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Inspection on 25/01/10 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 25th January 2010.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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

People who use the service say that they fell well cared for and they enjoy the food provided by the service. The staff demonstrate a caring approach towards the people who use the service.

What the care home could do better:

Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include improvements to the environment and ensuring that the supplies of incontinence pads and gloves are managed appropriately.

Random inspection report Care homes for older people Name: Address: The Pines Nursing Home 104 West Hill Putney London SW15 2UQ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Louise Phillips Date: 2 5 0 1 2 0 1 0 Information about the care home Name of care home: Address: The Pines Nursing Home 104 West Hill Putney London SW15 2UQ 02088771951 02088770916 Telephone number: Fax number: Email address: Provider web address: www.slnh.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : South London Nursing Homes Ltd care home 50 Number of places (if applicable): Under 65 Over 65 50 50 0 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 50 The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Physical disability - Code PD Dementia over 65 years of age - Code DE(E) Date of last inspection Brief description of the care home The Pines provides accommodation and nursing care for fifty older people. The service is privately owned and is situated on the A3 in Putney within easy reach of local shops and facilities. Care Homes for Older People Page 2 of 13 Brief description of the care home The home is an Edwardian building with additional purpose built areas. There is a large garden for residents to use. Information about the home is provided to residents in a written guide. The current daily fees start from GBP124.00 per day. Care Homes for Older People Page 3 of 13 What we found: This was a Random Inspection which took place over one day, including a visit to the service which started at 6:40am. The inspection was in response to allegations we had received about the service from a number of different sources, including that from statutory agencies, telephone calls and information gained from surveys that we sent to people who live and work at the home. We received survey responses from four staff who work at the home, and eight people who use the service, and these have been referred to in the report. During the inspection we spoke to people who live at The Pines Nursing Home, staff and the manager of the home. We also looked at relevant documentation in relation to information received. As this was a Random Inspection, we did not look at all the National Minimum Standards for Older People, but at those specifically in relation to the allegations and information we received. Those standards looked at are stated below, including the allegations made. In this report the requirements made following the last Key Inspection (on the 6th July 2009) are listed under the heading of Outstanding Statutory Requirements. Requirements are generally restated under this heading of the report as it means that they have not been met by the service. However, as we did not assess these during our visit, we are unable to confirm if they have been met, or not, and these will be assessed at our next key inspection of the service. We looked at National Minimum Standard number 15, regarding Meals and Mealtimes. We received information alleging that the quality of the food is poor and the amount given is not enough. The staff and people who use the service that we spoke to said that the food is good and that there is sufficient choice and quantity. One person who uses the service told us that the ..food is good, and well cooked... We looked at the food supplies in the kitchen and observed a variety of fresh, frozen, tinned and dry foods at the service, as well as a menu that varies throughout the week. The chef told us that they are responsible for ordering the food, and they said that at this time they feel the food budget is sufficient for purchasing the foods needed. We observed the chef preparing a number of cooked breakfasts of bacon and egg for some of the people who use the service. She said that people can also choose to have cereal or porridge for breakfast if they wish. We looked at National Minimum Standard number 19, regarding Premises; number 21, regarding Lavatories and Washing Facilities; number 22, regarding Adaptations and Equipment; number 24, regarding Individual Accommodation: Furniture and Fittings; Care Homes for Older People Page 4 of 13 number 26, regarding Services: Hygiene and Control of Infection. We received information alleging that the main lift at the home is not working, and has not done for a long time. During the inspection we checked the main lift and found it to be working. Staff we spoke to said that it often breaks down, meaning that people who live on the second and third floors of the home are unable to get down the stairs. We checked the maintenance records relating to the lift, back to June 2009. The records indicate that the lift stops working approximately every two months, and the records state that this is temporarily repaired within 24 hours, then a service carried out shortly after this, apart from on one occasion in August 2009, where the lift was out of service for a number of days. We spoke to the maintenance person and manager, who said that this is an ongoing issue at the service, and that they have recently changed the contractor for this, so that repairs can be carried out more swiftly. The maintenance person said it would be in the five year plan for the service to have the lift changed to one more suitable for use in a care home. The manager also spoke about ongoing issues with the Stannah stair lift, which runs from the ground to first floor, however this was in working order at time of inspection. We received information alleging that night staff are given limited gloves to use, and that these are not enough to carry out the work. We also received information alleging that there is limited equipment available to protect staff and people who use the service from infection. Similar to this, we received information alleging that there are not enough towels to dry people when attending to their personal care. Some of the staff we spoke to during the inspection said that there are not always enough gloves to carry out their work, whilst others said that there are sufficient supplies. The manager said that she orders forty-four boxes of one hundred gloves every two weeks, so that there are over two thousand gloves for use at the service each week. The manager said that she is in the process of changing the order for plastic, disposable aprons, following feedback from staff that the ones currently in use are too thin. Aprons were observed at the service. We observed that two bathrooms had no paper towels or soap in them, and this was conveyed to the manager during the inspection. Staff we spoke to said that there are sufficient hand and bath towels to use for drying people. The manager showed evidence from the external contractor who launders the towels to indicate that there are 425 hand towels and 300 bath towels that are used at the service. She said that because these are laundered by and external contractor, this number is not what the home holds at any one time, but approximately half of this number. We received information that there are not always enough incontinence pads, or that the wrong sizes are supplied, so that people who use the service do not get the right support in this area. One staff member said that there are often not enough larger pads to support people at night, so they have to use up to four smaller pads. Care Homes for Older People Page 5 of 13 Correspondence we saw indicates that the home receives a