Care Home: Pine Lodge

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What the care home does well The people living at Pine Lodge are supported by a staff team who know them well and can understand the different ways they communicate. Good support is provided to people in meeting their health and personal care needs. This includes supporting them to seek professional health advice and monitoring and acting on any potential health issues. This helps to ensure that people get the support that they need and choose to remain as healthy as possible. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Staff are aware of the different ways that people like to spend their time and provide support with this. In addition a number of on site facilities are available for people to use. This includes religious services, a day services and hydrotherapy pool. People are supported to make everyday decisions for themselves. Where they are unable to make a particular decision formal steps are taken to involve relevant people and establish that the decision is made in the persons best interests. Any concerns or complaints that are raised about the service are taken seriously and acted upon, with appropriate advice sought. This helps to ensure the people living there and their relatives can feel confident that Pine Lodge provides a safe place to live. Pine Lodge provides the people who live there with a well adapted home where their mobility needs and support needs around personal care can be met. Aids and adaptations are provided on an individual basis to ensure people are safe and their needs met. Staff receive training to help keep them up to date in how to support people safely and well. What has improved since the last inspection? Since our last inspection at Pine Lodge care plans for the people living there are reviewed more often. This helps to ensure that any changes to their support needs or choices can be quickly noted and acted upon and that they are getting the support they need. Meals for the people living at Pine Lodge are now cooked in the home rather than in a central kitchen. This means that menus can now be planned more directly around peoples preferences and meal times can be more flexible. It also helps the people living there to know when their meal is cooking and anticipate meal times. The support offered by staff at mealtimes is less rushed with meals becoming sociable occasion whereby people receive unrushed 1-1 support from staff where needed. Health and safety checks on the building and equipment are now carried out on time. This helps to make sure that Pine Lodge is a safe place to live, work and visit.Pine LodgeDS0000063016.V378186.R01.S.docVersion 5.3 What the care home could do better: Records keeping and care planning around people social choices and the support they get with this should be more detailed. This will help to ensure people are getting all of the support they need to live a lifestyle of their choice. Medication audits need to be more robust to ensure that any issues can be quickly noted and dealt with. This will help to ensure people are getting their medication as prescribed and any issues can be quickly noted and addressed. Regular checks needs to be made to ensure Nurses are registered nationally. This will help to ensure that they remain fit to carry out their role within Pine Lodge. Key inspection report CARE HOME ADULTS 18-65 Pine Lodge Blundell Avenue Freshfield Formby Merseyside L37 1PH Lead Inspector Lorraine Farrar Key Unannounced Inspection 18th September 2009 13.30p Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 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 home adults 18-65 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. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 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 Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Pine Lodge Address Blundell Avenue Freshfield Formby Merseyside L37 1PH 01704 872133 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) jennymcg@gotadsl.co.uk www.ftf.org.uk Frances Taylor Foundation Mrs Jennifer McGibbon Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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: Learning disability - Code LD The maximum number of service users who can be accommodated is: 12 Date of last inspection 6th August 2008 Brief Description of the Service: Pine Lodge is owned and operated by the Francis Taylor Foundation, a national organisation that provide care services for people with a variety of support needs. Located in the middle of Formby Pinewoods, Pine Lodge shares a site with two other registered care homes, a day centre for 65 people and a convent. All the services are for adults who have a learning disability. The services share extensive grounds and a hydrotherapy pool. Pine Lodge provides accommodation and support with nursing care for 12 adults who have a learning disability. Many of the people living there also have physical disabilities and the service provides aids and adaptations to meet their needs. There are care staff available 24 hours a day, to support people in all areas of their daily lives. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We gathered information for this inspection in a number of different ways. We carried out an unannounced visit to the home on 18th September 2009. This took place over 6.50 hours and included reading records and looking at the building. We spent time looking at the support the people living at Pine Lodge receive. This included looking at the support they get with their daily lives, care plans, medication, money, activities and environment. We met with some of the people living at Pine Lodge and some of the staff working there. We also spent time observing daily life and the support people receive in their everyday lives. We looked at any information we have received about Pine Lodge since our last inspection in August 2008. The manager also completed a questionnaire we sent her before our visit. This gave us information about the support they provide, health and safety, staffing and plans they have for the future. This all helped us in planning our site visit and writing this report. It currently costs £988.74 each week to live at Pine Lodge. What the service does well: The people living at Pine Lodge are supported by a staff team who know them well and can understand the different ways they communicate. Good support is provided to people in meeting their health and personal care needs. This includes supporting them to seek professional health advice and monitoring and acting on any potential health issues. This helps to ensure that people get the support that they need and choose to remain as healthy as possible. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 6 Staff are aware of the different ways that people like to spend their time and provide support with this. In addition a number of on site facilities are available for people to use. This includes religious services, a day services and hydrotherapy pool. People are supported to make everyday decisions for themselves. Where they are unable to make a particular decision formal steps are taken to involve relevant people and establish that the decision is made in the persons best interests. Any concerns or complaints that are raised about the service are taken seriously and acted upon, with appropriate advice sought. This helps to ensure the people living there and their relatives can feel confident that Pine Lodge provides a safe place to live. Pine Lodge provides the people who live there with a well adapted home where their mobility needs and support needs around personal care can be met. Aids and adaptations are provided on an individual basis to ensure people are safe and their needs met. Staff receive training to help keep them up to date in how to support people safely and well. What has improved since the last inspection? Since our last inspection at Pine Lodge care plans for the people living there are reviewed more often. This helps to ensure that any changes to their support needs or choices can be quickly noted and acted upon and that they are getting the support they need. Meals for the people living at Pine Lodge are now cooked in the home rather than in a central kitchen. This means that menus can now be planned more directly around peoples preferences and meal times can be more flexible. It also helps the people living there to know when their meal is cooking and anticipate meal times. The support offered by staff at mealtimes is less rushed with meals becoming sociable occasion whereby people receive unrushed 1-1 support from staff where needed. Health and safety checks on the building and equipment are now carried out on time. This helps to make sure that Pine Lodge is a safe place to live, work and visit. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 7 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. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 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. Sufficient information is provided to and obtained about people considering moving into Pine Lodge. This helps everyone to decide if it is the right place for the person to live. EVIDENCE: Pine Lodge has a policy in place that states before anyone is offered a place to live, a full assessment of their needs will be carried out. This will include obtaining information from the person, family and any professionals involved in supporting them. The person will also be invited to visit the home on several occasions and stay overnight if they wish. We looked at records for one person who had moved into Pine Lodge within the past year. Before they moved in a copy of their social worker assessment and care plan had been obtained. In addition staff had carried out an assessment of their needs and choices. We found that this contained clear information about the person’s personal care and health needs and choices. However information was more limited with regards to their chosen lifestyle and things they like to do. The information available helps staff to plan how to support the person, with their personal care and health care. Expanding the Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 10 information obtained about their lifestyle would also help staff plan the support they can offer in this area. Information about Pine Lodge is made available to people considering moving in and to their relatives. This is available in a DVD and picture format to help people understand as much as possible about the home and the service they can expect. However whilst the use of pictures will help peoples understanding, some of the words and phrases used are not easy to read. For example it states the person will be ‘assessed through observation and communication’, and that ‘dedicated support’ will be provided. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): 6, 7 & 9 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of the people living at Pine Lodge are recognised and they are supported to meet these. EVIDENCE: Individual care plans and records are in place for everyone living at Pine Lodge. These are written with input from the persons family and staff along with observations of the person in daily life. As many of the people living at Pine Lodge do not use verbal forms of communication this input from a variety of people ensures that as full a picture of the person is obtained as possible. Plans contain information about the support people need and prefer with their personal and health care as well as with their leisure interests. Information about people’s health and personal care needs was clearly recorded and Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 12 provided a good basis for staff to support the person safely and well. Clear information is also recorded about how the person communicates. As the people living at Pine Lodge do not use recognised forms of communication, this individual information helps to ensure that staff who may not know the person very well can communicate effectively with them. Care plans were up to date and had been reviewed regularly. This helps to ensure that any changes to the persons health or welfare can be quickly noted and dealt with. Although care plans do list the things people like to do with their leisure time the planning on how to meet this is not as detailed. Due to the level of support people require in this area more detailed planning and recording of the support provided would help to ensure people get the support they need and choose on a regular basis. Individual risk assessments are in place for people for that cover the different areas of peoples lives, such as getting out and about, relationships and their health and personal care. These assessments identify any risks to the person and given guidance on how they can be minimised, whilst ensuring people get the support they need. In discussions with one of the people living at Pine Lodge they told us that they make their own decisions about things and staff support them with this. The information in care plans helps staff to know how people show their decisions, for example what their non-verbal communication may mean. One plan we read explained that once the person is ready to get up in a morning they will become vocal to let staff know. This level of detail helps to ensure staff are aware of how people show their everyday decisions. In discussions with staff they had an understanding of how each person showed what they did or did not want to do. The inclusion of as many people as possible in contributing to care plans also helps to ensure as much as possible is know about the person and their preferences. Good practice was noted in that the home have organised a best interest meeting to discuss a way forward with someone health care needs. This meeting will involved as many people as possible in the persons life and provided a structured way to make a decision that is in the persons best interests, where they are unable to make that particular decision for themselves. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13 , 14, 15, 16 & 17 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 individual lifestyle choices of the people living at Pine Lodge are recognised and opportunities to meet these are increasing so they can take part in activities that they prefer. EVIDENCE: There are a number of facilities on the overall site that the people living at Pine Lodge use. These include a day service that provides different groups people can join depending on their needs and choices. Whilst at the day centre people are also supported to go out and about. The day centre is attended by people who have a learning disability and live in the wider community, providing an opportunity to meet new people. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 14 There is a hydrotherapy pool and ‘beauty rooms’ on site that are used for aromatherapy and reflexology. These facilities are decorated and equipped to a high standard and provide a relaxing environment for people. In addition a café partly run by volunteers opens on the site several days a week. This provides people with the opportunity to socialise in smaller groups and if possible help out with the café. There is also a chapel on site, which has Catholic services every Sunday and Church of England services occasionally. Relatives and members of the public also attend the Sunday service, which again provides people with the opportunity to meet others. Relatives of the people living at Pine Lodge have previously told us that they are able to visit when they wish and that they are kept informed about important events in their relatives’ lives. This was confirmed by records in the home that showed staff communicate with relatives on the person’s behalf. Care plans contain information about the things people enjoy doing both at home and whilst out and about. For example one plan we looked at said the person goes to church services regularly, likes music and watching sport. In discussions with staff they were able to explain the things people enjoy doing and how they provide support with this. New recording sheets have been introduced when people experience a new activity. These record whether the person enjoyed the activity, what went well and what didn’t and what support they should be offered next. As the people living at Pine Lodge often use non -erbal forms of communication, these are a good way to evaluate an activity they have experienced and try to establish their views. The manager explained that they are trying to support people with more varied activities. For example everyone has been on holiday this year and the hydrotherapy pool is booked for the home one evening a week. She also explained that they have booked to go horse riding with three of the people living there to see if they enjoy the experience. Records showed that people do get support to go out and about. However the support offered to people with the things they enjoy at home is not as well recorded. Recording this information, such as when someone is supported to watch their favourite TV programme or sport or listen to music they enjoy, would provide a clear way for staff to check that they are providing the support people need to live a lifestyle of their choice. Since our last big inspection at Pine Lodge the kitchen has been altered to become a fully working kitchen. Meals are