Inspection on 27/07/08 for The Pines Nursing Home

This inspection was carried out on 27th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

The Pines Nursing Home 25/01/10

The Pines Nursing Home 06/07/09

The Pines Nursing Home 15/10/07

The Pines Nursing Home 26/07/06

The Pines Nursing Home 17/01/06

The Pines Nursing Home 17/06/05

The Pines Nursing Home 07/09/04

The Pines Nursing Home 27/05/04

The Pines Nursing Home 12/02/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Pines Nursing Home 104 West Hill Putney London SW15 2UQ Lead Inspector Sharon Newman Key Unannounced Inspection 27th July 2008 10:35 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 DS0000019114.V366980.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. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Pines Nursing Home 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 Ltd Ms Annette Huskisson Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Old age, registration, with number not falling within any other category (50), of places Physical disability (50) The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 2. Dementia over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 50 15th October 2007 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 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 £124.00 per day. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection included a visit to the service which was conducted over two days. We visited the home on 28/07/08 and 30/07/08. The lead inspector was accompanied by a pharmacy inspector on the first day and by another regulation inspector on the second day. The manager of the home was present throughout both days. We looked at documentation including health and safety information, care planning, medication and staffing records. We also looked at the premises. We spoke to staff, residents and some relatives. The manager also completed a self-assessment of the home which is called an AQAA. Surveys were sent to the home for staff, and residents to complete. Twentynine were received from residents and one from a staff member before this report was completed. We were concerned to find several instances of inadequate recording of information at this home and this could place the people who live here at risk of harm. What the service does well: What has improved since the last inspection? The cleanliness of the home has improved since we last visited. The stained linoleum in some ensuite bathrooms has been replaced. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. The Pines Nursing Home DS0000019114.V366980.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 The Pines Nursing Home DS0000019114.V366980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Service User Guide has been updated but has not been distributed to all the residents. As stated in the last report people who use the service have a needs assessment carried out before they come to the home. However, these are not detailed enough to ensure that the residents needs can be met. EVIDENCE: Some comments made to us by the people who live here: “Its alright – its not like home, but most of the staff are very kind.” “I looked around many homes and this was easily the best.” “it is very agreeable here.” The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 9 The Statement of Purpose and the Service Users Guide have both been updated following the last inspection of the home. The manager reported that many service user guides have gone missing over time and had not been replaced. There were no copies of the Service User Guide or the Statement of Purpose available in different formats such as large print, pictorial or with photographs. Considering the needs of many of the people who live here the organisation should consider making these documents available in more easily understood formats. There was no copy of the last inspection report at the home. The manager reported that someone had taken it from the reception area and she was going to request another one. A copy of the last inspection report must be kept at the home. The manager reported that she always goes out to assess prospective residents to help to ensure that the home can meet their needs. However, the assessments seen were basic and did not contain enough information about the needs of the people who live here. Also, they did not contain details about the wishes of people for end of life care/burial. Additionally, information in the assessments sometimes differed from that in the care plans. For example in one assessment the individual had a ‘normal diet’, a month later in their care plan they had a ‘soft diet’, however there was no evidence of a change in need in this time. The manager told us that she was aware that the information in the assessments is not always taken into consideration when staff planned the care of the people who live here. She reported that a recent audit of the assessments and care plans by the organisation had found that the information in the care plans did not always follow on from that in the assessments. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans are not person centred and do not contain enough detail to ensure that the needs of the people who live here are met. Risk assessments are not always in place for identified issues/risks and this could place the people who live here at risk. Residents do not always have immediate access to equipment to meet their healthcare needs. There are many issues with the storage, recording and administration of medication. This may place the people who live here at risk of harm. EVIDENCE: We found that the care plans were disorganised in content - for example some relatives had given notes about when they were on holiday and these were filed in with the profiles, old notes and the more up-to-date information. One The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 11 person had a note saying that relative was away in August – but this was last August which is confusing. These files need to be re-organised so that they are easier to read and the old information should be archived. We found that some care plans were not regularly reviewed. One care plan recorded no review since July 2007, another none since March 2008 and only three times in 2007, another had not been reviewed since December 2007. One care plan stated that the individual needs at least one litre of fluid a day, however there was no chart in place and no evidence of any monitoring. None of the care plans that we looked at were person centred and all referred to ‘the client’ throughout and did not use the name of the person. There was use of some negative terminology in some of the care plans. For example: ‘bit noisy this morning’ and ‘sometimes gets cross.’ Another care plan starts with, ‘depending on her mood…’ and another care plan stated, ‘difficult to comprehend or obey commands.’ There was more reference to what the individual can’t do rather than what they can do for example the use of the term ‘immobility’ all the time and not ‘mobility’. The organisation need to ensure that staff use more appropriate positive terminology when writing about the people who live here. There were some concerning issues about medication practices. For example in one person’s care plan it said, ‘can become very agitated and usually shouts very often during contact which requires medication on occasion.’ Also: ‘sometimes needs medication to reduce shouting’. One care plan stated ‘give medication as prescribed’ for a PRN drug – however there were no guidelines and no other information. The home must ensure that it looks at alternative ways to manage challenging behaviour. Some care plans did not have photos of the individual, some information was not dated, some was wrongly dated and some was not signed. The information in the care plans was very inconsistent for example some care plans had inventories, some did not, some had personal care charts, others did not, some had activity charts (which were blank) and some did not. We found that the elimination and personal care charts we saw had long gaps where people did not have personal care or bowel movements and there was no recorded action taken about this. One person had no needs identified in the personal hygiene part of their assessment. However, their care plan showed that they clearly needed a lot of support in this area. Other monitoring charts that we looked at were not always completed. For example one individual known to be at nutritional risk had no observations carried out or weight check since March 2008. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 12 There were limited or no social history or personal histories in the care plans looked at. Where interests were identified there was no evidence that people were ever supported to pursue these. There was no personal information on children’s names or important dates. For example one care plan said, ‘has two children one of each sex and many grandchildren’. Another said, ‘social aim – to get her to socialise with others and be mentally stimulated’. This resident spent all day sitting in a chair with no one to talk to and the morning sitting in front of the TV which they were not watching. We found that there were limited records for multidisciplinary input. In one care plan the last entry was July 2007 and for another individual it was November 2007. There was no evidence of dental, chiropody, tissue viability or dietician input and no record of recent medication reviews in the care plans looked at even where there had been changes in medication. This information must be recorded in the care plan to demonstrate that individuals health care needs are being met. Some information was unclear, did not make sense or was so badly spelt it changed the meaning. For example one care plan stated ‘No (unreadable word) in diet’ – something which could be really important. Another care plan said, ‘no allergies. Penicillin’. This is very confusing and could place the people who live here at risk of harm. Risk assessments sometimes showed the risk but did not identify ways to minimise these risks. Some of these had not been updated since last year. For example the last update for one of them was June 07. Some information indicated restraint but these methods had not been agreed by multidisciplinary review, the resident or their family. For example a risk assessment stated that the resident frequently walked around and was at risk of injury so they ‘should be allowed to sit in a chair that is difficult for (them) to move without help’. In another example one residents risk assessment states that one carer wash them and the other carer ‘gently’ hold their hands down so they cannot hurt themselves or others. One risk assessment stated that a call bell must be within easy reach for one individual. However it was not for the whole time we observed them in the lounge. Risk assessments must be in place for all identified risks and must contain detail about how to minimise that risk. End of life/burial wishes were not always recorded. One care plan looked at referred to ‘no hospital treatment at request of family’. There was no further definition as to what was meant by this. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 13 We were informed that one individual has developed a pressure sore and another had developed a “superficial” break to their skin. However there was no care plan in place in either of their files for this and no nutritional action plan or monitoring in place. Both individuals had been highlighted as high risk for the development of pressure sores and at high nutritional risk but it appears little action had been taken and they have subsequently developed pressure sores. No wound photographs were in place either which indicates that staff are not following nationally agreed good practice guidelines for wound care management. A pressure sore care plan that was in place for one individual did not contain any photos, contained only basic information, and there was no evidence to say if it had healed or not. One care plan said someone had a pressure sore but there were no changes to the tissue viability risk assessment. The manager also informed us that due to changes bought in by the new organisation she was unable to access pressure relieving mattresses quickly enough. Some staff told us that there were not enough pressure relieving mattresses for the people who needed them. They said that sometimes they swapped equipment round from one person to another but there was not even enough equipment to do that at the moment. Equipment for the benefit of resident healthcare needs must be available when they need it. Care plans and appropriate monitoring must be in place for those with pressure sores/ulcers. Appropriate nutritional monitoring must carried out. We were informed that two residents are known to display certain behaviours. However there was no risk assessment in place for either individual or action plan to advise staff how to deal with the behaviour appropriately. One individual has a history of refusing medication however the risk assessment was drawn up only on the day of our inspection. Pharmacist inspection report below: We inspected the homes medication policy, storage, and the recording of receipts, administration and disposal to see if medication was being handled safely in the home. The homes medication policy was the corporate policy written in 2007 and it covered most aspects regarding the safe handling of medication. We noted that there were no local procedures for how the home managed the medication of those residents who went out on leave, the testing of blood coagulation and management of warfarin; and the management of medication for those residents on respite care. We were unable to find a list of specimen signatures and initials and this made it quite difficult to audit the Medication Administration Records (MAR). These should be linked to nurses understanding the updated medication policy and procedures so that error is prevented and best practice is met. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 14 Controlled drug balances in the home were correct. There were many residents prescribed Temazepam and none were stored in a cupboard meeting the requirements of the Misuse of Drugs Act. One patch of a medicine newly prescribed for a resident was borrowed from that belonging to a deceased resident, although a supply could and was obtained the same day. We looked at the recording of receipts. They were generally complete in the main unit but there were many omissions in the new unit particularly for new residents and for residents receiving respite care. There were no records of disposal in the home. In order to audit medication to see if it is being administered as prescribed then it must be possible to track all medication from receipt to administration to disposal. There were several gaps noted on the administration records particularly in the main unit. One resident prescribed insulin had not had it recorded as given for 2 mornings. A resident with Parkinson’s disease did not have any of their medication recorded as given on 24/7 and also at 7am the morning of the inspection. The stock counted for omeprazole for several residents was out by one or two tablets. Iron tablets were not recorded as given on 14,21,27/7 and tolteridone on 23/7. Unless medication is recorded when given then there is no evidence that it had been administered. This could adversely affect the health of the residents. Sometimes the correct codes were not used e.g. P and L instead of F =other and C = social leave so we did not know the reason for non-compliance. A tick was used for the administration of a suppository. This usually means that the nurse has delegated the task to a healthcare worker. We were told that the resident was self-medicating but there was no reference to this in the care plan and there was no risk assessment in place. In the new unit there were gaps noted for chloramphenicol eye drops and dipyridamole. For two residents it was noted that they did not have their medication for the heart and bladder respectively for 3-4 days at the beginning of the new medication cycle. Medicines were only being checked in the day before the cycle was due to start. This does not leave enough time for any corrections. Another resident ran out of a drug for cancer in the middle of the cycle. Three residents in the home were prescribed warfarin. It was not possible to audit these tablets. The transcription on the MAR was confusing. The recording and management of warfarin must be improved to prevent the risk of error. It was noticed that the home was sharing residents lactulose and paractamol tablets because there was insufficient room on the trolley. Medication prescribed for one resident belongs to that resident. Only one box of Residronate was in use for a man and wife living in the home and both prescribed the same medication. