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Inspection on 26/07/06 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 26th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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

Comments from residents were generally very positive and included "all very good", "a high standard", "a five star hotel" and "compassionate care". Feedback about the food served was also very good with comments such as "extremely good" and "they do a damn good job with meals". Residents benefit from a well trained staff team. The programme of training in place at the home is very good. The home provides very clean, comfortable and homely accommodation to residents.

What has improved since the last inspection?

The records for fire alarm tests are being kept accurately. Staff receive regular supervision from their line manager. Records are kept to show that Criminal Record Bureau (CRB) checks are carried out on all staff employed at the home.

What the care home could do better:

Care plans must be in place for all residents and these could be developed to better address the social care needs of residents. Risk assessments must be reviewed for individuals following any incident or accident such as a fall. Medication records must be fully completed at all times. Staff must administer medication to one resident at a time to make sure this is done safely.

CARE HOMES FOR OLDER PEOPLE Pines Nursing Home, The 104 West Hill Putney London SW15 2UQ Lead Inspector Jon Fry Unannounced Inspection 26th July 2006 10:45 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.V307492.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 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 www.slnh.co.uk 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.V307492.R01.S.doc Version 5.2 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. 27th January 2006 Date of last inspection Brief Description of the Service: The Pines provides accommodation and nursing care for fifty older people. The service is privately owned by South London Nursing Homes Ltd and is situated on the A3 in Putney within easy reach of local shops and facilities. 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 £118.00 per day. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The main part of the inspection was unannounced and was carried out by one regulation inspector on the 26th July 2006. A second announced visit took place on the 4th August 2006 to examine paperwork. The inspector spoke with ten residents, the manager and five members of staff. A number of records were examined, as well as a tour of the communal areas of the home. Completed written survey forms were received back from eight residents. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be in place for all residents and these could be developed to better address the social care needs of residents. Risk assessments must be reviewed for individuals following any incident or accident such as a fall. Medication records must be fully completed at all times. Staff must administer medication to one resident at a time to make sure this is done safely. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice about moving into the home. Individual needs of residents are assessed before admission to make sure that the home can meet these. EVIDENCE: The home’s Statement of Purpose and Service User Guide contain relevant information about the home and its operation. A Requirement has been made to make sure that information about fees as required by new Regulations in place from September 2006 is made available to both prospective and existing residents. Initial assessments of residents take place before admission with a full assessment of need being completed after individuals have entered the home. Three care plans looked at contained satisfactory assessments and these were seen to be kept under review by the home. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans could be improved to make sure that they fully address individual needs. Individual health needs are satisfactorily addressed. There are generally satisfactory arrangements to make sure that medication is safely administered to residents. Improvements however need to be made in record keeping and staff practice when administering medication to residents. EVIDENCE: Care plans were in place for two out of three residents whose files were examined. Care plans had not been completed for one resident who had been admitted two weeks previously. The care plans in place were being reviewed on a monthly basis. Information included addressed areas such as personal hygiene and mobility. There are opportunities to improve the information recorded to make it more holistic and Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 10 person centred. Care plans for social and emotional well-being must be included to make sure that this important area of need is formally addressed within the care planning process. The home must also make sure that risk assessments are reviewed following any accident or incident. One instance was seen where a resident had a fall and the assessment had not been reviewed following this accident. It is recommended that care staff review how they address care planning around ‘expressing sexuality’. Two care plans were seen to concentrate on how the resident likes to dress rather than any identified needs in this area. Health records were seen to be well maintained. Residents spoken to said that they were able to access a GP when they needed to. Five residents replied ‘always’ and two said ‘usually’ in reply to the survey question ‘do you receive the medical support you need?’ One resident did not answer this question. The medication records in one wing of the home were looked at. Administration records were generally well maintained but four instances were seen where the record had not been signed following administration. One member of staff was seen administering medication for two residents at one time which is not good practice. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to join in with a range of organised activities. Social and recreational care needs must be addressed within care plans. Residents are able to keep contact with friends and family. The dietary needs of residents are very well catered for. EVIDENCE: The home employs two part-time recreational therapists and they arrange a variety of activities including bingo, dominoes, music and exercise. Guest pianists and singers regularly entertain residents at the home. A Communion service takes place in the home each month. Comments from residents about the activities on offer included “lots of stimulation”, “we occasionally go out” and “I play scrabble “. Five of the eight residents who filled in surveys said ‘always’ when asked if there were activities arranged by the home that they could take part in. Two residents replied ‘usually’ and one individual said ‘sometimes’. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 12 As stated previously, it is important that each resident has a care plan that addresses social and recreational needs. Once these are in place, these should be reviewed on a monthly basis with direct input from the recreational therapists. Residents spoken to said they were able to have visitors at any time. A number of residents were seen to be receiving visitors either in the main lounge or in their room during this inspection. Residents generally made very positive comments about the food provided. Comments included “very good”, “very healthy”, “five star” and “a fairly high standard”. Staff were seen to help residents with eating as required and this was done in an appropriate and unhurried fashion. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is supplied to residents on admission to the home. The organisational procedure details the actions to be taken should there be any allegation or suspicion of abuse. Staff are provided with training on the Protection of Vulnerable Adults (POVA). EVIDENCE: There is an appropriate complaints procedure in place and this includes contact details for the Commission for Social Care Inspection (CSCI). One complaint had been received since the January 2006 inspection. This had been satisfactorily resolved with an outcome documented in the homes record. The CSCI had received one concern directly from a relative of a resident and the issues raised were discussed with the manager. A Requirement has been made for the home to review its reception arrangements to make sure that it satisfactorily monitors who is entering and leaving the building. The home maintains a record of all staff that have received training in Protection of Vulnerable Adults (POVA). An organisational procedure gives the action to be taken should there be any allegation or suspicion of abuse. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely and comfortable living environment. The home is kept clean and hygienic. EVIDENCE: Residents are provided with a comfortable and homely living environment. Further improvements were being made to the main kitchen and some bedrooms at the time of this inspection. Feedback from residents about the accommodation included “fine”, “very nice”, “very clean” and “ok”. All residents spoken to were satisfied with their bedroom. All eight individuals who filled in a survey responded ‘always’ to the question ‘is the home fresh and clean?’ There are adequate numbers of bathrooms and toilets for resident’s use, which are situated near bedrooms and communal areas. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels meet the care needs of residents accommodated. The training provision for care staff is very good. Residents are protected by the homes recruitment procedures. EVIDENCE: Feedback from residents was generally very positive about the care staff. Comments included ‘wonderful’, ‘very helpful and hard working’, ‘polite’ and ‘very nice’. One resident responded very positively about particular members of staff saying they were ‘always compassionate and efficient’. Two residents spoken to said there were differences between the staff working during the day and at night. This was discussed with the manager at the time of inspection. There is an impressive programme of training available to staff. All four staff spoken to said that they were offered plenty of training opportunities. Mandatory training for care staff includes Infection Control, First Aid, Food Hygiene and POVA. Very good records of training are kept for each member of staff to make sure all their learning is documented and kept up to date. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 16 Induction training is given to all new staff and this has been updated to the new national Common Induction Standards already. Over 50 of the staff are trained to NVQ Level Two with more individuals currently working to achieve this. Records seen confirmed that Criminal Record Bureau (CRB) checks are carried out for staff working at the home. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service benefits from the leadership of the registered manager. Systems for quality assurance are in place but could be further improved. Health and Safety records are generally well maintained. EVIDENCE: Care staff spoke positively about the manager and felt that the staff team in general worked well together. All individuals spoken to said that they received regular supervision with their line manager. Staff working at the home are issued with a small pamphlet telling about how supervision works to help them get the most out of these 1–1 sessions. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 18 A formal system is in place for quality assurance and surveys were last supplied to residents in 2005. A business plan is in place for the home. The manager stated that residents were continually consulted on an informal basis about areas such as menus and activities. Recent changes had been made to the menus as a result of feedback from residents. It is recommended that residents meetings are held more frequently as the last one was in 2005. The organisation has satisfactory systems for managing resident’s money. Records for two residents were seen and found to be satisfactory. Health and safety records for hot water temperatures, Fire Safety, electrical appliance testing and hoist equipment are all well maintained. A Requirement has been made for the home to make sure that First Aid boxes are checked monthly with records kept. One instance was seen where cleaning products were stored in an open bathroom. The home must make sure that these items are kept locked away at all times when not in use. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 19 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (a) (b) Requirement The Registered Persons must ensure that information about fees is supplied to both new and existing residents as required by the Amendment Regulations 2006. The Registered Persons must ensure that care plans are put in place for each resident on admission (or within 5 working days of an emergency admission). Risk assessments in place for residents must be reviewed following any accident or incident. 3. OP7 15 (1) 16 (2) (m,n) 13 (2) The Registered Persons must ensure that care plans address the social and recreational care needs of individual residents. The Registered Persons must ensure that: medication administration records are fully and accurately kept at all times, Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 21 Timescale for action 01/10/06 2. OP7 15 (1) 13 (4) 01/09/06 01/12/06 4. OP9 01/09/06 items of medication are administered to residents one at a time. 5. OP16 12(1) 13(6) The Registered Persons must ensure that the reception arrangements are reviewed to ensure that there is satisfactory monitoring of all persons entering and leaving the home. The Registered Persons must ensure that: monthly checks are made of First Aid boxes with records kept, cleaning products are kept locked away at all times. 01/09/06 6. OP38 13 (4) 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP33 Good Practice Recommendations It is recommended that care staff review their practice around care planning regarding ‘expressing sexuality’. It is recommended that resident meetings be held regularly at the home. Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Pines Nursing Home, The DS0000019114.V307492.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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