing and maintenance issues. Individual interests such as embroidery/knitting, shopping or sitting in the garden are also encouraged. A small library is available to residents. Residents stated that they enjoyed the activities available to them. One resident said that she really enjoyed the outings and was looking forward to seeing the sea this year. Another said that they enjoyed the bingo and film shows. Residents and The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 13 relatives confirmed that they celebrated special occasions such as birthdays. One resident had her newspaper cutting and telegram from the Queen on her room wall and spoke fondly of the day. Residents, religious needs are acknowledged and met by visiting priests who conduct services and give communion. Residents confirmed they were free to bring to the home personal possessions, including suitable items of furniture. They also confirmed that relatives were encouraged and made welcome by staff. Visiting relatives can have a meal with the resident if requested in advance or sandwiches can always be made up on the day. There are various areas as well as residents rooms where they can meet. The menu seen was varied and residents and relatives confirmed that residents 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. Comments received on the food included; “ the chefs are very good” and “nothing is too much trouble”, “ the food is well presented and there is always a choice”, and “I enjoy the food”. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 standard(s) 16 & 18 The home works hard at sorting out problems before they become complaints. Residents stated that if they had a complaint they could take it to the manager and it would be dealt with. Organisational policies and procedures are available to protect service users from abuse. EVIDENCE: There is a satisfactory complaints procedure in place, which is displayed on the notice board in the home. The home maintains a record of all staff that has received training in Protection of Vulnerable Adults (POVA). The records show that the training is updated for all staff. The manager informed the inspector that all new staff at the home receives training in abuse awareness during their induction period, which is in line with Sector Skills training. Since the last inspection the home has had a POVA investigation, the correct procedure was followed by the home. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22 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 building was carried out and the home was found to be tastefully decorated and furnished throughout including some residents’ bedrooms and lounges. Several residents spoken to stated that they were very happy with their accommodation. Many of the bedrooms have doors, which lead into a well-maintained garden. The manager stated that there is a maintenance programme in place and the home has access to staff within the organisation who will carry out routine repairs. The inspector noted that the stairs carpet is wearing and consideration will need to be given to replacing it before it becomes a safety hazard. The staff facilities e.g. changing room and rest room requires redecorating. Consideration should be given to making the rest room more relaxing for the staff that use it. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 16 There are adequate numbers of bathrooms and toilets for residents 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 communal toilets and bathrooms had liquid soap and paper towels, in line with infection control procedures. The home was clean and tidy on the day of inspection. There was no unpleasant odours within the home. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, & 30 Residents benefit from a committed and experienced team of staff at the home who have the skills and training to meet their needs. EVIDENCE: The published rota indicated that there were sufficient numbers of staff available to meet service users needs. In discussion with the manager she is undertaking a review of the night staff to ensure that sufficient numbers are on duty to meet the service user needs. A good deal of positive feedback about staff at the home was received from residents and relatives. Words used to describe staff included the following “kind”, “helpful” 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. One resident over lunch said that she had settled into the home better than she had expected. Training records were seen which demonstrated that staff had received training in a number of areas relevant to their roles. Such training includes health and safety, first aid, protection of vulnerable adults, and infection control. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36 & 38 The manager communicates a clear sense of direction and leadership in the home. The home is run in the best interests of the service users who are regularly consulted. Resident’s health and welfare is protected by policies and practices within the home. Supervision was found not to be taking place regularly, which compromised staff professional development. EVIDENCE: The manager has been in post since January 2005, she demonstrated that she is knowledgeable about her role in the home. Staff spoken to reported that they felt included in decision making and found the staff meetings a useful forum for discussion. Documentary evidence was seen which demonstrated that the portable appliance tests, 5 yearly electrical inspection, emergency lighting and gas safety checks are all up to date. Training records indicate that all staff have received recent fire safety training, weekly tests should be carried out on the fire alarm points however, gaps were noted. Records of the water The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 19 temperatures were in excess of the agreed maximum temperature of 43 degrees during May and June with no action being taken. This was discussed with the manager. A system must be introduced to ensure that appropriate action in taken when this is found to be the case. There also was no evidence of the recommendations made by “Water Care” following chlorination being carried out. Again a system must be put in place. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 x x 3 3 STAFFING Standard No Score 27 x 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x x 2 x 2 The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 21 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. 2. Standard OP 1 OP 3 Regulation 6(a) 14(1) (2) (3) Requirement The Registered Persons must update both the Statement of purpose and Service User Guide. The Registered Persn must ensure that :- The needs of the service users has been assessed by a suitably qualified or trained person. The registered person has obtaineed a copy of the assesment. There has been appropriate consultation with the resident or a representative of the resident. 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. The Registered Person must ensure that the fridge calibrated and that a system is put is place to address action to be taken where the temperature is over the recommended limit. The Registered Persnos must evidence in care plans that service uses/their representative Timescale for action 30/09/05 29/ 07/05 3. OP 7 15(2) (b) 30/07/05 4. OP 9 13(2) 30/06/05 5. OP14 15(2) (c ) 30/08/05 The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 22 6. OP19 23(2) (d) 7. OP 36 18 (2) 8. OP 38 13(1) (4) are encouraged to participate in care planning. The Registered Person must ensure that the staff facilties are decorated and suitably furnished for staff breaks. The Registered Person must ensure that staff receive formal supervision at least six times a year. The Registered Person must ensure that :-a system is in place which will address action to be taken where water temperatures are in excess 43 degrees. - Weekly testing of the alarm system must take place 30/10/05 29/06/05 & on -going 29/06/05 & on-going 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 OP 38 Good Practice Recommendations The registered pesons should ensure the recommendations made by Water Care following Chlorination are put in place. The Pines Nursing Home G54-G04 S19114 Pines V234016 170605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon 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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