Care Home: Pinewood

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What the care home does well Provide a safe and homely environment for its residents. They have also started focussing better on person-centred care and support, and are preparing staff through training and supervision to deliver an improved service. Good systems are in place for quality monitoring and developing the service and residents are quite happy with the meals provided at Pinewood. They have reported positively about the staffing deportment in valuing the principles of dignity and respect. Health and safety has been increasingly improving over the last two inspections. What has improved since the last inspection? There have been refurbishments to various aspects of the communal and bedroom areas of the home, as part of their rolling refurbishment plan. Some improvements have been noted in the provision of activities, although residents and relatives are asking for more. The provision of staff training and the staffing deployment in the home has improved. These two improvements, along with a new management team have had a marked and positive impact on the quality of services that residents are receiving at Pinewood. Residents now have the benefit of a large screen television in the main lounge. What the care home could do better: The quality and frequency of activities need to improve, as is the management of specialist health care support, and the support provided to all residents with their medication. Key inspection report Care homes for older people Name: Address: Pinewood 96 Manford Way Hainault Ilford Essex IG7 4DA     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: Stanley Phipps     Date: 1 5 0 6 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Pinewood 96 Manford Way Hainault Ilford Essex IG7 4DA 02085008499 02085000811 deborahwoods@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Denise Angelique Brown Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 54 The Registered Person may provide the following categories 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: Old Age, not falling within any other category - Code OP (maximum number of places: 40) Dementia - Code DE (maximum number of places: 14) Date of last inspection Brief description of the care home Pinewood is a 54 bedded home for older people, forty of which is for residents with needs associated with the ageing process and fourteen for older people with. a diagnosis of Dementia. The latter of the two categories has been the more recent of Care Homes for Older People Page 4 of 31 Over 65 0 40 14 0 Brief description of the care home the two types of service offered at Pinewood. The service is owned and run by Sanctuary Care. All beds are contracted to the London Borough of Redbridge and one of the fifty-four beds is used as an emergency respite bed. Accessing this bed involves a specific assessment based on agreed criteria between the home and the local authority. The home is situated in Hainault and is close to local amenities and bus transport systems. It is spread over three floors and is fully accessible to people who may be wheelchair dependent. There is a large garden for the benefit of service users with open spaces to the front of the home. A large dining area, kitchen, laundry and lounge areas on each floor ensures that service users are afforded communal spaces for relaxation and activities of their choice. A water feature has been added to the garden along with two rabbits for the benefit of residents. All residents have single bedrooms, of which approximately fifty per cent have en-suite toilet facilities. The home is staffed on a twenty-four hour basis, providing care and support to elderly residents. The fees are charged at GBP480.82 and do not include hairdressing - priced at GBP8.00, newspapers and toiletries variable prices, private chiropody GBP20.00 and dental charges dependent on residents finances. The homes statement of purpose is made available to residents on request and a copy is kept in the staff office. Each service user is given a copy of the homes service user guide, once admitted to the home. Care Homes for Older People Page 5 of 31 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 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: We carried out the inspection with a site visit, during which assessments were made: on the physical structure of the home, the quality of activities, the detail and quality of records including - health and safety, staff training, care-planning and risk assessments, recruitment and policies and procedures. We also interviewed and held discussions with the manager, deputy manager, staff , residents, relatives, external professionals, including a discussion with the area manager. The Commission also looked at quality assurance records and other records required by regulation to include; the Annual Quality Assurance Assessment (AQAA) document along with surveys returned by residents and their relatives. