Inspection on 06/07/09 for The Pines Nursing Home

This inspection was carried out on 6th July 2009.

CQC found this care home to be providing an Good 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 27/07/08

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Pines Nursing Home 104 West Hill Putney London SW15 2UQ Lead Inspector Sharon Newman Unannounced Inspection 10:00 6th July 2009 DS0000019114.V375487.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Pines Nursing Home DS0000019114.V375487.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.V375487.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 27th July 2008 Date of last inspection Brief Description of the Service: The Pines provides accommodation and nursing care for up to 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.V375487.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 2 stars. This means the people who use this service experience good quality outcomes. This inspection included a visit to the service which took place on 6th July 2009. The lead inspector was accompanied by a pharmacy inspector and another regulation inspector. The manager of the home was present throughout the inspection. 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 and some residents. Overall there have been improvements in many areas since the appointment of the new manager. However we found that there were still some instances of poor recording of health information. What the service does well: The home is clean and well-decorated; it provides a homely environment for people to live. The manager is experienced and committed to improvement at the home. Staff have a good rapport with residents and demonstrate a kind and caring attitude. There is a good staff training programme in place to help ensure that staff have the skills to provides care to residents. What has improved since the last inspection? A programme of re-painting and decorating has been taking place throughout the home. The entrance post to the home has been repaired. Complaints were seen to be fully recorded in the log book to help to ensure that they can easily be audited. The previous inspection report is now displayed in the reception area of the home. The service has provided many residents with specialist mattresses/beds where needed to help prevent pressure sores occurring and this is good practice. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 6 Residents have been asked to complete surveys to ask them their views about life at the home, this helps them to be involved in the running of the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Pines Nursing Home DS0000019114.V375487.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.V375487.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Resident’s needs are assessed before they move into the home. EVIDENCE: The information in the residents care plans we looked at showed that individuals receive full assessments prior to coming to live at the home. The assessment and care planning documentation is in the process of being changed and is an improvement on the previous system. The Statement of Purpose and the Service Users Guide have both been updated and are now available in large print to ensure that they are easier for residents to read. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 9 There is now a copy of the last inspection report at the home and this is kept in the reception area along with copies of the monthly Regulation 26 (audit) visits of the home. This demonstrates an open approach as anyone passing through the reception area may read these documents. The Pines Nursing Home DS0000019114.V375487.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been an improvement in the recording of information in the care plans. However, some information is not kept up to date and some health recording information is not detailed enough. Risk assessments are not always in place for identified issues/risks and this could place the people who live here at risk. Residents were observed to be treated with respect. Practice relating to medication is variable there have been some improvements but there are still areas that need to be addressed. EVIDENCE: The manager told us that the care plans are in a “transitional stage” at the moment as the home is changing the care planning system and is moving The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 11 away from the old ‘Standex’ system. She reported that they hope to become more person centred by doing this and also that the care plans will be easier for staff to use so that the recording of information improves. Care plans contained information regarding: social activities, activities of daily living, risk assessments, information relating to GP and healthcare visits and a daily record of care. We looked at four care plans and some of the documentation contained within them was observed to be up-to-date and informative. However some information had not been regularly reviewed and must be to help to ensure that residents needs are met. In one care plan the falls risk assessment had not been updated since February 2009 and some of the care plan information had not been updated since February and March 2009. A pressure sore risk assessment had not been updated since March 2009. A nutritional risk assessment had not been completed at all and a bedrail risk assessment had not been updated since February 2009. Another residents’ bed rail risk assessment had not been updated since December 2008. A weight chart showed a continual decline in weight however the comment column had not been completed. An assisted feeding care plan was in place but was not detailed and did not contain any reference to fluids. A care plan for another resident again contained risk assessments and charts that were not fully up-todate. A weight chart did not contain an entry since April 2009 and their nutritional risk assessment had not been updated since April 2009. Information seen in a resident’s fluid and nutritional charts was also found to be variable. Overall the documentation did not contain enough information and did not indicate that the resident was receiving sufficient fluids and nutritional intake. This was concerning as the care plan highlighted that this individual’s nutritional risk assessment indicated that they were a high risk. One chart indicated only “1 cup of tea” and “orange” in the fluid column it did not give details of how much of either had been taken by the resident and this was the only fluid recorded in a 24 hour period. Other fluid and nutritional charts for different dates also contained very sparse information. We discussed with the manager that the charts need to contain more specific information about the amount of fluid and type of fluid taken and also more detail about the food eaten. In one care plan a seizure report dated 12/05/09, stated that a person had a seizure however there was no evidence of a care plan or risk assessment leading on from this. On the medication chart they had been prescribed rectal diazepam for a number of months, yet again there was no care plan for this issue. This was discussed with the manager at the time of the inspection visit who said they would look into this and address it. Two nurses are completing the Gold Service Framework in End of Life care. We were informed there are no people currently requiring this care at present. