Care Home: Pinehurst Care Centre

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What the care home does well The home works hard to ensure that prospective residents have their needs accurately assessed and that they are provided with enough information so they can decide whether they wish to live at the home. Residents spoken with were complimentary about the staff and their life at the home and many positive comments were received. These comments received included: `They provide a friendly, caring atmosphere`; `they make all people of all ages comfortable. Happy staff`; `they maintain a friendly feeling at all times. Staff are very efficient and always willing to help` and `the staff are excellent. They are polite and helpful. If you want anything they will get it for you.` One visiting relative commented that `I have nothing but praise for the care my relative has received.` If residents 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. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere. All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team. One member of staff commented that: `I like it here, I can talk to the management if I have any problems, they are easy to talk to` and another that the home: `Cares for each resident as an individual. Makes sure we have the training we need.` What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme provides residents with a comfortable and homely environment in which to live. The care planning system has been reviewed and care plans now include more detail, with residents being more involved in the planning process. The staffing levels have been reviewed and additional staff employed to better meet the residents` needs. Staff recruitment procedures have been reviewed and amended so that residents can have confidence in the staff at the home because all the required checks have been done to make sure that they are suitable to care for them. What the care home could do better: Further work needs to be done to expand the details contained in the care plans and to make sure they are always kept up to date and include resident`s individual preferences. Action needs to be taken to ensure that individual resident`s social care needs are met, especially where residents are not able, or do not wish, to participate in group activities and staff involved in planning and providing social activities need to be provided with appropriate training. The home needs to develop and implement an ongoing system for monitoring that staff understand, and comply with, the home`s policies and procedures and any current legislation. Key inspection report Care homes for older people Name: Address: Pinehurst Care Centre 38-44 Duke`s Ride Crowthorne Berkshire RG45 6ND     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: Denise Debieux     Date: 1 0 1 1 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 34 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 34 Information about the care home Name of care home: Address: Pinehurst Care Centre 38-44 Duke`s Ride Crowthorne Berkshire RG45 6ND 08444725177 08444120627 pinehurstcare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pinehurst Care Ltd Name of registered manager (if applicable) Mrs Lynne Valerie Cotterell Type of registration: Number of places registered: care home 50 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 to be accommodated is 50. The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP). Date of last inspection Brief description of the care home Pinehurst Care Centre is a registered care home with fifty beds providing a residential care service for older people and is located in Crowthorne, close to the High Street and local amenities. The home consists of four houses: Pine House, Fern House, Cedar House and Hurst House, all located on one site. 1 7 1 1 2 0 0 8 0 Over 65 50 Care Homes for Older People Page 4 of 34 Brief description of the care home Fees range from £560 to £600 per week. This information was provided on 10 November 2009. Care Homes for Older People Page 5 of 34 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 Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 10 November 2009 starting at 10am. The registered manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last key inspection. The people who live at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit most of the fifty residents were involved in the inspection and information was gained from ten on duty staff. Prior to the inspection, survey forms were sent to twenty residents, ten social and health care professionals and to twenty Care Homes for Older People Page 6 of 34 members of staff employed at the home. Survey forms were returned by thirteen residents, four social and health care professionals and seven members of staff. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was clear and gave us all the information we asked for. Residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, social and health care professionals and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Further work needs to be done to expand the details contained in the care plans and to make sure they are always kept up to date and include residents individual preferences. Action needs to be taken to ensure that individual residents social care needs are met, especially where residents are not able, or do not wish, to participate in group activities and staff involved in planning and providing social activities need to be provided with appropriate training. The home needs to develop and implement an ongoing system for monitoring that staff understand, and comply with, the homes policies and procedures and any current legislation. Care Homes for Older People Page 8 of 34 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. Care Homes for Older People Page 9 of 34 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 34 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. People can be 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. This home does not offer intermediate care. Evidence: We were advised that, on the first enquiry from a prospective resident or their representative, the resident or their representative will be invited to visit the home. Following the initial visit to the home, and if the resident wishes to continue, the manager will visit the resident and carry out a pre admission assessment to ensure that the home can meet the residents needs and wishes. Four care plans were sampled during this visit. In each case comprehensive pre admission assessments had been carried out to ensure that the home could meet the Care Homes for Older People Page 11 of 34 Evidence: residents identified needs. In the AQAA, to demonstrate what the home does well, the manager stated that: Pre assessment of needs is carried out on residents prior to admission to the centre to ensure that their individual care needs can be met within the Home environment. We also offer an introduction to our service by offering a prospective client the option to visit the centre for lunch/teas and sample our activities. We offer respite breaks to prospective permanent clients in order to evaluate that the home can meet their care needs and support a phased entry into care. There is a one month settling in period for both the home and the resident. This statement is supported by the findings at this inspection. Residents spoken with confirmed they had been invited to visit the home prior to deciding to move in. Eight of the residents who returned survey forms felt they had received enough information prior to moving to the home, two answered no and three answered dont know. Care Homes for Older People Page 12 of 34 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. Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Some further work needs to be done to expand the details contained in the care plans and to make sure they are always kept up to date and include residents individual preferences. If residents 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. Evidence: At the last inspection a requirement was made setting out improvements that needed to be made to the care plans seen at that time. Since that inspection a new system of care planning has been introduced and the previous requirement has been mostly met. The four care plans sampled during this visit included an assessment that covers all areas of health, personal and social care needs. The care plans were all based on the assessments, had been drawn up shortly after each residents admission to the home and included appropriate risk assessments. For health and personal care, the care plans included actions that staff need to take to meet any needs that had been Care Homes for Older People Page 13 of 34 Evidence: identified. As yet social care needs are not included, although details of past and present social activities and pastimes had been obtained. All care plans had recently been rewritten, and most had been signed by either the resident or their representative to signify their involvement and agreement to the content. The daily notes demonstrated that any changes or new concerns are promptly acted upon, although not always added to the care plan. This means that the care plans are not always up to date and could lead to residents being given incorrect care, for example, one resident had a care plan for skin care in place, but the care plan was no longer relevant as the skin care has been taken over by the district nurse due to a change in the need. The monthly review of this persons pressure area risk assessment had also been missed for the month of October. The new treatment is documented separately from the care plan by the district nurse and, although staff spoken with were aware of the change, the care plan had not been updated. It was also noted that care plans that had been superseded were kept with the care plans that had been updated, with no indication that the old care plan no longer applied. Not all entries in the care plans had been signed to indicate who had written them. The care plans seen need to be developed further to include residents specific preferences and wishes in how they would like their care and support provided. Actions need to be more detailed so that staff have the detailed information they need to meet individual residents needs in the way they have chosen. At present only the duty managers and seniors write the care plans, but the home hopes that all staff will become involved eventually. In discussion with the manager we were advised that staff have not received training specific to care planning. The management plans to wait until a new, computerised care planning system is shortly introduced and then provide the training needed. It has been recommended that all staff receive training on the basic principles of care planning and documentation, training in using those principles in a new system can be added once the new system is introduced. Of the thirteen residents who returned survey forms, nine stated that they always receive the care and support they need and four answered usually. Comments received from residents included: Staff are very efficient and always willing to help and I am very well looked after. Part of the lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. It was noted that on one unit, in the controlled drugs register, the second staff member checking the totals had not always countersigned and whilst this is not a legal requirement, it is the policy of the home that staff are not always following. The need for management to introduce a system for monitoring that Care Homes for Older People Page 14 of 34 Evidence: staff are working to the policies and procedures of the home is addressed further in the Management and Administration section of this report. In the AQAA, to demonstrate what the home does well, the manager stated that: We have a self-medication policy and procedure for clients who wish to have the choice and we abide by the guide lines from the Royal Pharmaceutical Society. Our medication is audited by the local pharmacist. This statement was supported by the evidence seen on the day of this inspection. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. On the day of this visit staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. Social and health care professionals who returned survey forms felt that the staff respect residents privacy and dignity. Additional comments received included: Friendly local home which gives residents and their families a comfortable standard of care with dignity and Treat every resident as an individual, respecting their privacy. Care Homes for Older People Page 15 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The group activities provided by the home are varied and residents have the opportunity for contact with the local community. However, action needs to be taken to ensure that individual residents social care needs are met, especially where residents are not able, or do not wish, to participate in group activities. Residents are able to keep in touch with family, friends and representatives. Contacts with family and friends are encouraged. Meals are well balanced and varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with. In the AQAA, to demonstrate what the home does well, the manager stated that they: source professional activity providers and have utilised the skills of a duty manager to help provide regular in-house activity. We also have the use of a minibus which will enable us to take residents out on day trips. We decide the locations of these in our quarterly residents/staff meetings. We encourage residents to continue in their daily lives as if they were still living in their own homes and any residents wishing to attend Care Homes for Older People Page 16 of 34 Evidence: local day centres we help by organising the transport where needed. To ensure all religious backgrounds are catered for, we not only have local church representatives visit