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 7 of 31 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 8 of 31 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. Pre-admission assessments are carried out on all prospective residents, from which care plans are drawn up, identifying their needs and how they would be met. The involvement of residents and their relatives in this process gives them some assurance that the home is able to meet the residents needs. The home does not offer intermediate care. Evidence: The files of three of the most recently admitted residents were assessed and found to contain detailed information in relation to the admissions process for the individuals concerned. This included a holistic assessment of each resident covering the personal, social, emotional and health care needs, on which a care plan was formulated.There was also evidence that care management summaries were obtained from placement authorities so that the broadest picture possible was obtained for each individual. Care Homes for Older People Page 9 of 31 Evidence: Where possible residents, their relatives and/or representatives are involved in the admissions process and from the feedback received, residents were happy with the process - which they felt gave them good assurances that their needs would be met. Intermediate care services are not provided at Pinewood and the registered persons are aware that were they to provide such a service, then specific and alternative arrangements would have to be in place. This includes; a review of the staffing levels and skill-mix, the environment and policies and procedures. Care Homes for Older People Page 10 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are set out in their individual plans, and provide staff with the information they need to identify and meet the residents needs. Good evidence was available to indicate that residents health care needs are adequately provided for. More needs to be done to ensure that all residents get a good quality of health care support, particularly with their medication. Residents and their relatives are overwhelmingly pleased with the way how the principles of privacy, dignity and respect are put into practice in delivering the service at Pinewood. Evidence: At the time of the inspection a care plan audit was taking place and this process had started in March 2009. There was evidence to confirm that the implementation of the new care planning system was well on the way and also that staff had a better handle on using them in a more effective way. It must be stated that it has been a big stepup from how care-planning was done previously and the new manager reportedly put a lot of effort in trying to get all the residents on the new system. Most of the residents had a new care plan in place and from the four that were sampled, they were generally comprehensive with good detail around health and personal care Care Homes for Older People Page 11 of 31 Evidence: needs, with a slightly lesser emphasis on social care needs.There was evidence that care plans were reviewed in general on a monthly basis or as necessary i.e. if there is a change in the circumstances of an individual - particularly in relation to their health. It is fair to say that the care plans were person centered in their make up and it is positive to have seen that where possible residents and their relatives were involved in this aspect of the service provision. From the surveys returned by residents up to seventy percent stated that their medical needs are always met, while thirty percent stated that their medical needs are usually met. A close examination of the health records of three residents provided significant detail around health issues like; diabetes, preventative action in relation to pressure sores, dementia care and support provided with medication. This was complimented by good records being held on the involvement of external health care professionals for example, GP, opticians, chiropody, audiology, dentist, dietitian and the continence advisor. In many respects, the management and staff were generally on the on top of most of the health care issues that affected residents living at Pinewood. However, there was one individual that presented a much greater challenge to the staff team and although a referral to the community mental health team was made - this could have been done and followed up in a more timely manner. This resulted in a number of residents being physically attacked and verbally abused over an unacceptable period on the Dementia Unit. To make matters worse, her file contained a form for the assessment of her mental health and this was found blank i.e. with nothing recorded on it. It was not quite clear how a resident with such challenging behaviour/s was admitted to the home. While it was unknown whether the behaviours were associated with a mental health or personality disorder, related to her dementia, or the result of an underlying physical illness, the fact remained that the resident and others in her midst, as well as staff were put at risk. It is fair to say that strategies were put in place by the registered manager to include periods of one to one supervision and divisional strategies - which according to the records and from feedback provided by staff - did not work. As a matter of fact one staff member provided evidence of several concerns that she had brought to the managers attention - which she concluded was not acted upon. The staff concerned felt that it would require a major incident before more pertinent action was taken. This was discussed with the manager at the inspection and a plan was discussed to: chase up the mental health referral, take further action to reduce the risk of harm to residents and staff and to make contact with the local safeguarding authority with regards the residents at risk or actually on the receiving end of the behaviours exhibited by the resident, causing the distress. Care Homes for Older People Page 12 of 31 Evidence: Risk assessments were in place for all residents and covered a wide range of the key aspects of residents safety and independence for example: Falls Risk assessment and the Waterlow Pressure Ulcer risk assessment. In the case referred to above