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 12 Residents have access to a range of healthcare services, one resident was observed to be taken for a hospital appointment during the inspection visit. A physiotherapist and occupational therapists were also seen visiting the home and were spoken to. One health professional told us that they thought the home provided good care and that since the new manager has been in post there have been improvements at the home. The report of the pharmacist inspection is below: We inspected the safe handling of medication and followed up on the concerns raised at a previous inspection in 09/08. We looked at storage and the recording of receipts, administration and disposal of medication in both units and audited several packs of medicines to see if they were being given as prescribed. Progress was being made in achieving higher standards. The home now had a bulk prescription for lactulose and were no longer sharing residents own supplies. Lancing devices were of the professional type to prevent the risk of infection, oxygen was secure and the home was carrying out regular audits. We noted the good practice of keeping protocols for all the residents prescribed as required medicines so that staff knew the circumstances when they were to be administered. We checked the storage and balances of controlled drugs and found them to be satisfactory. We looked at the MAR (medication administration records) and there were no gaps in either the recording of receipts or administration. We noticed just one instance when aspirin was not available for 2 days at the beginning of the medication cycle because it was missed off the prescription. The manager was aware of this. There was good practice of writing the balances of stock carried over from one medication cycle to the next. We audited 8 packs of medication from the old unit and 6 samples were accurate. There was one too many tablets left for a medicine for Parkinson’s disease and 4 too few for an anticoagulant. This means that possibly in the former case one dose was signed but not given and in the latter the wrong dose was administered. In the new wing we audited 10 packs of medicines and only three samples were accurate. We could not find the alendronic acid for one resident and found omeprazole in the spare stock cupboard rather than the trolley. There were too many tablets left for a sleeping tablet, warfarin, and tablets for the heart. We noticed that the dose of one tablet had been halved but the record did not show when and we were unable to reconcile the balance and did not know if the correct dose had been administered. If there are too many tablets The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 13 left then there is evidence that medication is not being administered as prescribed. We noticed that one resident was away for the weekend and the MAR was recorded appropriately. The home still did not have a local written policy on how leave medicines were managed and recorded. We looked at three care plans. One of the residents with diabetes had a comprehensive care plan which was reviewed monthly. Blood glucose results showed that the diabetes was well controlled and there was also regular input from the GP, dietician and diabetic specialist nurse. Another resident who was being fed by tube because of swallowing difficulties also had a comprehensive care plan with protocols for feeding in place and records of visits from the GP, dietician, physiotherapist and speech and language therapist. A third resident’s care plan was not so comprehensive. The protocol for tube feeding was not available in the care plan and there were no records of review or visits from the dietician. A very faint copy was located in the clinical room but it was barely legible. There was also no care plan for managing seizures in this resident although one had been recorded as occurring fairly recently. In summary therefore there has been a lot of progress made in achieving safe administration of medication particularly in the old unit. Further tightening up of auditing is required with attention given to the new unit so that the health and welfare of the residents is maintained. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Contact with relatives is encouraged and they are welcomed into the home. Residents’ views are taken seriously and they are encouraged to participate in the running of the home. Mealtimes are an enjoyable part of the day and the food is nutritious. A range of activities is provided for residents. EVIDENCE: Residents and relatives meetings have now started to be held at the home to gain the views of the people who use the service and identify any areas needing improvement. Also, a recent residents survey was carried out and the people who live at the home were invited to complete a questionnaire about all aspects of life at the home. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 15 There is a suggestion box in the main reception area for anyone to write their ideas for any improvements. We observed relatives being welcomed in to the home during our visit. The manager brings her dog to work every day the home has a resident cat and this creates a pleasant homely atmosphere. The Activity Co-ordinator told us that activities offered include: bingo, dominoes, flower arranging, music and that outside entertainers come in to the home. Bridge is also offered. She was observed playing Scrabble with some residents during the inspection visit. One resident said that they go out on trips sometimes, and that they like the activities provided. There is a small activity lounge which provides equipment including a DVD player, TV, books, puzzles, and ‘talking’ books on CD, these are all for the use of the residents. The home now provides two meal sittings at lunchtimes. The first sitting comprises those residents who need more assistance. The manager reported that the residents are happy with this arrangement. The meal time observed was quiet and unhurried. When people required help this was carried out in a respectful and dignified manner with staff sitting down with residents to assist them. The chef now has meetings with the residents and also the residents recently completed a survey relating to food at the home. The manager reported that changes were made to the menus as a result of this. She gave us an example of residents saying they didn’t like the apples, as they were too hard to eat. One resident we spoke to said that they liked the changes made to the menu’s, particularly where they are able to choose what type of potato they want – they can now choose to have these boiled, as opposed to mashed. They also said that they like that they can choose to have a smaller or larger portion, depending on how they feel on the day. She said “…we all get fed well…”. The food looked appetising, with fresh vegetables and pasta and stew provided. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are listened to and taken seriously. Staff receive training in safeguarding vulnerable adults and whistleblowing to help them to understand the importance of reporting poor practice. EVIDENCE: The complaints log was found to contain full details of any complaints made with details of the action taken. The manager reported that all verbal complaints are also recorded. There has been one new safeguarding case since the last inspection and this was referred to Wandsworth local Authority for their advice and for them to investigate following the safeguarding protocol. The service manager told us that the home had learnt from this recent case and had ensured staff received the appropriate moving and handling training. We also noted that in recent staff meeting minutes the issues of moving and handling had been discussed and the importance of correct technique stressed to staff. Also the service manager told us that profiling beds have been used where needed. Decisions were reached by Wandsworth Local Authority regarding the three Safeguarding (SOVA) issues that were being addressed at the time of our last The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 17 inspection visit. The service reached a different conclusion to that of the Local Authority(Wandsworth). This was discussed with the service manager and the manager at the time of this inspection. The service manager reported that the home had followed the advice they were initially given by social services which was to start their own investigation and that they had also taken legal advice regarding the decision they reached. They reported that they follow the Local Wandsworth Safeguarding of Vulnerable adults Guidelines. The service manager reported that any complaints of abusive behaviour would be taken very seriously and always referred to the Local Authority. We saw evidence that staff attend the SOVA training given by Wandsworth Local Authority. All staff are given the local authority leaflet entitled “Your Rights and Responsibilities” regarding abuse issues. Staff also sign a document to say that they have received the policies in whistle blowing, vulnerable adults and No Secrets guidance. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a homely environment and provides an attractive place for people to live. Storage of equipment throughout the home needs to improve. The home is clean, pleasant and hygienic. EVIDENCE: As stated in the previous report 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 Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 19 The ground floor bedrooms all lead out onto a pleasant and well kept courtyard area. The bedrooms seen were of a good size and were well decorated and had been personalised by residents as they are able to bring in their own belongings, furniture, pictures, photos and mementoes. Those residents that we spoke to said that they liked their rooms. There is still an issue with storage at the home and hoists, trolleys and vacuum cleaners were observed to be stored throughout the hallways and communal areas and in the large lounge there was a clutter of tables and footstools which is unsightly. This was discussed with the manager who told us that a new storage area is being created to help resolve the problem. The outside back wall has been repaired and the gate post to the front of the property has been re-built and this improves the look of the building. Areas throughout the home have been redecorated, this is an improvement. A recent Regulation 26 report highlights that work is needed to improve the dining and lounge areas and the manager said the plan is to have this carried out within the next 6 months. The home employs their own maintenance person on site. We noted that the large windows in lounge (leading out to courtyard), could be potential hazard, as they open fully and need window restrictors. The home was clean and free from any unpleasant odours on the day of inspection. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were observed to have a good rapport with residents. Staff receive a good range of training and there is a rolling programme of training in mandatory areas such as safeguarding, health and safety and moving and handling. Appropriate recruitment practices are in place. EVIDENCE: The current staff complement at the home consists of: two trained nurses in the morning with eight health care assistants. There are two trained nurses employed for the afternoon shift with six health care assistants. On the night shift one trained nurse and four health care assistants are employed. We looked at four staff files and they contained relevant information around recruitment. Two criminal record checks were dated 2004 and we discussed with the manager that it would indicate good practice to have these updated. We met with the in-house trainer, who works four days a week, three of which are training days and the fourth is ‘manager-led’ – for example: audits, writing The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 21 up minutes or interviewing for new staff. She plans all the training for staff, using external courses and in-house, through training sessions and e-learning. She told us that she plans the induction for new staff and mentors any student nurses. The Induction for staff includes two days that are spent with the in-house trainer, and staff also undertake different training over three months. The induction is in line with Skills for Care and the common induction standards, covering health and safety, safeguarding vulnerable adults, moving and handling, fire safety and information about supervision. She said the home is an NVQ centre and she has the A1 assessors award to enable her to assess all staff doing their NVQ. She is currently doing the internal verifier qualification. 