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 15 Oxygen cylinders were standing loose in the home. This can pose a hazard if they are knocked over. Oxygen is a prescribed medicine and must be listed on the MAR even if the resident is self-administering. The clinical room was small and there was not really enough storage. There was quite a lot of excess stock. Medicines were not always disposed of in a timely manner when a resident died. There were several residents in the home who had their blood glucose tested on a regular basis. We noticed that the lancets in use were not for professional use and as a result both staff and residents could be at risk from the transmission of blood borne diseases. Three care plans were tracked. It was noted for one resident who had no MAR chart that she was refusing medication and it was documented that all had been stopped by the GP. In another care plan there would good records of visits by the speech and language therapist and the dietician to a resident being fed enterally. Because of the omissions in the recording of receipts, administration and disposal of medication, the lack of audit, and the use of the wrong lancing devices we were concerned that the health of the residents may be placed at risk. We therefore issued an immediate requirement notice for the home to comply with current legislation before the 1/9/08 The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although there is an organised activity programme in place not all residents wish to take part in this. The home needs to look at other ways of involving those people is suitable activities of their choice. Residents tell us that their choices are respected such as when to go to bed, rise in the morning and their meal choices. There is not enough information about residents social needs and interests in their care plans. The people who live here are able to keep contact with friends and family. EVIDENCE: Some comments made to us by the people who live here: “The food is ok it used to be better.” “The food is usually pretty good but not always to my taste.” The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 17 “We have a fish and chip day on Friday, I don’t like chips so I just eat one or two. I don’t like mushy peas either but it’s better than nothing.” “I like the food – it is usually good.” “Meals could be more varied” “I find I don’t know about things because I am not informed.” “I don’t take part in the activities they don’t do anything I like.” Although the manager reported that there is an organised activity programme we noted that no one in the lounge was supported to do anything. There was very little information on social needs in care plans, but where these had been identified people were not being supported to pursue these. The daily recording notes had no evidence of many residents doing anything different than they did during our inspection visit, that is sit in the lounge. There was often no staff in the room to chat to people or read them newspapers and no music was offered. Staff did walk through the lounge every now and then but no one spent time there. Individuals spent the morning just sitting around the walls staring at each other, into space or sleeping. The TV was left on but no one was watching it. The manager told us that the activity co-ordinator has copies of life histories for all who live here. Three of the people who live here were observed playing bingo in the activity room. Relatives were observed to be warmly welcomed into the home and some of those spoken to said that they were happy with the care given at the home. There has been only one residents meeting this year. More frequent residents meetings need to take place to allow them to have their say about life at the home. The manager reported that the main issue raised was about the standard of the food. She reported that some residents felt that the standard of the food had declined and also that the kitchen staff were changing menu choices without prior notice. She reported that this has been addressed and the menu has been re-written as a result to suit most of the residents. She said that residents had complained about a lack of cheddar cheese and cheese biscuits but that this had also been resolved. We were concerned that no one seemed to be monitoring fluid intake or checking up on people’s wellbeing - particularly as it was a hot day. No drinks were available in the lounge when we went there at 10:30am. Just after 11am the tea lady brought the tea and handed this out to everyone without The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 18 comment. She collected the cups a short time later. Two individuals had not had anything to drink and their tea was taken away still full. At lunch the same individuals were poured drinks but were not offered them and they did not have anything to drink. Their drinks were taken away after lunch. Different staff attended to different jobs and no one monitored their fluid intake or lack of it. There were no fluid intake charts in the care plans that we looked at, including none in a care plan which said the person must drink a certain amount of fluid each day. We discussed with the manager that fluid charts must be in place particularly for those people identified as having nutritional needs. Also it is important that staff actually take time to encourage the people who live here to drink and spend time doing this. Although fresh fruit salad was observed to be offered at lunchtime - no fresh fruit was observed to be offered between meals