Care Home: Pinewood

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What the care home does well Provides a consistent and well trained staff team to meet the needs of the current service users. The manager is competent and approachable, which provides a calm and organised home in which to live. Communication between staff is good, which ensure the needs of service users are well understood. Provides opportunities for service users to undertake activities appropriate to their needs. The arrangements for the administration of medication are particularly robust and protect service users. Handover meetings are comprehensive and ensure that all staff are kept informed of developments for the benefit of service users. What has improved since the last inspection? The appointment of a permanent manager has resulted in wide ranging improvements in the operation of the home and has provided positive outcomes for service users. There are now more opportunities for service users to attend activities outside of the home as a result of increasing the availability of drivers. The incidence of staff sickness has reduced improving staff consistency for service uses. The frequency of staff supervisions and staff meetings has improved providing greater support for all staff and greater consistency for service users. Care plans have been reorganized and considerable work has been undertaken to ascertain and reflect the needs and preferences of service users in documentation. Reviews of the medication taken by individual service users have resulted in more rational and simplified regimes. What the care home could do better: There are plans in place to improve mobility around the home particularly for wheelchair users. There are plans to improve lounge seating for one service user and to replace a bath and hoist. Improve training opportunities for night staff and non permanent staff to further meet the needs of service users. Further improve record keeping in relation to staff training and supervision. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pinewood 101 Pinewood Avenue Crowthorne Berks RG45 6RQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Newman     Date: 1 9 0 6 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Pinewood 101 Pinewood Avenue Crowthorne Berks RG45 6RQ 01344 773139 01344 752833 info@new-support.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Dimension (NSO) Ltd vacant post care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of services users who can be accommodated is 4 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: Learning disability – LD 4 Over 65 0 Date of last inspection Brief description of the care home 1 8 0 6 2 0 0 7 The home is a detached 2-storey house situated in a residential area close to the Crowthorne village centre. The village has shops, pubs and local community resources. There is an accessible garden that has been equipped for wheelchairs. The house has a large lounge diner, kitchen and laundry. The service users bedrooms are all single and on the ground floor. There are assisted bathing facilities to help service users with restricted mobility. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 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 Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that was conducted over the course of two days. On the 18th June the inspector arrived at the service but the manager was away conducting staff training. Following a telephone conversation with the manager the inspector decided to return the following day in order to provide for a full evaluation of the service and the outcomes for service users. On the 18th the inspector was assisted by a care worker who provided an overview of the changes that had been implemented in the service and a range of records were seen. This visit lasted for one hour. On the 19th June the inspector spent 4 hours in the service and was assisted by the manager and the staff on duty. A range of records were seen, a tour of the communal areas was undertaken, and two care staff were spoken to in private. During the course of the inspection service users were spoken to briefly by the inspector. Care Homes for Adults (18-65 years) Page 6 of 27 Over the last year the service has experienced considerable change in management with 4 changes of manager. In January 2008 the current manager was appointed to the home and he is awaiting confirmation of his registration from the Commission. This appointment has resulted in wide ranging improvements to the running and operation of the home. Staff morale was reported as much improved with staff feeling more valued and included in the running of the home. Care plans and supporting documentation has improved and the needs of service users are being more accurately assessed and recorded. The current fees for the home are between £1,447.31 and £1461.49. What the care home does well: What has improved since the last inspection? What they could do better: There are plans in place to improve mobility around the home particularly for wheelchair users. There are plans to improve lounge seating for one service user and to replace a bath and hoist. Improve training opportunities for night staff and non permanent staff to further meet the needs of service users. Further improve record keeping in relation to staff training and supervision. Care Homes for Adults (18-65 years) Page 8 of 27 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. 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 27 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. All service uses have their needs fully assessed prior to their admission to ensure the home will be able to effectively meet their needs. Evidence: There have been no service users admitted to the service since the last inspection. Evidence was accepted from the last inspection and from written information provided by the service that any prospective service users would have their needs fully assessed prior to a place being offered. It is known that the organization has comprehensive polices and procedures addressing the assessment of prospective service users and the arrangements for their admission. Care Homes for Adults (18-65 years) Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written plans of care (care plans) provide comprehensive and sufficiently detailed information to enable staff to meet the needs of service users. Residents are encouraged and supported to make decisions in relation to their everyday