Care Home: Pinebeach

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What the care home does well The home is well managed by Ms Hoar. People living at the home told us they were well cared for by competent staff and receive the care they need. Prior to admission, Ms Hoar carries out a full assessment of the individuals needs so that she can assure them that the home can deliver the care required. People are supported to maintain contact with family and friends, enabling those living in the home to continue to enjoy relationships that are meaningful to them. People told us that they enjoyed the activities provided. They said that the food was very good. The menu offered choice and staff were aware of the likes and dislikes of those living there. Visitors to the home told us that they were always made welcome. The complaints and adult protection procedures ensure that residents and their representatives well-being and comfort is important to the home and that any concerns raised will be properly investigated and resolved. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the care needs of people. Staff are very well trained to meet the nursing needs of those people in their care. What has improved since the last inspection? The refurbishment programme has been ongoing. The registered provider continues to try to improve the facilities provided at Pinebeach. Recent improvements have included the painting of certain rooms; recarpeting and provision of profiling beds. Ms Hoar continues to monitor care documentation and care provision and make improvements where needed. What the care home could do better: Some areas of the home need improvement. The registered provider has told us that the refurbishment programme is ongoing. To ensure that infection control measures are robust any rusty equipment and unlidded waste bins need to be replaced. During our inspection we found that the area where medications were held was too hot and this must be addressed so that medicines are held in line with the manufacturers guidelines. The home must also ensure they know exactly what medicines are held and a clear audit trail must be evident. The recruitment process should be more robust to minimise the risk of any unsuitable person being employed. Key inspection report Care homes for older people Name: Address: Pinebeach 53 Southcliffe Road Friars Cliff Christchurch Dorset BH23 4EW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Amanda Bell     Date: 2 7 1 0 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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. 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 Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Pinebeach 53 Southcliffe Road Friars Cliff Christchurch Dorset BH23 4EW 01425273122 01425272876 info@pinebeach.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lifecaring Holdings Limited Name of registered manager (if applicable) Ms Beverley Myfanwy Hoar Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Pinebeach is located opposite the sea and beach at Friars Cliff near Mudeford. The lounge, library and some of the rooms have sea views. The building has a lower ground floor. The laundry, kitchen, boiler room, registered persons office and staff facilities are located on this floor. The ground floor comprises of dining area and annexe, lounge, library, managers office, service user bedrooms, sluice room, Care Homes for Older People Page 4 of 26 Over 65 36 0 Brief description of the care home communal bathrooms and toilets. The first floor comprises of service user bedrooms, a sluice room and communal toilets and bathrooms/shower rooms. There is level access throughout the floors and access by passenger lift to all floors. The outside area has two large wooden benches facing the sea. In the summer months additional garden furniture is put out that includes tables, chairs and parasol. The garden attracts wildlife, particularly birds. There is off road parking for staff and visitors. The fees for the home as provided to CQC at the time of inspection range from £555 to £775. Additional charges include hairdressing, chiropody, toiletries and newspapers. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on the 27th October 2009 over a period of approximately five hours. The purpose of the inspection was to assess all of the key standards. The inspection was carried out by one inspector, however the term we is used throughout the report to reflect the findings of the Care Quality Commission, (CQC). The Registered Manager, Ms Beverly Hoar, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including reports made to the Care Quality Commission by the home; the annual quality assurance assessment Care Homes for Older People Page 6 of 26 (AQAA) completed by the registered manager; discussion with people living, visiting and working at the home; a tour of the premises; review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. During the course of the inspection people were asked their views on the service provided at the home. They said: The staff are very good. They look after me very well. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 26 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. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met fully. Evidence: The pre admission assessments for people who had moved into the home recently were seen. The initial assessments were completed by the manager and gave enough information for her to be able to determine whether the home could meet the persons needs. One new resident told us that a family member had been invited to visit the home prior to a decision being made about admission. They said that they had been given sufficient information on which to make a decision about staying at Pinebeach. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. However the storage and recording of medications held in the home could be improved to ensure that they are held safely. Evidence: The care documentation for three residents was reviewed and it contained the relevant assessments and care plans needed so that staff had the information to be able to give a good standard of care. The care plans were evaluated on a monthly basis. Where the need for specialist equipment was identified it was provided. It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, district nursing services and chiropodists. Care Homes for Older People Page 12 of 26 Evidence: The medications policies and procedures were reviewed. The home had a medicines policy and procedure including reference to self administration and associated risk assessment and arrangements for ordering, administration and disposal. Examination of records and observation of medication administration showed us that medicines were administered in accordance with the prescribers instructions and residents could be assured that they were getting the medication that their doctor said they needed. However the room in which medicines were stored was too hot. The temperature at the time of inspection was 26oC and some of the medicines held needed to be stored at 25oC or below. This may have altered the efficacy of certain medications. There was no clear audit trail for some of the medicines held so that the home could not be sure what supplies they held. Residents we spoke with said they were happy with the care they received and confirmed that staff treated them with respect and were supportive and kind. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to maintain their independence, contact with important others and lifestyle, which enhances their quality of life. Evidence: The registered manager had produced a newsletter to keep people up to date with any changes at the home and any planned events and activities. Activities included trips out, massage, visiting entertainers, the mobile library and visiting members from the local churches. People at the home were encouraged to maintain links with their family and friends who were made welcome on their visits. The home supports people in their spiritual needs by the involvement of church ministers of varying denominations if necessary. People spoken with and observed spent their time how and where they chose. Menus showed that the people who live there have a choice of meals through the day. The menu was varied and meals appeared nutritious. Care Homes for Older People Page 14 of 26 Evidence: There were choices offered for each meal each day, specialist diets are catered for including diabetic, pureed and soft diet alternative when necessary. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to an effective complaints procedure. Protection from abuse is promoted. Evidence: A copy of the complaints procedure was displayed contained in the service user guide. The procedure needed to be updated to contain the contact details for CQC and to reassure people that they can contact the Commission at any time and not just if they were unhappy with the outcome of a complaints investigation. People spoken with knew how to complain and who to speak to if they were unhappy. People told us that they felt safe living at the home. The adult safeguarding procedures were available to staff. Staff spoken with told us that they had received training and guidance on how to recognise and report any allegations of abuse during their induction. They were able to give examples of when and how and to whom they reported their concerns. It was recommended that the policy in place was cross referenced with the local guidance on safeguarding vulnerable adults. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is safe and secure but people will benefit from the continued refurbishment. Evidence: We toured the premises and found most areas comfortable and clean, however some areas did look old and tired. One bathroom ceiling had suffered water damage and was heavily stained. The vinyl flooring around the toilet was also heavily stained. Some areas in the home were malodorous. The registered manager told us that the refurbishment programme was ongoing. Recently two bedrooms carpets had been replaced and new bedroom furniture had been ordered for these rooms. A number of profiling beds had been purchased recently and people living in the home had benefitted from this. The dining room can only seat eighteen people at a time, therefore a number of people eat their meals elsewhere. People were able to personalise their rooms with items of furniture, pictures and a variety of mementos. People told us that they were comfortable. We saw that one sluice contained an old and rusty bedpan/urinal rack and some waste Care Homes for Older People Page 17 of 26 Evidence: bins in the bathrooms were not foot operated peddle bins. This posed a risk of cross infection and we required the home to replace these items. The laundry was well managed and adequate supplies of clean linen were seen to be available. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of experienced staff are on duty to meet the needs of the people living at Pinebeach. However some areas of the recruitment process could be more robust to ensure that the home only employs suitable staff to care for the people living there. Evidence: We reviewed the duty rotas, which told us how many staff were on duty at any time. They showed us that there were adequate numbers on duty at the time of inspection. We reviewed three staff recruitment files. We saw that application forms only asked for the last ten years of employment and not a full working history, with any gaps in employment explained. Interview records were not held. One file contained only one reference. Criminal Records Bureau checks were sought before employment commenced. The training programme for all staff was ongoing. At the time of inspection 50 per cent of care staff held level 2 NVQ award or above in care. Staff confirmed that they were offered regular training and this included induction, moving and handling, fire safety, palliative care and medication updates. Care Homes for Older People Page 19 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 home is well organised and the daily management and running of the home centres round the care of residents. The management practice, systems in place, and records kept, confirm the health and safety of all in the home. Evidence: Ms Hoar is registered with the Care Quality Commission as manager of Pinebeach. She had the qualifications and the experience to run the home well. Ms Hoar was supported by the responsible individual, Mr Dedman and a team of experienced staff. People told us that they felt supported by the management team and that they could express any concerns that they had. There were quality assurance and quality monitoring systems in place. The home took steps to review its performance regularly and residents relatives views were sought and suggestions put forward were acted upon. Care Homes for Older People Page 20 of 26 Evidence: The Registered Manager confirmed that the home does not hold money for residents. Frequently relatives helped residents with their financial affairs. Records showed us that most staff had received recent training in fire safety and manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Care Homes for Older People Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must make arrangements for the safe recording of medicines. All handwritten changes to the medication administration records must be signed and countersigned. To ensure that medications are administered in accordance with the prescribers instructions. 24/11/2009 2 9 13 The registered person must 24/11/2009 make arrangements for the safekeeping of medicines. All medicines must be held at the correct temperature set by the manufacturers. To ensure that medicines do not become ineffective due to poor storage conditions. 3 26 15 The registered person must 24/11/2009 ensure that the home is kept clean and make suitable Page 23 of 26 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action arrangements for maintaining satisfactory standards of hygiene in the care home. This must include the removal of rusty equipment and the provision of foot operated pedal bins in the bathrooms. To ensure that the risk of cross infection is minimised and the home is a more pleasant place to live. 4 29 19 The registered person shall 24/11/2009 not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. To protect vulnerable people from risks of harm and abuse. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 16 The complaints procedure should be updated and contain the current contact details for the Care Quality Commission (CQC) and the document should make it clear that a complaint can contact CQC at any time. The homes policy for safeguarding vulnerable adults should make reference to the local guidance. Worn and foul smelling carpets should be replaced to Page 24 of 26 2 3 18 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations improve the comfort of those people living at Pinebeach Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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