Inspection on 23/11/05 for The Pines Nursing Home

This inspection was carried out on 23rd November 2005.

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 16/11/06

The Pines Nursing Home 15/03/06

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 23rd November 2005 09:50 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.V259627.R01.S.doc Version 5.0 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.V259627.R01.S.doc Version 5.0 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.V259627.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The service must at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Twenty One people in the category OP (OP21) may be accommodated. One named person under the age of 65 years of age may be accommodated. 18th February 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.V259627.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and over lunchtime. The registered manager was on duty at the time. When I arrived most residents were up, some were bathed and dressed, while others were having breakfast in their nightclothes. I toured the building, looking at bedrooms, bathrooms, lounges, the kitchen and the laundry. I talked with residents, staff and the manager. Then I looked at records, including care plans, medicine records, staff and management files. I saw the mid-morning tea and coffee being served, and I saw lunch being taken in the dining room. What the service does well: What has improved since the last inspection? Following the last inspection requirements were made to improve the management of medicines, the oxygen storage and staff supervision. The manager had addressed all of these issues and brought the home up to the required standard. Medicines were being properly managed, an improved oxygen storage area had been provided and formal staff supervision had commenced. Recommendations were also made that the home should make links with the local wound care nurse; care staff should undertake NVQ training, and the manager should complete a management qualification. All of these items had been addressed. Improvements had been made to the building. An extension had been built to house a new laundry, staff kitchen, and changing rooms. The residents commented that the new extension looked nice and blended in with the main house. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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.V259627.R01.S.doc Version 5.0 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.V259627.R01.S.doc Version 5.0 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 and 3 The home had produced good information for prospective residents and relatives. Residents’ needs had been assessed before they were offered a place in the home. The information and assessment helped people make their own judgements about whether The Pines would suit them. EVIDENCE: The Pines had produced a Statement of Purpose and Service User guide. It set out the type of residents cared for, the management and staffing structure, staff training, levels of service offered and details about the accommodation. This gave interested persons a very good overview of what the home is like, and whether it would suit their needs and preferences or not. Care records showed that residents’ needs had been fully assessed before they came to The Pines. The assessments covered general and specific health and social care needs. Information had also been taken from social workers, and hospital records if appropriate. This meant that residents could know in advance if the home could meet their needs by providing the type of care they needed. It also helped the manager brief staff about any new resident, and make sure that any equipment needed was in place. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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 Staff were meeting residents’ health, personal and social care needs, to the residents satisfaction. Residents said they were treated with dignity and respect. The management of medicines was good, and residents’ health and wellbeing benefited from this. EVIDENCE: Residents were smartly dressed in clean clothing, and had been bathed and had their hair washed as they wished. One resident said, that although each person was “marked down for one bath each week”, you could “always ask for another”, and she often had at least two baths a week. Care records showed what help each resident needed, and when. It also detailed personal preferences, such as liking a shower instead of bath. There were good records for any nursing care needed, and this information had been updated and was current. The instruction for the care of specialist needs such as tube feeds and wound dressings were clearly recorded. Any changes in a residents’ condition had been noted so it was easy to follow improvements or deterioration. There were risk assessments on file with action plans for protecting the health and safety and wellbeing of residents and staff. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 Page 10 Residents felt very well cared for and said, “you couldn’t have a better place”, “we are so well looked after here”, “the staff will do anything for you”. Residents felt that the staff respected them and upheld their privacy. Two residents said they liked to keep their bedroom door open, so they could see who passed by. Another preferred to keep the door shout when she was in her bedroom, and staff respected this. There were door locks in bedrooms, bathrooms and toilets. There was evidence that peoples’ health needs were being met. Visits by the doctor had been recorded, along with any new instruction for the persons’ care. Residents had received eye and dental care as required. The Pines was well equipped with special mattresses for anyone at risk of pressure sores. There were no residents with pressure sores, and only one who required a dressing to an old surgical wound. The manager liaised with the local wound care specialist nurse for advice as needed, and attended annual update training. The storage and record keeping for medicines was good. The nurse on duty was knowledgeable about the residents’ medicines. She was aware of side effects and special instructions such as the need to monitor blood levels of residents taking certain medicine. The home had a new system for disposing of leftover/waste medicines, which was in accordance with new Department of Health guidance. An improved oxygen storage area had been provided. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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, 14 and 15 Residents were able to spend their days as they liked, and had plenty of opportunity for activities and social stimulation if they wanted. Residents thoroughly enjoyed their meals, saying there was a good choice of foods, and the quality was excellent. EVIDENCE: Residents were able to spend their days as they wished. Staff recorded residents’ interests and hobbies in their care plan, so they could provide suitable activities/entertainment. One lady enjoyed the homes’ library, which had a lot of large print books. A gentleman enjoyed watching sport on television, and the manager had arranged for Sky TV to be installed for him, (at his own cost). Other residents liked to sit outside if the weather was nice, and go into town with their families. One resident was interested in gardening and liked to study the garden and see it change through the year. Another said she liked the religious services held once a fortnight for different faiths. There was a regular activity programme including bingo, videos, religious services, hair and beauty and movement to music. Care plans showed who had attended what activity, and whether the person had enjoyed it. One The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 Page 12 person’s care plans stated they had not liked the movement to music session, and did not want to attend