lives. All risks to service users safety are fully assessed and guidelines are in place to reduce the risk identified. Evidence: Care plans have been completely reviewed in respect of format and content and do now provide sufficiently detailed and up-to-date information that enables staff to effectively meet service users needs. Further work is being undertaken that includes the provision of person centered planning, which is a system involving service users much more closely in the assessment of their needs, for each service user. A range of Care Homes for Adults (18-65 years) Page 12 of 27 specific guidelines in relation to specific duties including bathing and transporting have been introduced. This enables staff to be clear about the service users needs and preferences are met. It was evident from talking to staff and from records seen that the staff team as a whole do have the skills necessary to involve residents in the on-going development of their care plan. The gender and racial mix of the staff team reflects the current service user group and enables a more specific matching of staff to service users needs. A revised key worker system is in operation which enables staff to establish an effective relationship with individuals and work on a one-to-one basis with each resident. Key workers have been chosen in consultation with service users and for their rapport with particular individuals. There is evidence that individuals are involved and consulted about decisions about the home such as activities of daily living and social activities and staff are being encouraged to record when service users have made decisions for themselves. The introduction of a daily record that includes prompts will assist with this level of recording. Two service users have had there communication needs assessed by a Speech and Language Therapist that has resulted in the introduction of tailor made communication tools in respect of each of the service users. Although only recently introduced this was proving to be beneficial in reducing distress resulting from communication difficulties. Each care plan includes comprehensive risk assessments. Management of risks takes into account the age and specialist needs of individuals, balanced with their personal aspirations for independence and choice. Where there are limitations in place, discussions have taken place with the resident. Care Homes for Adults (18-65 years) Page 13 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service take part in activities that provide opportunity for personal, practical and emotional development and are encouraged to be part of the local community. Service uses are provided with a menu that is nourishing, varied and meets their individual and cultural needs. Evidence: One staff member has been designated with the task of co-ordinating activities for service users. Currently all service users are provided with the opportunity to engage in activities that are stimulating and worthwhile. There was evidence in the daily records that people make good use of community facilities including local restaurants, Care Homes for Adults (18-65 years) Page 14 of 27 cinemas, sports facilities and public houses. Each resident has an activity plan, which is displayed in a discrete communal area of the home. As part of the ongoing work on person centered planning the likes, dislikes and the preferences of individual service users is being explored in detail to enable individuals to take part in activities relevant to them. An example provided at the time of the inspection involved annual holidays. For some service users a stay away from the home did not meet their needs or preferences and therefore arrangements were being made for those individuals to have days out relevant to their interests. The home is responsible for ensuring residents are transported to the different venues in order to take part and have a house vehicle, which is wheel chair accessible. There was good evidence from care plans that activities within the home were being thoroughly explored to ensure that all service users were being provided with occupation and activities appropriately whether in the home or outside. The home provides a nourishing menu, which meets the needs of the residents. Staff demonstrated a sound knowledge of the likes and dislikes of individuals. New and different foods were being regularly introduced and monitored by staff with some positive results. The home was awarded with a Silver Food Safety award in November 2007. This is the highest award a small care home can achieve. Care Homes for Adults (18-65 years) Page 15 of 27 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. Services users physical, health and personal support needs are met and medication is handled safety and appropriately. Evidence: From the examination of 2 service users care records it was evident that service users physical and personal care needs are met by the home. Care plans have been reorganized making the accessibility of vital information much easier. Historic information has been rationalized to ensure that only up to date and relevant details are kept in the operational file. The inspector was informed that key workers had commenced the task of compiling Health Action Plans provided by the local Health Care Trust that will gather all health related information. Arrangements were in hand to organized planned health care checks for all service users including dental, optician and any other individually required reviews. Observation of staff and residents interaction demonstrated that care was provided in Care Homes for Adults (18-65 years) Page 16 of 27 a manner, which maintained the users right to dignity, privacy, independence and choice. Service users do not self medicate at the home. The system adopted for the administration of medication is the monitored dosage system. This system reduces the likelihood of medication error and provides an accurate record of administration. All staff designated as administrators of medication have been fully trained in safe practice and administration and have been assessed by the Organization as part of their formal training. Care Homes for Adults (18-65 years) Page 17 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes has a complaints procedure, which is clear and accessible. Service users views and comments are listened to and acted upon. Service users are protected from abuse and exploitation by well trained and competent staff. Evidence: From the examination