Care Home: Pinetree Place

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What the care home does well Service users have their individual health care needs met. Staff are well trained and have the skills and experience to provide residents with the care they require. Staff receive regular supervision and support in the form of one to one sessions, meetings and appraisals. Paperwork and records in the home are well kept. What has improved since the last inspection? Since the last inspection the Manager has worked hard to try and ensure that all the outstanding requirements had been met. She has put in systems and procedures to ensure the National Minimum Standards are being met and also to try and improve the service. Areas around Deprivation of Liberty have been identified and assessments and referrals have been completed. Regulation 26 reports are now being completed and these help to highlight areas around the home that need to be developed or where progress has been made. The houses are in process of being redecorated and new carpets fitted. Some service user`s bedrooms had been personlised and decorated to their choice. What the care home could do better: Service User`s at Pinetree Place are at present given limited opportunities for personal development and to maintain social, emotional and communication skills. Care plans need to be developed to evidence a plan of care for social, training, educational, emotional, personal development and activities. Many of the service users spend the majority of their time within the house that they live in. Due to the layout of the houses and present number of staff on duty, this could limit how much social interaction, personal development or activities that could take place. The staffing of the houses need to be reviewed to ensue it can meet the identified needs of the individual service users. Activities need to be developed further and include details of hobbies and interests that each individual service user may have and a care plan produced to reflect this. Although there was some record of activities, the information varied and some service users had limited social, educational and daily activities arranged for them. This area needs to be developed further to help staff enable the service users and offer wider choice. Care plans need to be developed to ensure they include details of the areas of care each individual service user needs and provide details of care needed and the actual abilities of the individual.Pinetree Place has a complaints procedure, but this needs to be reviewed to ensure it contains all the required information. The making and the receiving of complaints is an area that needs to be developed at Pinetree Place, this is to ensure that the service users feel their views and concerns will be listened to and acted upon and a clear written record is made. Service users did not appear to be aware of how to make a complaint, so perhaps a more simpler method is required. Key inspection report Care homes for adults (18-65 years) Name: Address: Pinetree Place 36a-d Ashingdon Road Rochford Essex SS4 1NJ     The quality rating for this care home is:   one star adequate 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: Sharon Lacey     Date: 0 8 1 2 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 Adults (18-65 years) Page 2 of 33 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Pinetree Place 36a-d Ashingdon Road Rochford Essex SS4 1NJ 01702540135 01702543777 john.wyatt@estuary.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Estuary Housing Association Ltd Name of registered manager (if applicable) Ms Loi Angela Kitamirike Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 12 The registered person may provide the following category of service only: Care Home only - Code PC 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 Date of last inspection Brief description of the care home Pinetree Place is a Care Home providing personal care for twelve residents with Learning Disabilities. The cost of care at this home is £1,724.96. per week. It is situated near to Rochford town centre, local shops and amenities. There are local bus and train routes nearby. Pinetree Place is divided into four houses, referred to as House A, B, C and D, with D also known as the bungalow. There are three residents in each house. Two offices are situated in another building, which was used previously as a day centre. Each resident has a single bedroom with a shared lounge, bathroom, Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 12 Brief description of the care home toilet and kitchen facilities. Each house has their own garden with a security gate. A car park is situated between houses A, B, C and the bungalow and offices. Care Homes for Adults (18-65 years) Page 5 of 33 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection to Pinetree Place was on the 18th January 2008 and an Annual Service Review took place on the 12th January 2009. The Key inspection was in the form of an unannounced inspection and took place over seven hours. All the Key Standards were inspected, but also evidence was gained on some of the other National Minimum Standards. Pinetree Place consists of three houses and a bungalow. A tour of two of the properties took place, and an inspection of relevant records and documentation. Areas looked at included information given to service users before being admitted, information gained when service users first come into the home, how information is given to staff on the care the service users may require, the facilities and the environment of the home, and any complaints or safeguarding issues that may have been received since the last inspection. Also staffing and management of the home were inspected. Care Homes for Adults (18-65 years) Page 6 of 33 An Annual Quality Assurance Assessment (AQAA) was sent to us by the Manager. The AQAA is a self-assessment in which services identify how they feel outcomes are being met for the people using the service. The AQAA submitted provided some information on the service, but needs to be developed further to include more details on what