that again. Residents they were free to choose whether to join an activity, and did not feel that they must. There were plans on place for the forthcoming Christmas festivities. The residents enjoyed their meals at the Pines. Breakfast was served throughout the morning, so residents could have an early or late breakfast as they preferred. Lunch was the main meal of the day. While most residents gathered in the dining room for this, others stayed in their rooms to eat alone if they wished to. All staff were present at mealtimes, to give assistance as needed. There was a good provision of equipment such as adapted cutlery and plate guards. The atmosphere in the dining room was very pleasant. Residents said, “the food here is lovely”, “it’s braising steak today and I really like that”, “the meals are very nice”, “the food is marvellous, and I have lots of allergies which they know all about”. The cook knew each residents preferences, and cooked good homely meals made with fresh ingredients locally purchased. There was plenty of fresh fruit and vegetables in the menu, as well as home-baked cakes. Teas and coffees were served at regular times throughout the day, and could be asked for at any time. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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 There was a system that enabled people to complaint about the service if they wished to. The home was protecting people from abuse. EVIDENCE: The home had a complaints procedure on display in the entrance hall. This referred people to make complaints to the homeowner Mr Johnson, and addressed postcards were available to use. It also gave the contact details for the CSCI office. Mr Johnson visited the home each week, and spoke to residents, which also gave an opportunity for people to raise any concerns. The manager said she expected any small matters to be brought to her attention for immediate remedy. No complaints had been made to CSCI about The Pines. All staff had received training of the protection of vulnerable adults (abuse). This was in the form of a training video with a questionnaire. The questionnaires had been kept on each staff members file. Talking to staff showed they understood their responsibilities in this area. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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 and 26 Residents were living in a warm, comfortable and safe environment. The standard of cleaning and general hygiene was very good. EVIDENCE: The Pines is well suited as a nursing home. Resident accommodation was all on the ground floor, and there was ramped access outside. The building had been well maintained, and the standard of décor and furnishings was high. There were two comfortable lounges, a conservatory and a dining room. Residents said they enjoyed the conservatory in the summer months, but it was a bit cold in the winter. The doors into the conservatory were closed across, as it was a very cold frosty day. The remainder of the home was lovely and warm. Bathrooms were spacious and well equipped, and there were ample toilets around the home. Some new beds had been purchased, as part of a gradual replacement plan. The Pines was very clean and fresh in all areas, including residents’ bedrooms, lounges, bathrooms, the kitchen and laundry. There were two domestics who The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 Page 15 worked opposite shifts, and both had been working at The Pines for many years. Between them they had developed very good ways to ensure all areas of the home were clean. There was a set programme of curtain and carpet washing, as well as attending to any in between emergency problems. Staff knew about good infection control procedures, and there were plenty of aprons, gloves and hand washing facilities around the home. Staff were seen using these as a matter of course. The equipment in the home, hoists, slings and oxygen sets were also kept very clean. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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 and 29 Residents at The Pines benefited from having a well motivated and caring staff team, who had the time to care for them properly. Recruitment practices were very good and protected residents from harm. EVIDENCE: The Pines is staffed appropriately to meet the needs of residents. There was generally one registered nurse and three care staff on a morning shift. Today the registered manager was due to have an “office” day, but as one carer had gone on sick leave, so the manager was working in a “hands on” role instead. Other staff present were a domestic, a laundress, a cook and a kitchen assistant. Staff felt that staffing levels were sufficient, they were able to provide good care to residents, and had time to chat with and spend time with residents. Whilst it was positive to see the manager taking a very “hands on” role in the home, she was struggling to keep up with some managerial duties in the time allowed. Out of 19 care staff, 7 had completed an NVQ in care, and another group (probably 6) were to commence their NVQ in January. This will give the home a very high percentage of care staff with a care qualification, which will be excellent. New care staff complete a skills council induction training in care. The Pines operated thorough recruitment practices, with all new staff undergoing the necessary checks, before being employed in the home. This was in order to safe guard and protect residents form harm. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 Page 17 Residents spoke highly of the staff, saying they were “lovely”, “marvellous”, and they felt “so well cared for”. The Pines had a lovely friendly atmosphere, and staff clearly took a pride in their work. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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, and 36 Residents benefit from having a very competent and experienced home manager, and a staff team that is well supervised. The quality assurance system would be better if residents views were formally taken into account. EVIDENCE: The registered manager Mrs Barbara Goad is a registered nurse. She has recently completed a registered managers award, as recommended for care hone managers. She is very experienced in nursing care of the elderly and has good managerial qualities. The registered manager completed an in house quality audit last November. This meant she checked various aspects of the home including the building, cleanliness, the catering, care delivery and medicines. This audit was comprehensive and the manager scored the home for each section, and produced an action plan for any areas identified for improvement. Due to The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 Page 19 restrictions on the managers’ time, some of these actions had not been completed, and the audit is due to be completed again. Although this quality audit tool was thorough, it did not take into account residents’ views. It is recommended that the homes quality assurance system be based on seeking the views of residents and visitors. In response to a previous requirement, the manager has commenced work on introducing formal staff supervision. She has developed the necessary paperwork and has started to complete a clinical skills audit with each registered nurse. The manager is intending to undertake all supervision herself during her “office” hours, as the nurses on duty are too busy caring for residents. The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X x The Pines Nursing Home DS0000010099.V259627.R01.S.doc Version 5.0 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. 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. 1 Refer to Standard OP33 Good Practice Recommendations It is recommended that the homes quality assurance system should include formally seeking the views of residents. 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