64 of care staff currently hold the Level 2 or Level 3 NVQ qualification. Safeguarding training takes place yearly with Wandsworth Local Authority, and all staff receive this including domestic and kitchen staff. Moving and handling training now includes specific training in assisting people who have had a stroke – since a recent safeguarding incident. We were informed that all nurses are doing dementia training which is either ‘Yesterday, Tomorrow and Today’ distance learning, or through e-learning dementia training provided by organisation. Training has been completed in venepuncture, male catheterisation, fire safety twice a year, moving and handling annually, first aid every three years, health and safety, recording, customer service - all through e-learning. The trained nurses also complete a competency of medication assessment. The nurses have undertaken training in Deprivation Of Liberties, though not the care staff. Also no training has been completed by care staff about the Mental Capacity Act. We looked at three staff training records they contained good information about the training received and the content of the training this needs to be archived, which the in-house trainer acknowledged. The in-house trainers’ office contains a wealth of training information, including videos and training manuals around areas such as dying and bereavement, risk assessment, diabetes, wound care, abuse, supervision and caring for people with alzheimers. She says that she keeps up-to-date through undertaking relevant courses and showed us her training records Regular staff meetings are now held to help to ensure that staff have the opportunity to put forward their views and that important information is passed on to them. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 22 The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is experienced and caring. Quality assurance is taking place to help to ensure that residents views are taken into consideration regarding the running of the home. The recording of residents financial transactions needs to improve. There is a programme of health and safety checks at the home to help protect residents and staff. EVIDENCE: The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 24 The new manager is experienced and committed to making improvements. She was seen to be respectful and caring to residents. She told us that she will come in to the home at weekends if requested by relative to meet with them. We discussed that the main issues that still need to be improved are regarding medication practice and recording of information in the care plans and health care information. This is important and poor recording can affect the care and safety of the residents. However, overall there have been steady improvements at the home under the leadership of the new manager. We looked at the supervision records for five staff. We saw that this is occurring six times a year in most cases, however this depends on who is providing this, as two staff supervised by the same person had not received sufficient supervision. We raised this with the manager during our inspection. From the evidence we looked at we saw that staff annual appraisals take place A full quality assurance programme is in place which includes audits of all areas of the home. Also, residents and relatives opinions are sought through either surveys or meetings. There are joint resident and relatives meetings quarterly, with the next planned for August 2009. The manager said that she plans these to take place in the evenings or at weekends when relatives are most likely to be able to attend. This helps to ensure that their views are taken in to consideration regarding the running of the home. Health and safety meetings take place every two months with the heads of departments. Care staff and nurse meetings take place approximately every 4-6 weeks. Additionally morning meetings are held for night staff and the manager reported that she will come in early to attend these. Small amounts of money are kept at the home belonging to residents which are stored safely. However, as found at the previous inspection visit the recording of financial transactions needs to be improved. It was difficult to follow the logged entries in the notebooks and we discussed that a hard back book need to be purchased with numbered pages and clear columns so that money leaving and entering the home can be clearly logged. The service manager and manager reported that they would address this. Health and safety meetings are held every two months and a programme of health and safety checks continues at the home. Checks relating to safety including electrical installations, portable appliance testing and fire drills were up-to-date. This helps to ensure the safety of the residents and staff. With regard to Regulation 26 (audit) visits we saw records to demonstrate that these take place. We also saw an internal audit that had been completed by the ‘Regulation Manager’ within the organisation it was very thorough, The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 25 addressing areas needing to be improved and we were informed that the results of this is fed back to staff. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 26 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X X The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 27 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 Standard OP7 Regulation 15 (1) 13 (4) 16 (2) (m) (n) Requirement 1. Care plans must be regularly reviewed. 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. 1. Risk assessments need to 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. Health information such as nutritional and fluid monitoring systems need to be more detailed and must be fully completed. Audits must be further developed so that there is DS0000019114.V375487.R01.S.doc Timescale for action 01/09/09 2 OP8 13 01/08/09 3 OP8 12 (1) 01/08/09 4 OP9 13 (2) 01/08/09 The Pines Nursing Home Version 5.2 Page 28 5 OP9 13 (2) 6 OP9 13 (2) 7 8 OP19 OP19 13 (4) 23(2)b & d evidence that residents are receiving their medication as prescribed. The home must formulate a local policy on how medicines are managed and recorded when residents go on leave. The care plans including the management of seizures and PEG feeds must be expanded upon. Window restrictors must be in place to all ground floor windows that require them. Alternative storage solutions 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. The method of record keeping for the logging of individuals transactions must be improved. Previous timescale of 01/10/08 not met. 01/08/09 01/08/09 01/09/09 01/11/09 9 OP35 13 (6) 01/09/09 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 3 Refer to Standard OP29 OP30 OP36 Good Practice Recommendations The organisation should consider updating criminal record checks for staff at least three yearly. Health care assistants should be prided with training in the deprivation of liberties. Supervision should be planned monthly to ensure that people receive this regularly and at appropriate intervals. The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 29 The Pines Nursing Home DS0000019114.V375487.R01.S.doc Version 5.2 Page 30 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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