of the complaint record, which is now maintained in bound book form, it was evident that there had been only one complaint made to the home since the last inspection and no information concerning complaints have been reported to the Commission. The recorded complaint had been fully investigated and the outcome was fully recorded. Service users have access to the complaints procedure, which is explicit in their copy of the Service User Guide and readily available on the homes notice boards. Discussion with the Manager and staff indicated that feedback is actively sought from service users and their families on an ongoing basis. There are regular residents meetings that are recorded. There was evidence in staff files that all staff receive training in the abuse of vulnerable adults as part of their formal induction and NVQ training in which it is a Care Homes for Adults (18-65 years) Page 18 of 27 core module. Refresher training courses are also offered at regular intervals. Those staff spoken to confirmed that they had attended protection of vulnerable adults training and one staff member provided examples from recent training where more subtle abuse situations were discussed. A comprehensive financial audit of the home was undertaken on 8.5.08. The findings resulted in some minor recommendations to tighten up on the current good practice. Care Homes for Adults (18-65 years) Page 19 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, homely and well maintained environment for service users. Evidence: The home was clean and hygienic throughout. Communal areas were spacious and comfortably furnished. All bedrooms were personalized to the choice of each resident. Two service users have been provided with specialist chairs for use in the lounge following professional assessment. The garden was well kept and is well used by residents. A gardener visits the home regularly and involves one of the service users in planting flowers, an activity he particularly enjoys. Since the last inspection the kitchen has been refurbished and now allows access for a wheelchair user to prepare food and to make himself a hot drink when he wishes. Some fogged window panes have been replaced following the previous inspection with a few small panes scheduled for replacement. There is a programme for ongoing redecoration and replacement of worn items for the home to enhance the environment for service users. Care Homes for Adults (18-65 years) Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are caring and kind and benefit from good support and supervision in their job role. Evidence: Examination of the staff recruitment and training files for 3 workers at the home evidenced that staff were appropriately recruited, inducted and trained. Selection and recruitment procedures at this home involve residents and are robust. All necessary checks are carried out on staff to ensure that they possess the necessary attributes to care effectively for the residents. The manager advised that ongoing work was being undertaken with staff files to ensure that all relevant information is accessible. It was evident from talking to staff and from observation of practice within the home that staff have a good understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with residents. Since the appointment of the current manager there are now regular staff team days that involve as many as the permanently employed staff as possible. Staff reported these had been very effective in enhancing teamwork and individual staff felt Care Homes for Adults (18-65 years) Page 21 of 27 valued and involved. It was reported at the last inspection that staff supervision fell short of the required standard with some staff not receiving supervision for up to 4 months. This situation has greatly improved with the majority of staff now having one to one supervision on a monthly basis. Those staff spoken to advised that this was working well but that they also could ask senior staff or the manager at any time if they were not sure of anything. The manager informed the inspector that the staff training records had been brought up to date. All staff were not up to date with core training and three staff not in possession of an NVQ qualification had registered for the appropriate level. It was recognized that newer staff need to undertake Skills for Care induction training and this was being put into place. Care Homes for Adults (18-65 years) Page 22 of 27 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. The home is safe and well managed by a competent manager and professional staff team. The home seeks and focuses on the views of its residents on an ongoing basis. Evidence: Since the last inspection there have been 4 changes of manager. In January 2008 a permanent manager was appointed. There was considerable evidence that this appointment had resulted in wide ranging positive changes within the home. Quality assurance is being monitored during the monthly proprietors visits and from regular surveys distributed to parents and carers. These are collated at head office and an annual customer satisfaction survey sheet is produced which identifies areas of satisfaction and improvement. Care Homes for Adults (18-65 years) Page 23 of 27 Examination of the health and safety records indicated that all necessary checks and servicing of equipment is routinely undertaken to safeguard the health and welfare of users. The records have been reorganized and one member of staff has been designated with the task of over seeing health and safety matters within the home and ensuring that all the necessary checks are undertaken. A new fire risk assessment has been introduced with a revised emergency evacuation procedure. This now incorporates the involvement of one service users who had experienced unpredictable behavior at the sound of the fire alarm. His active role in the new procedure has reduced his distress and has made the process easier and safer for all concerned. General risk assessments are being reviewed and all identified risks are being managed by a risk assessment management plan. An Environmental Health Dept health and safety inspection conducted in April 2008 identified some areas requiring attention. The manager confirmed that the requirement and recommendations from this report had already been addressed or were in hand. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 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 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!