the risk assessment needed to be regularly reviewed to ensure that risks to self and others were kept to a bare minimum. This was not the case in this instance. However, there were other aspects of good risk assessment planning in the home, which ensured residents safety, while promoting their dignity and independence. It is important for lessons to be learnt from the case discussed above so that the service could demonstrate that a good level of support with health care matters is provided to all residents living at Pinewood. All staff were observed to treat residents with kindness and respect, and the quality of interactions between them was generally positive. Most of the staff observed, demonstrated a good understanding of the need to promote residents dignity through practice, by addressing residents by their preferred names, and knocking on bathroom and bedroom doors before entering. Staff spoken to were also very conversant with the individual needs of residents. In speaking with a number of residents, some of their responses to the care they received in the home included: We get good care and are well looked after, All the staff give good care and attention to my mum when needed and There is always someone around when you need advice. Relatives expressed similar sentiments, some of which included:The service caters for all the needs of my mother, Pinewood meets my mums needs as she is very frail and The service provides the very best of care for my mother. An audit was undertaken for the handling and recording of medications in the home and a sample of the Medication Administration Record (MAR) charts were examined on each of the units, including the Dementia Unit. This was against the background that the home had for the last two key inspections performed under the required standards in this outcome area. As a result the Commissions pharmacist was sent out to do an assessment and to provide relevant professional guidance. Along with this, an Annual Service Quality Audit was undertaken on the 27/4/2009 by a representative from the Sanctuary Care Homes Quality Assurance team. On the day of the visit, an updated medication policy was in place and available to the staff responsible for handling drugs in the home. There was also evidence that there was regular monitoring of drugs taking place in the home, moreso since the arrival of the new manager in December 2008, who as of May 2009 had the support of a new deputy manager in this respect. It was against this background that the inspector was concerned to have found at least three areas of medication administration that was not up to standard. The importance of the self audit referred to above was that Pinewood was scored as Care Homes for Older People Page 13 of 31 Evidence: adequate by Sanctuarys standards - the key reason being how drugs were recorded in the home. This was also a problem at the key inspection of the service to the point where uncertainty was created in all the cases identified. The registered manager and her deputy were very adept to the challenge of getting it right - where medication is concerned and so an investigation was carried out promptly following which a report was submitted to the Commission. A comprehensive improvement plan was also submitted on the 18/6/09 three days after the inspection. Some of the key action points to come out of the improvement plan were : the introduction of a dedicated individual to improve, monitor and maintain a good standard of medication practice in the home, the monitoring of staff performance using best practice recommendations, and taking action where necessary including Sanctuarys capability and /or disciplinary policies to meet required standards for medication management to include record keeping, more training and supervision to include refresher training and regular auditing of drugs by the manager, deputy and the regional manager. On paper although the plan sounds fantastic, what matters is that its implementation brings about the desired change in enhancing the outcomes for residents living at Pinewood. This would be tested in full during the next key inspection of the service as the Commission reserves the right to initiate enforcement action against the registered providers to bring about improvement for residents through compliance with requirements. The context of this statement is that the home has failed to demonstrate a sustained pattern of improvement with health care support, particularly in a critical area such as medication. There are good areas of practice that has remained generally good, such as storage, temperature control and monitoring and in some respects the acquisition of medication. This outcome group remains adequate. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there have been some improvement in the delivery of activities in the home, residents still seek a higher quality experience that is best-suited to their interests.They are well-supported to maintain their family networks and enjoy good opportunities to exercise choice and control in their lives. At Pinewood meals provided are reflective of residents choice, taste, culture and nutritional requirements. Evidence: Although there have been some improvements with regards to activities, residents and their relatives still identified it as an area that needed improving. A new activities coordinator started in January 2009 and she set out in writing what her experience has been and what she has managed to achieve so far, including the difficulties that she comes up against. It was clear that there was quite a bit to be done, although she felt that she had