now cooked on Pine Lodge instead of being delivered from a main kitchen. This means that menus can be better tailored to the needs and choices of the people living there. It also means that people are getting the experience of smelling their meal cooking and the hustle Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 15 and bustle of meal preparation. This not only helps people to live a more ordinary lifestyle it may also help people to anticipate meal times and possibly stimulate their appetite. An audit carried out by the organisation noted some concerns with the quality of meals provided and staff confirmed that this had been an issue. One of the people living there told us that the meals are, “okay” and they always get a choice. There were sufficient food stocks in the kitchen including fruit and vegetables and staff confirmed that the issue with quality of meals is being addressed. We observed part of the time meal and found it to be a pleasant occasion. Staff took time to sit one to one with people and provide the support they needed in a calm atmosphere. Again this helps to promote a more ordinary lifestyle and make meals a social occasion. Staff monitor and record peoples food intake and seek advice appropriately if there are any concerns. This helps to ensure people are supported to remain as healthy as possible. Routines within the home are varied depending on the things the person does that day. For example if someone is going to the day service they need support to get up earlier, whereas people staying at home can have a lie-in if they wish. One of the people living there confirmed to us that they decide when to get up in a morning and go to bed, this is not decided by staff. The fact that meals are now made on Pine Lodge also means that routines can be more flexible now that they are not waiting for meals to arrive from a central kitchen. During our visit we observed people spending time in different areas of the home as they chose. Some people were using communal rooms whilst others were sitting in their bedroom watching TV or listening to music and one person was out and about as they preferred. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): 18, 19 & 20 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 people living at Pine Lodge receive support to meet their health and personal care needs in a way they prefer. EVIDENCE: Discussions with staff working at Pine Lodge showed that they have a good understanding of people’s health and personal care needs and how to support them with these. In meeting the people living there it was evident that they are supported with their appearance and personal care in a way that meets their needs and choices and is appropriate for their age. Everyone living at Pine Lodge has care plans in place to guide staff on how to support them with their health and personal care. These contain information about the person’s health history, how they communicate, their current health care needs and how these are to be met. They also contain a series of health records and assessments around areas such as their weight, pressure areas and moving and handling needs. These records are updated regularly and Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 17 provide a good way to measure any changes to the person’s health and support needs. Care plans around health and personal care contain detailed information about the support the person requires. As the people who live at Pine Lodge do not use recognised forms of communication, this level of detail helps to ensure that staff can provide a good level of support. Records showed that people receive support to access a range of health professionals. This includes regular appointments such as the optician as well as more specialist appointments such as the dietician and appliance clinic. A health professional was visiting Pine Lodge during our visit to review several of the people living there. We observed that the manager had a good knowledge of the support people needed with their diet and nutrition and was able to answer the questions asked. In discussions with the health professional they told us that staff are good at alerting them to any issues and at following advice given. During teatime we noted that written advice given from a speech therapist to support one person at mealtimes was being followed. This all helps to ensure people are supported to remain as healthy as possible. There is a separate room to store medication at Pine Lodge and this was seen to be clean and tidy. Care plans contain information about the support people require with their medication. Where it is given with their food this is clearly documented, agreed by relevant people and the reasons why are clearly recorded. This helps to ensure the process is clear and people are given their medication in a way that meets their health needs and also respects their rights. Records of medication given to people and received into the home are clearly recorded, an audit system is in place and staff receive training in dealing with medication. We checked samples of medication and records. The majority had been well recorded, were stored correctly and tallied with stock and records. However one person had not received one of their medications for a period of three and a half days. Stock levels showed that this had not been given and it was not signed for on their medication sheet. However there was no explanation as to why this medication had not been given to the person and it had not been noted via auditing medications. Where a medication is not given for a reason this must be clearly documented. Audit systems also need to be robust enough to quickly note and deal with medication issues that arise. This will help to ensure that people are getting all of their medication as prescribed and where it is not be given for a reason there is a clear audit trail so that it can be reviewed. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): 22 & 23 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 people living at Pine Lodge are confident that any concerns they have will be listened to and acted upon. This is backed up by clear polices and procedures for staff to follow. EVIDENCE: Information about how to raise concerns or complaints is made freely available to the people living at Pine Lodge and their relatives and friends via the service user guide. Relatives of the people living at Pine Lodge have previously told us that they know how to raise any concerns that they have and feel they would be responded to appropriately. During this visit the people living at Pine Lodge told us that they would talk to staff if they had any concerns and were confident they would help. One person explained they would talk with the Manager as “she would sort it out for me”. There are clear polices and procedures in place at Pine Lodge for dealing with any concerns, complaints or safeguarding adults issues that arise. Staff receive training in recognising and dealing with safeguarding issues and in discussion with staff it was clear that they are aware of the indicators to abuse and how to respond to any concerns that arise. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 19 Where concerns have been raised in the past the organisation have responded to these by co-operating with any investigations and following procedures. This open approach to concerns helps to ensure that people can feel confident they will be listened to and any concerns they have will be acted upon. Systems are in place for supporting people to manage their money. Records and receipts are kept of purchases made, a sample of which we checked and found to tally. This helps to ensure that any issues that may occur would be quickly noted and acted upon. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): 24, 26, 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. Pine Lodge provides a safe, comfortable and well adapted home for people to live in. However staff do not always support people to keep their environment tidy and pleasing to look at. EVIDENCE: Pine Lodge is based in the middle of Formby Pinewoods, near to the National Trust Park. Its location means that it is not directly part of the wider community, however there is a local train station, shops and facilities approximately 20 minutes walk away. The location of Pine Lodge means that it has scenic views and there are nearby walks within local areas of interest. It also has several gardens within the larger grounds that people can access, as well as an enclosed courtyard with seating that is directly accessed via the home. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 21 Due to the layout of both Pine Lodge and the site, all areas are accessible for people with physical disabilities, with wide corridors and doorways and all areas at ground level. Shared areas of Pine Lodge include a large dining and living room, a small lounge and a seating area overlooking the courtyard. Building work is currently being undertaken to provide an additional two single en-suite bedrooms. Once completed everyone living at Pine Lodge will be able to have their own bedroom with en-suite toilet and sink. In discussions with one of the people living there they confirmed that they had been able to choose the décor for their new bedroom. We also observed that other bedrooms have been personalised to suite the needs and choices of the people living there. However two small lounges were being used as temporary bedrooms whilst building work was undertaken. Although the aids people needed had been put into these rooms little effort had been made to make them comfortable and homely. For example one room had boxes of clothes and the persons belonging stacked on a settee, the fire surround was dusty and clothes hung from a wall light fitting. Although a temporary arrangement this may not meet the needs or choices of the people using the bedroom and staff should make every effort to ensure peoples rooms are comfortable and appealing for them. The manager did advise us that they have appointed a cleaner for the home whom they hope will commence work shortly. Other areas of the home including the kitchen, bathrooms and large lounge along with other bedrooms were clean and tidy. There are a number of aids and adaptations within Pine Lodge to support people with their mobility. These include overhead tracking, hoists, grab rails and electric beds. Bathrooms and the shower room are also fully adapted to support people. We checked a number of the aids in use during our visit, including, tracking, baths, taps and electric beds and we found them to be in working order. These aids mean that it is as easy as possible for people to get around and to receive support with their personal care. There is a separate laundry room with industrial washing and drying machines. Systems are in place for minimising the risk of cross infection with laundry and throughout the home and staff we spoke with had a good understanding of infection control and their role in ensuring systems were followed. This helps to prevent or quickly deal with any outbreak of infection that may occur. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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): 32, 34 & 35 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 people living at Pine Lodge are supported by a staff team who know them well and are able to meet their needs and choices. EVIDENCE: One of the people living at Pine Lodge told us that they like the staff team and that they get help and support when they need it. The people who live at Pine Lodge have specialist needs in regard to all areas of their daily lives. This includes the support they need with their personal care, how they communicate and the things they enjoy doing. In discussions with some of the staff it was evident that they have a good understanding of the individual likes and dislikes of the people living there, as well as their support needs and how they communicate. Staff were seen to spend time chatting with people and taking plenty of time to support them on a 1-1 basis with their personal care and with their meals. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 23 Records showed that before anyone starts work at Pine Lodge a series of checks are carried out. These include a set interview process, obtaining written references and checking with the Criminal Records Bureau (CRB) and register of people unsuited to work with vulnerable adults. These checks help to ensure staff are suitable to work with people who may be vulnerable. However recent checks had not been carried out to ensure Nurses working in the home are still registered to practice. Nurses need to register nationally each year. It is therefore important that checks are made on their registration to ensure they remain fit to carry out their role. Over half the staff team hold a nationally recognised qualification in care (NVQ). In discussions with a member of staff they told us that, “we are always training. We get what we need”. Records show that staff undergo a variety of training in different areas. This includes training in areas of health and safety such as food hygiene and fire as well as more specialist areas such as use of a Peg feed and learning disabilities. The manager and deputy have had training in recent laws around supporting people, such as the Mental Capacity Act and Deprivation of Liberty laws. The manager explained that training for all staff in these areas is planned within the next couple of months. The training that staff have and that is planned helps to ensure that they are up to date with current good practice in supporting people safely and well. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): 37, 39 & 42 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. Pine Lodge is safely managed for the benefit of the people who live there. EVIDENCE: The registered manager of Pine Lodge is experienced in managing a care service for adults who have a learning disability. She holds a management qualification and is a registered nurse for people with learning disabilities. Records showed that she attends regular training to keep herself up to date with current good practice in the field of care. There are a number of systems in place at Pine Lodge to review and check on the quality of care they are providing. A regular visit is made to Pine Lodge by Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 25 a senior manager from the organisation. This looks at different areas of the support provided at Pine Lodge and notes any areas of good practice as well as areas for improvement. For example the visit from September 2009 had noted the concerns around quality of food and the fact that this was being addressed. In addition a larger audit based on national standards of care is carried out each year. We looked at the audit carried out in March 2009 and noted that it contain an action plan to follow to address any improvements needed. Regular reviewing of care plans help to ensure that the support offered to people is monitored regularly. However as identified earlier medication audits are not always robust enough to quickly note and deal with any issues that arise. Records and certificates showed that regular checks are carried out on the building and equipment. This includes regular checking of the fire system, gas and electrics. Staff have training in areas of health and safety and in discussions were able to explain the actions they would take to prevent a spread of infection or in response to the fire alarm sounding. This helps to ensure that Pine Lodge is a safe place to live, work and visit. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 3 28 3 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Version 5.3 Page 27 Pine Lodge DS0000063016.V378186.R01.S.doc No Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13(2) Requirement A more robust audit system for checking medications must be set up. This will help to ensure that any issues are quickly noted and can be dealt with. Regular checks should be made to ensure Nurses are registered to practice with the NMC. This will help to ensure they remain fit to practice within their role. Timescale for action 25/11/09 2. YA34 18 25/11/09 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. Refer to Standard YA1 Good Practice Recommendations The wording used in the statement of purpose and service users guide should be reviewed to ensure it is as easy to understand as possible. This includes the use of plain English. This will help to ensure people can understand as much as possible about the service they can expect. The assessment documentation used for people considering moving into Pine Lodge should be used to record as much information as possible about the persons DS0000063016.V378186.R01.S.doc Version 5.3 Page 28 2. YA2 Pine Lodge likes and dislikes and their chosen lifestyle. This will help to ensure staff can plan how to meet all of the persons support needs successfully. 3. YA14 Planning and recording around peoples social choices and the support they get should be more detailed. This will help to ensure they are getting the support they need to live a lifestyle of their choice. Pine Lodge DS0000063016.V378186.R01.S.doc Version 5.3 Page 29 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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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