and the only snack offered was a biscuit or piece of cake with the cup of tea given to some people. Often no choice of biscuit was given, one was selected and placed by hand on saucer for some residents only. We discussed with the manager that trays of cut up fruit are offered at regular intervals to help with fluid intake. Two residents reported that their choices were respected regarding taking lunch in their rooms and they said that they liked this arrangement. At lunchtime the food was nicely presented and people were given a three course lunch. The dining room tables were set up nicely with water jugs. The staff said that people made their choices a day in advance but that they were offered something else if they changed their mind or could not remember and didn’t like what they received. Three people in the lounge area needed constant support during lunch. Two people needed encouragement and some support. The staff were not allocated to a particular resident and did not stay with one person throughout the meal. To start with three people’s soup was brought and one staff member started helping one person. One individual waited with their soup on the table for ten minutes, another waited for twenty minutes. No one offered to warm the soup or checked the temperature. Other courses arrived while people were still eating their soup. To start with one member of staff fed two residents in turn. Other staff drifted in and randomly helped different people. There was no continuity and some staff just walked up to people and started spooning food in to them. There was very little conversation from the staff to the resident and only one member of staff told a resident what they were actually eating. One member of staff blew on food to cool it. All the people were given bibs whether they needed them or not. None of the staff offered people drinks while supporting them. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 19 Staff helped someone cut up their meat, but not their broccoli which was just as difficult for them to cut up and they really struggled with it. One resident who kept getting up and walking off was not assigned any staff member although various different staff either offered them forkfuls of food while standing over them or guided them back to their chair and told them to eat. They only ate some food when a staff member spent time with them and sat when they sat and stood when they stood, offering them encouragement and support. This individual should be assessed to have one-to-one support at mealtimes. Their nutritional risk assessment identified risks of not eating and without support they would not have eaten anything at that mealtime. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are not always fully logged with details of the outcomes and there is little evidence of the follow up needed. Not all allegations have been reported in a timely fashion this year and must be to prevent risk to the people who live here. However, Staff spoken to were aware of the importance of reporting poor practice or safeguarding issues to the authorities immediately. There is an ongoing programme of SOVA training for staff. EVIDENCE: The complaints log contained four entries made since our last inspection. One was concerning the loss of one individual’s money and a cheque and the manager reported that these had been found. However this was not documented in the log. All complaints must be fully logged with full details of the outcome included. One complaint was concerning an individual who was found to be ‘upset and crying’ after being ‘dressed in a rush’ by staff. This entry did not indicate how the behaviour of the staff was going to be addressed and there was no evidence of the need for further training for these staff members. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 21 Two safeguarding vulnerable adults issues have been brought to our attention following the last inspection. It was concerning that in one case staff had not come forward with full information immediately and the other incident was not reported to Wandworth Social Services until we contacted the home. We discussed with the manager that staff must be aware of their obligation to act in the best interests of the people who live here and report any poor practice or suspected abuse immediately. She reported that she felt there was a reluctance on the behalf of some staff to do this and stated “ I can’t say why staff don’t come forward with information.” She said she had spoken to staff about this and did not know what else she could do. However, we could not find any evidence that staff have been involved in discussions about this area. Only two care staff meetings and two registered nurse meetings were documented this year and did not include any mention of abuse awareness or whistle blowing in the minutes. The home must ensure that it explores any reasons for staff reluctance to come forward and that staff are aware of the importance of following whistle blowing procedures. The manager acknowledged that the incidents should have been reported following the Wandsworth Local Authority procedures but said that she was often confused by these procedures as they seemed to vary and ‘there never seemed to be a proper conclusion’ to the allegations made.’ We noted that the home has a rolling programme of SOVA training and is planning to send staff on the Wandsworth SOVA training as well which is good. However, information in the training plan for the organisation indicates that they plan to send staff on SOVA updates on a three-yearly basis. We would strongly recommend that this training is carried out more frequently. A copy of the local authority safeguarding procedures were at the home but they were in the office and should be displayed in an area where staff can easily access this information. The training co-ordinator reported that some staff had recently attended the Wandsworth Safeguarding Vulnerable Adults training day to help ensure that they were up-to-date with the relevant procedures. Some staff we spoke to said that they had good training with regular updates and had found this useful. They said they had SOVA training and said that they knew what to do if they suspected abuse. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-decorated however the storage of equipment throughout the home detracts from the homely atmosphere. Residents spoken to said that they liked their bedrooms and those seen were decorated to individual taste. It is clean and hygienic. EVIDENCE: Some comments made to us by the people who live here: “It is extremely clean. I love my room it is so nice.” “I like my room” The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 23 “I love my room and I like the garden.” There is a large pleasant lounge on the ground floor which leads through to the dining room. Both were clean and homely. There are also small lounge areas that lead out onto very well kept courtyard areas. The home was bright and airy and not too hot. It was a hot day and doors were open and fans were used in communal rooms to help cool the air. There were no unpleasant odours. The ground floor bedrooms all lead out onto a pleasant and well kept courtyard area. Some bedrooms were labelled with pictures, but most only had small name plates. We discussed with the manager that staff should think about ways to help people identify their rooms with pictures, symbols, numbers or larger name plates. The manager reported that a delivery lorry had recently knocked down one of the large brick exit posts outside the home. She showed us the pile of rubble that was left - this looks unsightly and needs to be replaced. We noticed that one of the large ornamental metal railings was missing. The manager reported that these had been stolen from the home. She said that the CCTV cameras no longer work. The manager told us that storage was a problem throughout the home. We could see that equipment including hoists, trolleys and wheelchairs were stored in communal areas and bathrooms. The hairdressing salon was full of old equipment including a medication trolley that was not in use, a metal trolley, a linen trolley and a broken set of weighting scales. This looks unsightly and does not create a homely atmosphere and the home must look at ways of providing enough storage space. In the lounge opposite the activity room there is cracked and bubbling paintwork on the ceiling that needs maintenance. There are areas of chipped and cracked paintwork in most of the bathrooms that need attention and the cracked paintwork on the wall at the turn of the stairs leading to the second floor also needs attention. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staffing levels appear to meet the needs of the people using this service, however more effective organisation of the staff would benefit the people who live here. The training provision for care staff is good. Residents are may not be protected by the homes recruitment procedures. EVIDENCE: Some comments made to us by the people who live here and visitors: “Some of the staff are interested in one’s welfare” “The staff are very friendly and approachable and provide a high standard of care” “Some staff are impatient with those who have dementia” “Staff are pleasant and helpful” The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 25 “Sometimes there are one or two staff who are not friendly and just do what they have to do and go.” “The staff really actually talk and explain (to my relative) it is really lovely, they are friendly and genuine.” “They always go to hospital appointments with (my relative).” “The nurses are caring.” The staffing levels appeared satisfactory during the inspection visit. The manager reported that there are two registered nurses on duty on each day shift (both morning and afternoon) and one registered nurse on duty overnight. She said that in addition to this eleven care staff are on duty for the morning shift, eight in the afternoon and four overnight. Although staff numbers looked sufficient we discussed with the manager that attention needs to be paid to the actual organisation/use of staff so that they can carry out care more effectively. At times many staff were observed to be in one area such as the dining room but did not seem to have adequate supervision or knowledge of what their roles were. Five staff files were looked at. One did not contain any references, the manager told us that the staff member had worked at the home previously and had been informed that she did not need to obtain them, however references must still be obtained to help to ensure the safety of the people who live here. No evidence of any criminal record bureau (CRB) checks were seen in three of the files looked at. Staff recruitment files must contain all the required information to help to ensure that the people who live here are not placed at risk. As stated in the last inspection report one member of staff is responsible for all staff training at the home. There is a good staff training programme in place and mandatory training such as moving and handling, food hygiene, first aid takes place on a rolling programme and was seen to be up-to-date in those staff files that we looked at. The staff we spoke to said that they had good training with regular updates and had found this useful. Although there was evidence to show that some dementia training has taken place, the organisation should consider more comprehensive training in this area for all care staff. Many of the people who live here have complex needs and from the evidence of poor recording in the care plans, the lack of risk assessments relating to challenging behaviours and being informed that occasionally some staff can be ‘impatient’ with those with dementia this indicates that more training is needed. It would also be good practice to seek advice from experts outside the organisation. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 26 Only two health care assistant meetings have been documented since our previous inspection and only two trained nurse meetings. Staff meetings must take place more frequently so that information can be passed on to staff, any important matters (for example safeguarding, abuse awareness and whistleblowing) can be discussed and staff can raise any issues they may have. A staff handover that we attended was observed to be in depth and senior staff seemed knowledgeable about residents and how to manage situations. All staff contributed. Other staff talked about residents with fondness and showed that they knew about their needs. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. As stated in the last inspection report there are a number of issues that need to be addressed in this service. The recording of information in much of the documentation still needs to be improved. Also there is again not enough evidence of the involvement of the people who live here in the running of the home or the quality assurance process. Staff do not receive regular one-to-one supervision which they need to help them to understand their roles and plan their development. There is a rolling programme of health and safety checks. EVIDENCE: The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 28 The manager reported that she was leaving the home. She told us that there were many issues with supplies of equipment such as hand towels and some incontinence aids as she no longer has control of the budget. She reported that it was “very frustrating” and that they had to visit another home recently for equipment as they ran out of hand towels. The organisation must ensure that adequate supplies are available at the home at all times. Regular staff one-to-one supervision is not taking place and this must be carried out. This will help to ensure that staff have the direction and support that they need to carry out their roles. Training needs can also be identified. Staff that had been involved in the recent safeguarding allegations at the home did not have any support plans in place to demonstrate how they were being supervised and supported. They had not received adequate levels of one-toone supervision. The training co-ordinator reported that she was aware that senior staff were not carrying out enough supervision of care staff and had discussed it with them. Staff must ensure that they carry out supervision of other staff as part of their role and must make time for this. The manager reported that only small amounts of money are kept on behalf of the people who live here. This is locked away securely and each individuals money is kept separately. Monies for two individuals was checked and found to be correct. The transactions are recorded on scraps of paper which is disorganised and this system need to be tightened up – separate books with numbered pages need to be used for each individual. Although the manager reported that a recent audit has taken place, as found at the last inspection there was not enough evidence to demonstrate that the views of the people who live here, relatives and other interested parties have been sought recently. The manager reported that the organisation had sent out surveys to relatives shortly after they took over last year. However she reported that she was unaware of the results of this survey. The home should ensure that the views of the people who live here are taken into consideration as part of the quality assurance process. This helps to make sure that residents and relative’s views are taken into account regarding the running of their home. The manager reported that residents meetings are still not taking place regularly. There has been only one this year. The home needs to look into ways of involving the people who live here in the running of their home. A programme of health and safety checks is in place at the home. Checks relating to safety including gas safety, electrical installations and legionella were up-to-date. This helps to ensure the safety of the residents and staff. There are many issues that need to be tackled at this home as we found many examples of inadequate recording of information that could place individuals at The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 29 risk. There is also a need to enhance the staff communication at the home through meetings, more frequent supervision and better organisation of the staff and their roles. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 3 The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP1 OP3 Regulation Sch. 4 14 (1) Requirement Previous inspection reports must be available at the home. Assessments must be fully completed to ensure that the needs of the residents can be fully met. Previous timescale of 01/11/07 not met. 1. Care plans must be regularly reviewed. 2. Care plans must be fully completed with enough details to ensure that the needs of the people who live here are met. This includes all the monitoring charts including: fluid, bowel and personal hygiene needs. 