us on a monthly basis, we also have the use of the community bus which will take residents to their preferred place of worship. This statement was supported by the findings on the day of this inspection. Since the last inspection the activity coordinator has left the home and, to date, the vacant position has not been filled. As stated in their AQAA, one of the duty managers is covering this position but it is noted that this is in addition to the duty managers other duties and the staff member has not received specialised training in the provision of activities. Six of the thirteen residents who returned survey forms stated that there were always activities arranged by the home that they can take part in if they want, four residents answered usually, one answered sometimes and one left this question blank. Comments made to us on the day of the inspection by residents were mixed and included: Youre never idle, they arrange things for you, Very rarely do they arrange things, it would be nice to have someone sit and play cards, We have singers and dancers come in. Staff members spoken with were asked about activities and how staff meet individual residents social care needs. We were advised that the staff try to do individual activities with residents and that the afternoons between 2 and 4 pm are the best times as the mornings are usually too busy. One staff member commented that We dont have activities everyday. I will do activities but I may have to help someone with personal care. One social and health care professional also commented on their survey form that they felt the home could improve the individual activities, on a one to one, basis for people who do not want to join in group activities. At the last inspection it was particularly noted that the residents care plans did not include individualised social care plans and that care plans must include details of how each residents individual social care needs are to be met. This was incorporated into the requirement made at that inspection relating to care plans. That part of the previous requirement has not been met and a new requirement has been made in this report specifically relating to the need for improvement in this area to make sure that all residents are enabled to participate in social activities that are meaningful to them. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships inside and outside the home. Relatives visiting on the day of this inspection were complimentary about the staff and home, comments received included: We have no negatives, we feel fortunate to have found Pinehurst and Its very nice, they are good to us, we have been offered meals. Care Homes for Older People Page 17 of 34 Evidence: Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining rooms was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. Of the thirteen residents surveyed, four said that they always liked the meals at the home, seven answered usually and two answered sometimes. Care Homes for Older People Page 18 of 34 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. If residents 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. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents guide. All residents surveyed said that they always knew who to talk to if they were not happy, with one resident spoken with commented that: we have two managers, we can always talk to them. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. All staff surveyed stated that they knew what to do if anyone raised concerns about the home and the home have shown that they take appropriate action if any concerns are raised with them. In the AQAA, to demonstrate what the home does well, the manager stated that: We have a clear complaints procedure and ensure all staff, residents and visitors to the home have access to the guidelines. Upon receiving a complaint we ensure it is dealt with as efficiently as possible and in confidence. Records of all complaints are Care Homes for Older People Page 19 of 34 Evidence: retained. Open management style which views any complaint as a potential positive suggestion in the area that needs to be addressed. This statement was supported by the findings on the day of this inspection. Residents spoken with said that they felt safe at the home with one resident commenting I feel very safe when the staff help me. Care Homes for Older People Page 20 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. Evidence: Residents spoken with expressed their satisfaction with the accommodation provided at the home and a number of residents said how much they liked their own rooms. Comments made included: I like my room it is always very quiet, they keep the place nice and clean and the cleaners come through everyday and carers at night give it another do. On the day of this visit we were shown around all areas of the home and grounds. The furniture and furnishings were seen to be of a good quality and personal bedrooms were all seen to be personalised to the individual residents wishes. The maintenance and redecoration programme for the home was seen to be ongoing. Since the last inspection the home have employed a permanent maintenance person and plans for the next twelve months include making the garden more user friendly, introducing raised garden beds and covered seating area to allow the garden to be used in all weathers. Laundry facilities are sited on the ground floor in one of the units, with washing machines suitable for the needs of the residents at the home. There are plans to move Care Homes for Older People Page 21 of 34 Evidence: the laundry to a more central position in the next few months. In the AQAA, to demonstrate what the home does well, the manager stated that: Pleasant home with very nice gardens and water features, the centre is sub-divided into separate units with a homely feel. Schedule for cleaning weekly and monthly. Checked regularly by management. All staff either completed, or under training for Health and Safety, Control of Substances Hazardous to Health and infection control. This statement is supported by the findings on the day of this inspection but some concerns were raised by a recent Health Protection Agency visit where staff were seen to be not always following the homes infection control procedures. The need for the manager to monitor that staff are following the homes infection control procedures is included in a requirement made under the Management and Administration section of this report. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a good standard of housekeeping apparent. Care Homes for Older People Page 22 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of the staff meets the residents personal and health care needs. Residents can 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. Evidence: The four houses that make up the home are in the grounds and there is a separate administrative block. Pine House and Fern House are adjoining and connected via the communal rooms of the building. These two houses are staffed as one unit with the morning (8am to 2pm) shift being covered by three care workers, three care workers cover the afternoon/evening shift (2pm to 9pm) and the night shift is covered by two waking care workers. Hurst House and Cedar House are sited next to each other with a connecting door in between the two houses. These houses are staffed individually. Hurst House has two care workers covering the morning and afternoon/evening shift and one waking night staff. Cedar House has one care worker covering the morning and afternoon/evening shift and one waking night staff. At the last inspection a requirement was made relating to staffing levels from Care Homes for Older People Page 23 of 34 Evidence: observations made at that inspection. Since that time staffing levels have been increased in Pine and Fern House so that an extra person now works from 8am until 10.30am each day to cover the busiest period. In the AQAA the manager stated that: We have increased kitchen staffing levels to satisfy the residents wishes. We have increased the number of care staff and domestic staff to meet our residents needs. Although one resident said that sometimes they have to wait for staff to answer their call bell other comments were positive and observations during this inspection demonstrated that the increase in staffing levels has been successful. Of the seven care workers who returned survey forms, three said there were always enough staff, three answered usually and one left this answer blank. One care worker commented on their survey form: The home is adequately staffed and meets staffing criteria but it would be nice to have more staff. Comments made by staff spoken with, relating to staff levels, included: Sometimes it is enough, other times, when someone is ill or confused it may not be. We can call on the manager or duty manager and they will come and help and usually it is enough, sometimes when it is very busy the manager or duty manager will help us, the management team are very helpful. The manager advised that they are planning to move the duty managers office in to the care setting to make them more accessible to residents and staff. Of the thirteen residents who returned survey forms, four said that staff are always available when needed, eight answered usually and one answered sometimes. One resident commented that: Staff are very efficient and always willing to help. In the Daily Life and Social Activities section of this report it has been identified that the home needs to take action to ensure that the social care needs of all residents are met. Once these needs have been fully assessed and identified for each resident, the home will need to determine how those needs will be met, this may involve a further review of staffing levels if the provision of activities is to be included in the role of the care staff working in the units. As mentioned earlier in this report, at present staff responsible for planning and providing social care activities have not received any specialised training, a requirement has been made under this section. Of the thirty three care staff, twenty two hold a National Vocational Qualification (NVQ) level 2 or above in care. At the last inspection, concerns were identified relating to the homes staff recruitment practices and a requirement was made. At this inspection it was seen that this requirement has been met and that the home now follows robust recruitment practices, with all staff involved in recruitment very aware of the requirements. The files of three recently recruited members of staff were sampled. All files were seen to Care Homes for Older People Page 24 of 34 Evidence: contain proof of identity, two references, a full employment history. In each file it was seen that an enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list check had been obtained before the person started working at the home. Staff induction is in line with the mandatory Skills for Care common induction standards and we were advised that staff are supervised until they have completed their induction. The training log sampled evidenced that staff receive all mandatory training and that they are booked on additional training and updates as needed. This was also confirmed by staff members spoken with during our visit. During our visit we spoke with members of staff on duty and asked five of the care workers about their understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. None were able to describe their responsibilities under this legislation and they were not aware of how this affects the residents they care for or the way they work. This was discussed with the manager who advised that there were leaflets available in the office but that training had not yet been organised. It is important that all staff are aware of their responsibilities under this legislation and a recommendation has been made. Guidance is also available on the CQC web site on the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards, these guidance documents also include useful information on what the staff should be recording in the care plans. In the AQAA, to demonstrate what the home does well, the manager stated that they: Provide training for all staff and regularly asses their training needs. Over 65 of care staff trained to NVQ level 2 or above. Robust staff records maintained in line with Schedule 2 of National Minimum Standards. When recruiting, we follow an equal opportunities procedure but ensure that all of the necessary checks are carried out, for example, enhanced CRB and POVA. We have a full induction programme which includes completing a Skills for Care induction manual which is fully supported by the management. This statement was supported by the findings on the day of this inspection. Of the seven staff who returned survey forms, all said that they are given training which is relevant to their roles and helps them understand and meet the individual needs of the residents. One member of staff commented that they: Make sure we have the training we need. Of the thirteen residents who returned survey forms, three said that the staff always listened and acted on what they said, eight answered usually and two answered Care Homes for Older People Page 25 of 34 Evidence: sometimes. Additional comments made on the survey forms included: The staff listen but do not always make it clear that they are doing what was asked, They listen, no problems, Staff always kind and Pinehurst looks after me well, I feel well looked after, always warm. Care Homes for Older People Page 26 of 34 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. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents and policies and procedures are in place to protect service users financial interests. All policies, procedures and practices are in place to ensure, so far as is reasonably practicable, the health safety and welfare of residents and staff, but a monitoring system needs to be put in place to ensure that staff have understood and follow the homes policies and procedures. Evidence: The manager has worked at Pinehurst since June of this year. She has over twenty years experience working in care, and has been a registered manager for the past six years. She holds her Registered Managers Award qualification and became registered as the manager of Pinehurst Care Centre in October of this year. Her management style is inclusive and the residents benefit from the ethos, leadership and clear Care Homes for Older People Page 27 of 34 Evidence: management approach at the home. From our observations and from comments made by staff, residents and visitors on the day of our visit, it is clear that the home has a close and caring staff team. Staff spoken with all felt that the manager and duty managers were approachable and willing to offer help or guidance when asked. The home has a quality assurance system in place that is based on seeking the views of the residents and their relatives. We were advised that the quality assurance questionnaires are sent out to residents and their relatives on a rolling, continuous basis sampling a number of clients and staff each month. In the AQAA, to demonstrate changes made as a result of listening to the residents, the manager stated: The menus have been changed on several occasions where we have adapted the menu to suit the needs of the residents. After discussions with residents they requested quiet areas to sit in with their families or to listen to music other than the television. We have moved the televisions around and we plan to upgrade the area by decoration and introducing memorabilia and sensory equipment. There are quarterly residents meetings. One resident commented: I like the residents meetings, you can say what you like. Policies and procedures are in place to protect residents financial interests. The manager stated that the home does not handle the financial affairs for residents. In the AQAA, to demonstrate what the home does well, the manager stated that: Management ensures all staff are fully trained to cover all areas including health & safety, fire safety, food Hygiene and infection control. The manager ensures compliance with all relevant legislation. This statement was not fully supported by the findings on the day of this inspection. The staff training log evidenced that staff are provided with the required safe working practice training and updates, this was also confirmed by staff members spoken with on the day. However, health and safety monitoring check sheets were sampled and, although mostly found to be up to date, there were some days where kitchen food safety checks had not been carried out e.g. hot food and fridge/freezer temperature checks, this had not been identified until we pointed it out. Earlier in this report we have identified other examples of staff not always following the homes systems, policies and procedures. For example: the homes procedures for writing, reviewing and maintaining care plans and risk assessments are not always followed; the second staff member checking the totals of controlled drugs not always countersigning the controlled drug register. A requirement has been made for a management monitoring system to be put in place so that the manager can be sure that staff understand and follow the policies and procedures of Care Homes for Older People Page 28 of 34 Evidence: the home and comply with any current legislation. All interactions observed between the staff and residents were inclusive, caring and respectful. Comments received from social and health care professionals on their survey forms included: Staff are approachable and open to comment. Good communication between outside agencies and manager/duty managers, responding to issues or concerns promptly. Improved environment for residents since change in management and the managers and staff have always been helpful and open in their discussions. One resident commented on their survey form: I have been very pleased to stay at Pinehurst and would recommend it to friends. Care Homes for Older People Page 29 of 34 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 30 of 34 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 7 15 The registered person must ensure that residents care plans are updated whenever the residents needs change or new problems occur. The staff actions set out in the care plans must be detailed and up to date, and reflect the persons known preferences in how they would like their care delivered. The care plans must be signed by the person completing or updating the care plan and the resident or their representative should be asked to sign their plan to evidence their involvement and agreement. So that residents can be confident that the staff all work to an up to date plan of care that they, or someone close to them, 22/12/2009 Care Homes for Older People Page 31 of 34 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 have been involved in making. 2 12 16 The registered person must 10/02/2010 consult with individual residents and make arrangements for them to engage in local, social and community activities. Details of actions staff need to take to meet each residents social care needs must be included in their individual care plans and kept under review; particular consideration must be paid to addressing any specific needs relating to any sensory or cognitive impairment and/or any physical disabilities. So that residents can be confident that the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. 3 30 18 The registered person must ensure that staff receive training appropriate to the work they are to perform. This requirement relates specifically, but not exclusively, to staff involved 10/02/2010 Care Homes for Older People Page 32 of 34 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 in the planning and provision of activities. So that residents can be confident that the staff team has the knowledge and skills necessary to make sure that their individual social care needs will be met. 4 33 24 The registered person must develop and implement an ongoing system for monitoring that staff understand and comply with the homes policies and procedures and any current legislation. So that residents can be confident that they are supported by a staff team that understands, and follows, the way things should be done. 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 10/01/2010 1 30 It is recommended that the registered person arranges for all staff, who are involved in writing and/or working to care plans, to receive training in the principles of care planning. It is recommended that the registered person ensures that all staff are aware of, and fulfil, their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberties safeguards. 2 30 Care Homes for Older People Page 33 of 34 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. 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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