good support to achieve the main outcome of providing activities in line with residents needs, wishes and interests. An outline submitted for activities Monday to Sunday included: One to one with residents, Bingo, Trips to local shops, Quiz/hairdresser, Hairdresser/manicures, Old time music/Party time and Old time films. Records showed evidence that local schools come in for a bit of caroling and religious services are held in the home. It was also noted that a memorial service was held followed by a D-day party on the 6/6/09. Incidentally, there were other Care Homes for Older People Page 15 of 31 Evidence: activities for the rest of that week. It is acknowledged that a large screen television was purchased for the main lounge, and a mobile sensory unit for use with the Dementia residents, and at the time of the inspection a garden was being developed on the Dementia Unit with the decking and a water feature already in place. The management and staff were also making a better attempt to identify personal preferences through the person-centred planning and do offer some level of individual and group activity. Residents and relatives are saying that it is not enough. Fifty per cent of the responses by relatives indicated that the activities were occasional and needed to be regular. It was accepted that the range of needs and interests of residents are different, however all required a better quality and level of stimulation. Relatives reported that on many occasions residents would be sat there falling asleep in front of the television, which they claim offer little mental stimulation. Many relatives and some residents felt that there should be more short trips out in the community along with regular film nights. Most of the residents spoken to had little recall of the activities provided in the home and this included residents from both the dementia and elderly frail units. The activities coordinator spoke of working closer with staff to enable them to contribute to the provision of appropriate stimulation for residents. On the day of the visit, some staff were interacting with a group of residents in the main lounge. It is interesting that from Sanctuary Housings Quality Audit of the service in April 2009 - it identified the need to improve in the Daily Life and Social Activities area. The registered persons would benefit immensely from increasing their engagement with relatives and residents in respect of developing activities. It is clear that there may well be implications from a resourcing point of view, but relatives went as far as comparing what happens in other homes by way of activities. As a result of the evidence gathered the registered persons need to continue to drive up improvement in the quality and range of activities that is currently provided at Pinewood. There was good evidence to confirm that residents are encouraged to maintain their family and friends networks. This was observed throughout the course of the inspection as relatives and friends were welcomed as they visited. There is an opendoor approach to visitors, which is supported by a visiting policy. One hundred per cent of the feedback received from relatives indicate that they are kept informed about the care and support developments of their loved ones and this includes invitation to resident reviews. Some residents have the experience of being taken out by their relatives and the management and staff have demonstrated a willingness to engage relatives and friends in what happens in the home. This includes social and seasonal events and indeed, in the quest to develop their residents personal Care Homes for Older People Page 16 of 31 Evidence: histories portfolio.This is an area that is gaining more and more strength in the home and as such, is more than likely to enhance the experience of residents living there. Residents are given good opportunities to exercise choice and control in their lives and to this end risk assessments were in place to ensure that a reasonable balance is placed between, minimizing residents freedom and promoting their safety and independence. As such where there are restrictions - evidence was in place as to how they came about. This has become more important with the introduction of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DOLS), as there is a move to ensure that the infringement of residents rights and capacity is not based primarily on assumptions or at least taken for granted. The manager has had the benefit of attending a DOLS (Deprivation of Liberty Safeguards) conference and this learning could be brought back into the service for the benefit of staff and the service as a whole. It was also pleasing to see that a greater emphasis is being placed on residents End of Life wishes as seven of the staff had already attended training related to this, and the manager had booked in to attend, in July 2009. Other key areas where residents influence choice and control included: their food, dress, what they do in general and the ability to personalise their rooms with personal effects that mattered to them. Forums that are used to attract residents views are: complaints, surveys, residents meetings, one to one chats and residents reviews. There were cases in which residents were unable to actively make choices on various aspects of their life and support and or a better understanding is acquired through liaising with relatives and the using personal histories, which is positive. The inspector was able to observe the tail-end of lunch for the day, as well as the tea served later on in the evening. The lunch menu was; Savory Mince and Dumpling, or Poached