3. Care plans must be more person centred and address the social and recreational care needs of individual residents. Risk assessments must be in place for all identified risks they must contain enough detail to ensure that the needs of the residents are met. DS0000019114.V366980.R01.S.doc Timescale for action 01/10/08 01/10/08 3 OP7 15 (1) 13 (4) 16 (2) (m) (n) 01/10/08 4 OP7 15 (1) 13 (4) 01/10/08 The Pines Nursing Home Version 5.2 Page 32 5 OP8 12 (1) 6 OP8 12 (1) 7 8 OP8 OP9 12 (1) 13 (2) 9 OP9 13 (2) 10 OP9 13 (2) Care plans must be in place for all individuals with wounds and pressure sores/ulcers. These must follow good practice guidelines and contain adequate monitoring tools such as photographs and wound mapping. Equipment to meet health needs such as pressure relieving mattresses must be easily accessible. Nutritional and fluid monitoring systems must be put in place. Medication must be checked in a timely manner to ensure that supplies are available for the start of the new cycle. The home must record accurately the receipt, administration and disposal of medication. Balances brought forward must be recorded so that medication The homes manager must audit medication regularly to gain evidence of accurate administration so that the health needs of the residents are met. Temazepam must be stored in a cupboard meeting the requirements of the Misuse of Drugs Act. Lancing devices for professional use must be used in the home to prevent the risk of infections from blood borne disease. Individually prescribed medicines must not be shared between residents in the home. The homes policies and procedures must reflect local practice for managing anticoagulants; leave medicines and medication for those on respite care. There must be a list of signatures and initials for DS0000019114.V366980.R01.S.doc 01/09/08 01/09/08 01/09/08 11/08/08 01/08/08 01/09/08 11 OP9 13 (2) 11/08/08 12 OP9 13 (2) 01/09/08 13 14 OP9 OP9 13 (2) 13 (2) 11/08/08 01/10/08 The Pines Nursing Home Version 5.2 Page 33 15 16 OP9 OP9 13 (2) 13 (2) 17 18 19 OP12 OP16 OP18 16 (2) (m) (n) 22 13 (6) 20 OP19 23(2)b & d those staff who understand the homes polices and procedures and who are trained to administer medication. Risks assessments must be in place if a resident self medicates and these are regularly updated. Oxygen cylinders must be stored securely in the home in a stand or chained to the wall so that they do not fall over. If Oxygen is prescribed then this must be included on the MAR. The home must look at ways of involving more residents in fulfilling activities of their choice. All complaints must be fully logged with details of the outcome. All staff must be aware of the importance of reporting poor practice and suspected abusive behaviour using the agreed protocols immediately. The organisation must ensure that all areas throughout the home requiring attention are redecorated. This includes the cracked and bubbling paintwork on the ceiling in the small ground floor lounge and the chipped and cracked paintwork in the bathrooms. Alternative storage solutions must be found and the home must stop storing equipment throughout the communal areas of the home. The external entrance post must be repaired. Staff files must contain all the information required in Schedule 2 of the Care Homes Regulations 2001. The organisation must ensure more effective management of DS0000019114.V366980.R01.S.doc 01/09/08 14/08/08 01/12/08 01/10/08 01/09/08 01/02/09 21 OP29 19 (4) (b)Schedu le 2 10 (1) 01/10/08 22 OP31 01/11/08 Page 34 The Pines Nursing Home Version 5.2 23 OP33 24 24 25 OP35 OP36 13 (6) 18 (2) staff at the home and hold more regular staff meetings to help to improve communication at the home and pass on important communication. The organisation must look at ways of including the views of the residents in the running of the home. The method of record keeping for the logging of individuals transactions must be improved. Regular one-to-one staff supervision must take place. 01/11/08 01/10/08 01/11/08 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 OP1 Good Practice Recommendations The organisation should consider making the statement of purpose and service user guide available in different formats such as large print or pictorial to help to meet the needs of the people who live here. It would be good practice to attach colour photographs to the residents care plans. The organisation should also consider re-organising the care plans so that they are easier to follow and any old information is archived. The home should consider (in addition to regular drinks) offering individuals alternatives such as peeled fruit or ice lollies on sticks to ensure that they have enough fluids. The organisation should look at providing safeguarding (SOVA) training yearly in line with good practice. The home should look at ways to offer more comprehensive training in dementia care to all staff which will help them to meet the needs of the people who live here. It is recommended that resident meetings be held regularly at the home and that these are fully recorded. DS0000019114.V366980.R01.S.doc Version 5.2 Page 35 2 OP7 3 4 5 OP15 OP18 OP30 6 OP33 The Pines Nursing Home 7 OP33 The home should look at the organisation of staff within the home and consider a more effective way of ensuring staff are aware of their roles and responsibilities. Particular attention should be paid to meal times. The Pines Nursing Home DS0000019114.V366980.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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