delivery on incontinence pads every eight weeks. The manager told us that these are supplied by the PCT (Primary Care Trust), and those delivered are based on the assessed needs of people who need these. She also told us that shortages are due to staff using the incorrect pads for different people, such as using larger pads for people who need to wear smaller ones. The manager said the home sometimes running out of incontinence pads is something that she is aware of, as they have had to borrow pads from their sister home where supplies have run out. She said that she is planning to work with some of the qualified nurses at the service in re-assessing the pads that each person needs, and that the order will be altered to ensure that appropriate pads are in use at the service, and in sufficient quantity. She also said that staff will be informed of which pads to use for each person. We received information alleging that two bedrooms, numbers 11 and 29 had cracks in the ceiling, which let in water, following the recent snow that has fallen in the area. We saw that the ceiling and one wall in bedroom 11 was in a bad state due to the water damaged, with paper hanging down from the ceiling and paper having peeled away from a wall. There was a lot of water damage to the wall, and we were informed that the carpet had been wet when the water came in. We requested that the person living in bedroom 11 be temporarily moved to an alternative bedroom of their own, whilst the rectifying of the area of damp takes place. The manager informed us that this would take place by the end of the day of our visit, the 25th January 2010. The manager and maintenance person said that work has been carried out in bedroom 29, and planned for in other parts of building to repair the damp and leaking roof areas. We saw that bedroom 29 has a thin crack on the ceiling, which we informed the manager and maintenance person of during the inspection. The dining room has a hole in the ceiling, also caused by damp, though evidence indicates that this had been already identified for repair by the service. We received information alleging that the shower on the ground floor is broken and has not been repaired for a number of years. We found that the shower room on the ground floor next to room 39 was not in use, and were informed that this had not been in use for a number of years. The manager said that following a recent visit by the owner of the organisation, this had been prioritised to be addressed, and work started on this during February 2010. We received information that the one standing hoist at the service was not working. The manager said that staff had reported this to her the previous Friday, 22nd January 2010, and that they charged up the battery over the weekend, to find that there is a fault with this. She said she is reporting it to the Property Services department on the day of our inspection to be repaired. During the inspection we also found that the sink in the bathroom next to room 28 had Care Homes for Older People Page 6 of 13 no water running from the hot tap. The manager said that this had been turned off due to the water being too hot, and awaiting the installation of a thermostatic control valve to regulate the water temperature. We also observed that a number of the armchairs in the large lounge on ground floor, were stained and in need of cleaning. We looked at National Minimum Standard number 27, regarding Staff Complement. We received information alleging that staffing levels are low. We looked at the staff roster for January 2010. The staffing levels remain unchanged to that of the previous inspection. Feedback from staff, via surveys and from those we spoke to is that the majority feel there is not enough staff on duty. They said that sometimes when staff are absent due to sickness, their shift is not covered, so they are down on the staffing level for the shift. We spoke to the manager about this, where she said that when given enough notice about a staff absence, she endeavours to cover the shift with a bank of agency worker, but that this is not always possible, due to the lateness that staff sometimes informed her that they will not be able to attend work. The staff roster for January 2010 indicates that bank and agency staff have been used on occasions. People who use the service told us that there are usually always staff available when they need them, though approximately half of those who responded to our survey said that this is only sometimes. One person who uses the service said that there is a good level of staff during the day, though there are not enough staff working at night. Another person said that they would like more personal contact from staff. We spoke to the manager about needing to ensure that staffing levels are kept under review to ensure that they are sufficient to meeting the assessed changing needs of the people who use the service. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 13 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) 13 (4) 1. Care plans must be 16 (2) (m) regularly reviewed. (n) 2. Weight charts must be kept up-to-date. 3. Care plans must be more person centred and address the social and recreational care needs of individual residents. Previous timescale of 01/10/08 not met. 01/09/2009 2 8 12 (1) Health information such as nutritional and fluid monitoring systems need to be more detailed and must be fully completed. 01/08/2009 3 8 13 1. Risk assessments need to 01/08/2009 be in place where needs such as seizures have been highlighted. 2. All risk assessments must be kept up-to-date. This includes those covering nutrition and pressure areas. 4 9 13 (2) Audits must be further developed so that there is evidence that residents are 01/08/2009 Care Homes for Older People Page 9 of 13 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action receiving their medication as prescribed. 5 9 13 (2) The home must formulate a 01/08/2009 local policy on how medicines are managed and recorded when residents go on leave. The care plans including the 01/08/2009 management of seizures and PEG feeds must be expanded upon. Alternative storage solutions 01/11/2009 must be found and the home must stop storing equipment throughout the communal areas of the home. Previous timescale of 01/02/09 not met. 6 9 13 (2) 7 19 23(2)b & d 8 19 13 (4) Window restrictors must be in place to all ground floor windows that require them. 01/09/2009 9 35 13 (6) The method of record 01/09/2009 keeping for the logging of individuals transactions must be improved. Previous timescale of 01/10/08 not met. Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The Registered Persons must 31/03/2010 ensure that the service is clean and maintained in a good state of repair at all times, including ensuring the lift works at all times, all bathrooms are usable and repairs are made to all areas of water damage in the home. To ensure the home is safe, and can meet the needs of the people who live there. 2 22 23 The Registered Persons must 29/01/2010 ensure the hoists in use at the home are in working order at all times. So that people who use the service can be supported appropriately. 3 26 16 The Registered Persons must 29/01/2010 ensure that soap, gloves and continence supplies are in sufficient supply at all times. To minimise the risk of infection to people who use Care Homes for Older People Page 11 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the service and staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 26 It is recommended that the service implement appropriate systems for the management of personal protective equipment, such as gloves, aprons and continence aids, to ensure that the supply of them is appropriately managed at the service. Staffing levels need to be kept under review and adjusted where necessary, to ensure the assessed needs of the people who use the service are met. 2 27 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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