Fish in Parsley sauce, Creamed potato,with carrots and green beans. Tea consisted of Tomato soup and scrambled egg on toast with a choice of cake, fruit or yogurt for a sweet. In most cases residents were very happy with the meals provided on the day and in general. One hundred per cent of the feedback received from relatives was positive about the meals provided in the home. The combination of meals on the day, as well as those recorded on past menus looked balanced, varied and nutritious. It was also clear that residents were afforded a choice and that changing their minds on the day did not affect their ability to have an alternative dish. One relative went as far to say that the food is excellent, while another said that the food is great. Fifty per cent of the residents responses indicated that they always liked the meals provided, while forty percent stated that they usually liked the food with ten percent stating that they sometimes like meals in the home. The registered Care Homes for Older People Page 17 of 31 Evidence: manager and staff have worked well in meeting the nutritional needs of the residents, which involves nutritional screening to include weight monitoring and the use of the dietitian when and where necessary. Food was also provided in a variety of ways e.g. soft,pureed to meet residents individual needs. In speaking with the head caterer,it was clear that a reliable system in place to ensure that residents received diets that were appropriate to their health care needs. From the observation of meals in the Dementia Unit, consideration should be given to the greater use of pictorial menus, finger foods, small nutritious snacks, smaller portions and more flexible eating at times to maintain independence and exercise choice around food and eating. In general there was a good supply of food in the home that was appropriately stored and generally attractively presented.Throughout the inspection and at various intervals residents were offered drinks and a light snack and some reported that they could get a bit of a nite-bite should they require this. Staff were observed assisting residents with meals in a very flexible and sensitive manner, making the process of dining a pleasurable one. It was clear that this aspect of the homes operations continues to gain strength - which is a really positive outcome for residents living at Pinewood. Care Homes for Older People Page 18 of 31 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. The manager and staff make every effort to resolve concerns and complaints as they arise in the home. As a result, residents and their relatives feel assured that when complaints are raised, that they would be taken seriously. Now that safeguarding training has been provided for most of the staff team, residents enjoy a greater sense of protection from the risk of coming into harm and/or abuse. Evidence: The home has a written complaints policy and procedure for dealing with complaints, and staff spoken to were aware of the protocols around complaints, including how to deal with complaints and concerns made to them. The complaints log was inspected and indicated; complaints received, details of investigation, action taken for resolution and the outcome for the complainant. The registered persons have acted in line with their guidelines of investigating and responding to complaints within a twenty-eight day period. Feedback from residents and their relatives overwhelmingly indicated that they knew how and who to complain to. There is a more positive approach to complaints under the new management in that a strong emphasis is placed on using them as an opportunity to develop the service, which is positive. Residents and their relatives commented that they feel assured that when they raise complaints and/or concerns - that they would be dealt with in a manner that would not deter them from thinking about raising a concern in the future. The registered persons carry out a monthly audit of complaints as part of their quality monitoring. Care Homes for Older People Page 19 of 31 Evidence: There was evidence to confirm that a significant number of staff had been on safeguarding training, including refresher training. All staff as part of their induction must go through the safeguarding and whistle-blowing procedures to ensure that opportunities are not lost to educate and develop staffs knowledge on the importance of safeguarding vulnerable adults. Staff spoken to had a good understanding of safeguarding issues and in one of interviews held with a staff member, a clear example was given relating to how resident on resident violence - was a safeguarding matter.It was noted that the level of safeguarding issues had decreased in comparison with the two previous years and for those that were raised since the last inspection there have been little for the home to do by way of improvement actions. However, it was pointed out to the manager that the case of the resident on the Dementia Unit referred to earlier in this report - hitting out at residents, that these incidents needed to be referred to the local safeguarding coordinator. This has since been complied with, along with other interventions to reduce the risk of harm to residents on the unit in question. It should be noted that the robust staffing recruitment practices undertaken by the registered persons also acts as a safeguard to residents living at Pinewood. Care Homes for Older People Page 20 of 31 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. Residents enjoy living in a home that is very welcoming, clean, comfortable and generally designed to meet their