they do well, how they are meeting the outcomes for each of the National Minimum Standards, what improvements had occurred over the last 12 months and what improvements they still hope to make. Information from this document has also been used in this report where appropriate. During a tour of the home a number of service users were spoken with about their life experiences at Pinetree Place. Some of the service users approached were unable to express their thoughts or feelings, so they were observed during the day interacting with staff. Questionnaires were sent out and information from those returned have been included in this report. Most staff members on duty were spoken with informally during the visits to the home and any feedback has been included as part of the report. Staff questionnaires were also distributed and information from those returned have been included. At the end of the day the findings of the inspection on the home were discussed with the Manager and advice and guidance was given. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Service Users at Pinetree Place are at present given limited opportunities for personal development and to maintain social, emotional and communication skills. Care plans need to be developed to evidence a plan of care for social, training, educational, emotional, personal development and activities. Many of the service users spend the majority of their time within the house that they live in. Due to the layout of the houses and present number of staff on duty, this could limit how much social interaction, personal development or activities that could take place. The staffing of the houses need to be reviewed to ensue it can meet the identified needs of the individual service users. Activities need to be developed further and include details of hobbies and interests that each individual service user may have and a care plan produced to reflect this. Although there was some record of activities, the information varied and some service users had limited social, educational and daily activities arranged for them. This area needs to be developed further to help staff enable the service users and offer wider choice. Care plans need to be developed to ensure they include details of the areas of care each individual service user needs and provide details of care needed and the actual abilities of the individual. Care Homes for Adults (18-65 years) Page 8 of 33 Pinetree Place has a complaints procedure, but this needs to be reviewed to ensure it contains all the required information. The making and the receiving of complaints is an area that needs to be developed at Pinetree Place, this is to ensure that the service users feel their views and concerns will be listened to and acted upon and a clear written record is made. Service users did not appear to be aware of how to make a complaint, so perhaps a more simpler method is required. 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 Adults (18-65 years) Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Perspective service users are provided with information about the home, but this may not be up to date or in a format that they can easily understand. Evidence: Pinetree Place had a Statement of Purpose, which set out the homes aims and objectives and also the services provided. The Manager explained that due to one service user destroying paperwork, a copy of the Service User Guide and Statement of Purpose were not kept on show, but these would be made available on request. Both documents had last been reviewed in September 2008, and were in the process of having further updates. It was confirmed that these would be given to perspective service users as part of the admission process. Feedback from the four service user questionnaires reported that one felt they had received enough information about the home before they moved in, whilst three did not. The Manager explained that she is looking to produce a pictorial Service User Guide, which would be easier to read and more appropriate for their present client group. There is an admission process in place and all new service users would have a full Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: assessment completed, before being admitted to Pinetree Place. The Manager added that this would be done by herself and a Social Worker,and an individual care plan would be written from the information received. She added that as part of the assessment the familys needs would also be taken into account. Pinetree Place presently have three vacancies and no new service users have been admitted for at least eight years. Due to this it was not possible to view any recently completed assessments. The Manager confirmed that Deprivation of Liberty assessments had been completed with the present service users and where restrictions were identified, appropriate referrals had been made. Perspective service users would be given the opportunity to visit the home and have a trial visit, so that they could meet the staff and other service users. There would also be a trial period, with a review at the end to ensure the home would be able to meet the new service users needs. During a visit to one of the houses, it was noted that there was a good atmosphere and the staff member was talking to the service users and offering choice where possible. This was in connection to what they would like to eat and drink at lunchtime, encouraging service users to help put things away, whether they would like to watch television or listen to music. Feedback from the service user questionnaires confirmed that they were involved in making decisions for what they did each day and that the care staff treated them well. Documentation seen showed that training had been arranged for staff to help ensure they had the skills and knowledge to care for their present service users. A copy of the inspection report and certificate of registration were on show. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Service users may not receive the care they require as the care plans in place do not fully record their wishes and needs or provide staff with all the necessary information. Evidence: Three service users care plans were viewed. These had been completed with the service user, their families and advocates and consisted on a list of tasks and details of how much assistance or supervision each individual required. Care plans covered personal care, communication, family access, relationships, food and eating, activities, finance, work and education, health, environment and medication. When looking at the quality of the information recorded, some had been completed better than others. One care plan included details of the areas of care needed and an overall picture of the care required and abilities of the individual; were the remaining two were not so informative and needed to be developed further to make it more person centered. The Manager explained that she is in the process of trying to arrange a day-to-day care plan, which would help staff easily identify what care needs were to be provided, she added this was due to the present paperwork being very complex. On viewing the Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: information recorded, the area around activities also needed to be developed further, due to the files containing limited information on daily activities or social and educational opportunities for individual service users. There were behaviour and risk management plans in place and service users files had been regularly reviewed and updated when changes in care had occurred. Service User files contained set forms for risk assessments, which identified basic risks and hazards and the degree of risk and support needed. Risk assessment training had been organised for staff on the 15/12/09 and 20/01/09. Risk assessments had been reviewed with the care plans every three months. Details of an advocacy service could be found in the foyer for the service users and relatives to gain access to if required. The Manager stated that the advocacy services were involved at the home and they visited regularly. She added that families are included in any decisions and kept up to date with information about the service users. Most residents have assistance with their finances and there are systems in place to ensure any money kept at the home is regularly audited. Deprivation of liberty assessments had also been completed around finances for each service user. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 activities available may not meet individual service users needs nor enhance their leisure, training and educational needs. They will have meals that offer choice, variety and meet their dietary needs. Evidence: Service Users at Pinetree Place are at present given limited opportunities for personal development and to maintain social, emotional and communication skills. When looking at the care plans and the activity section, there was limited evidence to show a plan of care for social, emotional and personal development. Although there were some activities organised; it was felt that there could be more opportunities to develop social, training, education, communication and independent living skills for the present service users. Due to many of the service users not attending any form of daycare, the majority of their time is spent within the house that they live in. Due to the layout of the houses and present number of staff on duty, this would limit how Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: much social interaction, personal development or activities that could take place. Two service users reported on their questionnaires that they would like more activities arranged. On viewing the care plans it was apparent that the area around activities needed to be developed further and include details of hobbies and interests that each individual service user may have. There were records of activities on each file, but the information varied and some service users had limited social, educational and daily activities arranged for them. It was felt that this area needs to be developed further to help staff enable their service users and offer a wider choice. The Manager confirmed that none of the present service users at Pinetree Place are in employment, although she did not feel that they they would have the capacity. Only one service user goes to a day center twice a week. The Manager stated that they do have someone who comes in twice a week for cookery or to arrange to take the service users to a local cafe. The Manager gave examples where she wants to develop this area in both individual and group activities. She added that some of the service users help with the daily chores such as washing up, hoovering, dusting, but this needs to be developed into a more structure process. At present it is down to staff to arrange activities with the service users, but as previously stated due to the layout of the home and staffing levels this can restrict service users choice. The Manager stated she is looking at friends and volunteers to work at Pinetree Place to help increase numbers, so that more activities can take place. All service users have access to the bungalow where craft and music is organised. When looking at what access the service users had to the local community, the Manager stated they often go to Rochford market, feed the ducks in the local park, play football, visit the cinema, go to pubs, restaurants, libraries and go shopping. Some of the service users often go out for lunch on a Friday and there is a disco arranged on Thursday evenings. The Manager stated that a barbecue was organised in the summer and they also had a Summer Ball. Staff were observed supporting the service users and offering to take them out. Every house visited on the day of the inspection had Christmas trees and the service users confirmed that they had helped decorate them. Service users had been on holiday and this included trips to Norfolk, Clacton and Sussex. On the day of the inspection some had been out for lunch. If they have access to transport and sufficient drivers they will then arrange to take the service users out for drives. Although there were activities organised,it was difficult to establish which service user did what and this needed to be recorded clearer and take into consideration individual choices and abilities. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: The Manager stated that family and friends are always welcome and relatives are invited to any activities that are organised at the Home Files viewed showed that individual choice is offered in the daily routines within the houses. Care plans showed that there was choice on what time individuals wanted to go to bed and get up. Evidence of staff offering choice in house C was good, this included what the service users wanted to eat for lunch and also assisting with the chores. Each house has their own menu and staff and service users do their own shopping. There is a four week menu and this had a good selection and choice of foods and had been produced with the service users, taking into consideration their likes and dislikes. A Sunday lunch is arranged every other Sunday for all staff and service users in the bungalow. Snacks are available during the day. Each house has some flexibility around meals times and on the day of the inspection lunch was served at 1.00 pm. The staff member was observed offering a choice of tea or coffee and the service users chose beans on toast for lunch. Both residents were happy with the food. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Service users can be sure that they will receive personal support in the way they prefer, and that their health care needs will be met. Evidence: The service users at Pinetree Place receive personal support in the way they prefer and require. On the day of the inspection staff were observed offering them choice in the way their care was provided, and privacy and dignity was upheld. Individual care plans showed that support is given to try and enable the service users to have choice on when they want to get up and go to bed, and also other general routines within the home. There is a Key Worker system in place, which can assist in enhancing choice and offering individual service users continuity of care. Documentation seen showed that the healthcare needs of the individuals were being met. Care plans showed that regular visits occurred from the optician, social workers and advocates. The community nurse visits on a fortnightly basis and visits to the GP are organised when needed. The Manager confirmed that the service users have access to NHS services when needed and that annual healthcare checks are also organised. Equipment was available around the houses to help individual service Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: users mobility; and this included wheelchairs and handrails. Pinetree Place has a policy and procedure for the recording, storage, handling and administration of medication. None of the present service users are able to administer their own medication and rely upon staff to assist in this process. The lunchtime medication in house C was observed. Appropriate systems were in place for the storage and recording of medication administered. The staff member was able to show a good understanding of the systems in place. All staff had received medication training. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Service users cannot be sure that their concerns/complaints will be listened to or acted upon. Evidence: Pinetree Place has a complaints procedure, which is available to all service users and their families, and provides details of how to make a complaint and the timescales. Details of the complaints procedure could also be found in the Service User Guide and Statement of Purpose, but it was noted that the Care Quality Commissions details were missing and this needed to be added. There was also a brochure called We are all Ears, but it was noted that this also had no details of the CQC. The Manager was not aware of a form to record complaints and could not provide any records of complaints that they had received since the last Inspection. The Inspector was aware of issues that had been brought to the CQCs attention and letters had been written to the Manager since the last inspection to request these were investigated and further information provided; no record of this was made available during this visit. It was explained that there should be a system in place to clearly record details of complaints, any investigation that takes place and the outcome. When looking at the information returned on the service user questionnaires, only one had stated that they knew how to make a complaint. It was established that there is an advocacy service in place to assist service users who wished to make complaints if needed. The making and the receiving of complaints is an area that needs to be developed further at Pinetree Place, this is to ensure that the service users feel their views and concerns Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: will be listened to and acted upon and a clear written record made. Policies and procedures were available on Whistle Blowing and the Safeguarding of Adults. The Manager also had copies of the Local Authority Guidance. All staff at Pinetree Place had received training in safeguarding vulnerable adults. The Manager confirmed that there had been three referrals to the local authority, all of which had been investigated and appropriate action taken. There were clear systems and procedures in place for service users monies and financial affairs and regular audits are completed. Care Homes for Adults (18-65 years) Page 21 of 33 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Service users live in a home that is clean, comfortable, homely and meets their individual needs. Evidence: Pinetree Lodge consists of four separate houses, which have either two or three residents living in them. The houses would be fit for purpose for those residents who are fairly able, but they would not be suitable for those with restricted mobility or who may need a wheelchair. There is a bungalow for those with reduced mobility. The furnishings in each house were of a good quality, but most houses needed some decoration and the flooring needed to be replaced. On viewing the Regulation 26 reports it was noted that a new kitchen and flooring to all houses had been recorded. The Manager also kept a maintenance programme of any work needed. The Manager advised that the houses were to be decorated in February 2010 and all the carpets replaced. Each of the houses visited were found to be clean, hygienic and free from offensive odours. It was confirmed that each of the houses would be cleaned by staff on duty. Those service users who returned questionnaires reported that their home was always (x3) or usually (x2) fresh and clean. The laundry facilities in each house consisted of a washing machine and tumble dryer. Those houses visited had hand Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: washing facilities in the bathrooms, which consisted of liquid soap and paper towels. Disposable gloves were also available. COSHH chemicals were stored in a lockable cupboard in each individual house. The Manager advised that staff needed to update their infection control training, as none had been organised since she had been employed there. Each of the houses visited had a large communal lounge area and all service users had single bedrooms and most were of a good size. The bedrooms in house C were well presented and had been personalised and decorated to each individual service users choice. None of the bedrooms have ensuite facilities. The furniture in each of the houses were of a good quality. It was noted that one service user had linoleum on their bedroom floor and the Manager was advised that this would need to be the service users choice to have this form of flooring and this should be clearly recorded on their file. Each of the houses had their own bathroom. The bathroom in the bungalow is to be made into a wet room, which would be more suitable for those service users with mobility problems. Service Users at Pinetree Place have specialist equipment were needed to maximise their Independence. The Manager stated that they have access to an Occupational Therapist and added that the OT had been brilliant dealing with requests so quickly. There is a call bell system in each of the houses if needed. Care Homes for Adults (18-65 years) Page 23 of 33 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Service users who live at Pinetree Place receive care from skilled and experienced staff, but there may not be sufficient staff to meet their assessed needs at all times. Evidence: Copies of the staffing rota were viewed and these contained the required information. The Manager advised that there is one staff member per house on each shift and extra staff sometimes come in for key worker activities. Night-time cover is 4 staff. The issue around individual service users being able to have a more active life was discussed; as it was felt that the present staffing levels may have an impact on what the service users can and cannot do each day. Staffing levels at Pinetree Place need to be reviewed and service users care plans updated to identify individual needs and enable service users to participate in activities and enhance their quality of life. Staff spoken to generally seemed happy that there was only one staff member per house, but a couple stated that there should be at least two staff in two of the houses, due to the personalities and behavior of the service users who live there. The Manager stated that when the home is short staffed they only use one agency to try and ensure continuity of care. A staff member spoken with during the inspection and they confirmed that they had worked at Pinetree place for a number of months and was happy there. On observing their interaction with the service users it was Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: noted that she knew their care needs and had a good relationship with them. Estuary Housing have a Human Resources department who oversee recruitment and have responsibility for collecting all the recruitment information on the individual. This would include Criminal Record checks, written references, health declarations and application forms etc. No new staff files could be viewed due to none being employed at Pinetree Place over the last 12 months. The Manager stated she would be involved in shortlisting and the interviewing of candidates. Staff would receive copies of the General Social Care Councils code of conduct and job descriptions. All new staff would complete an induction, which the Manager confirmed was in line with Skill for Care. All three staff who returned questionnaires confirmed that their induction covered everything they needed to know before they started work as a carer. When looking at NVQ training it was established that the home has 18 staff, of which one is doing their NVQ 2, six have achieved their NVQ 3 (and 4 doing) and one has completed their NVQ 4 and another working towards this. It was established that Pinetree Place are on their way to having 50 of their staff trained to NVQ status. Details of staff training is kept on computer. Training information was printed off and this was cross referenced against staff files. It was noticed that some of the files viewed did not contain copies of training certificates to match the list on the computer. Both in house training and external training is organised for staff. There are also some areas where training is cascaded down to staff by another member of the staff team. The Manager advised that training is covered as part of staffs appraisal, so that appropriate training can be provided. Training that had been organised over the last 12 months included essential appraisal, moving and handling, first aid, equality and diversity, health and safety, key worker training, medication, first aid and risk assessments. When looking at two staff files these had training certificates to confirm they had attended training on first aid, food safety and safeguarding. Those staff who returned their questionnaires reported that they had been offered training that was relevant to their role and this provided them with the skill and knowledge needed. Staff supervision is in place and consists of one to ones, meetings, appraisals and general support. From the supervision documentation seen it showed that there had been limited one to one supervision completed during October and November, but monthly meetings had occurred. All staff had been seen in September for one to one and the Manager had just started to complete staff appraisals. Team leaders also have responsibility for the supervision of staff. Two staff files were inspected one staff Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: member had received eight individual supervisions and two appraisals, whilst the second had received five individual sessions and two appraisals. Of the staff who returned questionnaires, two stated they received regular support from the Manager, whilst one stated they sometimes did. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Service Users can be sure that Pinetree Place is run by a person who has the skills and experience required, and their views will be sought about the running of the home. Evidence: The present Manager has applied for registration with the Commission for Quality Care and had recently been interviewed. She has the experience and knowledge to run a care home and is presently doing her NVQ 4. Estuary Housing is a large organisation who have clear lines of accountability and systems in place for the Manager to receive support when needed. The Manager has worked hard since she has been employed to try and put systems and procedures in place to help with the smooth running of the home and to also show that the National Minimum Standards are being met. The AQAA stated that regular house meetings are organised and minutes of these are made available. They also send out a survey/consultation to those involved in the lives of their service users to find out what they do well or what they could do better. Estuary Housing have in-depth policy procedures, which comply with current Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: legislation and are regularly reviewed. Copies of the organisations policies and procedures are kept in the office and whilst viewing staff files there was documentation in place to show that staff had received copies of specific policies and procedures. There are also policies and procedures in place to ensures that the health and safety of both staff and service users are safeguarded. Evidence was gained that regular checks had been completed and copies of certificates were available for lifting equipment, fire alarms, controlled waste, gas safety certificate and PAT testing. Water temperatures are tested and records are kept in each individual house (these were not inspected during this inspection). The accident book was viewed and records were made available and there was a health and safety certificate in the foyer. A food hygiene inspection had been carried out on 06/10/09 and comments included good operational standards. Records kept at the home were well presented and the information fairly easy to find. Each resident and staff member had their own file and records were well kept. The Homes insurance certificate was seen and in order. Care Homes for Adults (18-65 years) Page 28 of 33 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 Adults (18-65 years) Page 29 of 33 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 12 16 Service users should be 26/03/2010 consulted with about a programme of activities that take into consideration their recreational, fitness, training and independent living skills. This is to ensure that individuals are given the opportunity to personally develope and take part in appropriate activities and training. 2 22 22 There must be a clear and effective complaints procedure, which includes details of who to complain to, timescales and details of the CQC. Service users must be confident that their complaints will be listened to and that the procedure is appropriate to their needs. Complaints should be clearly recorded and include details 31/03/2010 Care Homes for Adults (18-65 years) Page 30 of 33 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 of any investigation and outcome. 3 33 17 There must be sufficient staff employed at Pinetree Place to meet the assessed needs and plan of care for the service users. This is in connection to ensuring there are sufficient staff on duty at all times to enable service users to participate in activities and general day to day routines and to ensure the safety of staff and service users. 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 30/04/2010 1 2 1 1 Ensure the Statement of Purpose and Service User Guide is regularly reviewed and information is kept up to date. It is recommended that the Service User Guide is in a format that is suitable for the service users it is intended for eg picture format, symbols etc Continue to develop care plans to ensure they include all areas of care required and how this is to be provided. Some care plans contained more information than others and need to be developed to be more person centred and show how the residents have been involved in the decision making processes. It is recommended that systems are put in place to clearly record and show what activities, training and social interaction each resident has taken part in. It is recommended a complaint form is produced, which 3 6 4 14 5 22 Care Homes for Adults (18-65 years) Page 31 of 33 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 clearly records details of who made the complaint, how it was investigated and the outcome. 6 26 Ensure that linoleum is only used in service users bedrooms, when it has been discussed with them and is their choice. This process should be clearly recorded. It is recommended that infection control training is organised for staff. Need to ensure there are copies of staff training certificates on file and that this collates with the information kept on computer for staff training. It is recommended that staff should receive supervision and support at least 6 times a year. 7 8 30 36 9 36 Care Homes for Adults (18-65 years) Page 32 of 33 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). 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