needs. Ongoing maintenance and development, along with continuous monitoring of the environment at Pinewood, would ensure that residents continue to enjoy that experience. Evidence: An inspection of the premises took place and this included some of the bedrooms by personal invitation. All bedrooms seen were personalized and were indeed individual. They were clean and carried a pleasant scent. The home was generally clean, bright and airy and despite the fact that there were individuals with continence problems no offensive odors were present, during the course of the inspection. The decor, furnishings and fittings were maintained to a good standard. This was achieved through the employment of ancillary staff to include domestics and a maintenance officer who picks up issues as they come along. A sound recording and reporting system is in place to ensure that the home remains well-maintained. A routine pro gramme of maintenance and refurbishment for the home is also in place and the environment is also a key feature of the quality assurance audit that is carried out by the registered persons. On the day of the visit there were small items of repair identified, most of which had already identified for repairs. Feedback received from residents, relatives and external professionals indicated that Pinewood was homely and welcoming. Residents and relatives were particularly complimentary about the Care Homes for Older People Page 21 of 31 Evidence: standard of hygiene that is maintained in the home. It was noted that some work has started in relation to the signage on the Dementia Unit, although this is an area that could be developed further. The laundry area was inspected and this was found to be clean, with soiled articles, including clothing and bed-linen being appropriately stored - pending washing. The laundry staff were aware of health and safety measures including infection control, and the handling and storage of chemicals. Personal Protective Equipment(PPE) such as clothing, gloves and aprons were available and in use. The laundry floor covering was suitable and the facility is cited well-away from the kitchen. One of the residents commenting on the laundry services stated that; the home keeps my clothes nice. Relatives were also complimentary about the quality of the laundry services and some of whom were happy that their relatives always get their clothing back. It was clear that all aspects of the home internal and external were well-maintained in that it was safe, clean and hygienic. The environment at Pinewood therefore generally remains fit for its purpose in providing care and support to elderly residents. Care Homes for Older People Page 22 of 31 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. Residents have the benefit of receiving care and support from a staff team that is sufficient in numbers, has a good balance of skills and training to meet their needs.The robust recruitment practices undertaken by the registered persons provide good safeguards for people living in the home. Evidence: There has been an improvement in the staffing levels, as well as how the staff were deployed in the home. On the day of the visit there were ten staff on the morning shift and ten on the afternoon shift. As a matter of fact a recruitment drive was on the way and clearances were being awaited for care support staff and a team leader. It was observed that team leaders were on each shift including the night shift. The rosters were examined and a clear pattern was observed where the numbers and deployment of staff were relatively in line with the needs of the resident group, including at peak times. The care staffing levels are separate from cleaning, laundering and cooking which helps to ensure that the care staff are dedicated to providing personal care and support in promoting the independence and well-being of the residents living at Pinewood. The positives observed included; there appeared to be a lower incidence of falls when compared to previous years, as well generally - a reduction in the concerns raised by residents and their relatives about staffing low levels. Some of the comments made by residents included; Staff are always there when you need them, All the staff give care and attention when needed and There is always someone Care Homes for Older People Page 23 of 31 Evidence: around when you need advice. It is important for the registered manager to continue monitoring and keeping under review, staffing levels in the home. In discussion with external professionals and staff, they were also generally satisfied with the staffing levels maintained by the home. The recruitment files of four of the most recently appointed staff were examined and found to be in order. Necessary checks such as Criminal Records Bureau (CRB) checks, Safeguarding of Vulnerable Adults First checks, and the required minimum of two satisfactory references were all in place. Completed application forms were on file as well as interview notes, health care declarations and valid identification checks. Staff have access to the General Social Care Councils code of conduct and so have a good basic understanding of the principles of delivering safe and effective care. The written procedures for the recruitment of staff are robust and provide safeguards for people living in the home, which is positive.All staff spoken to were in receipt of a statement of their terms and conditions. There has also been an improvement in the frequency and level of training that has been provided for staff since the last inspection of the service. This included refresher training in areas such as safeguarding, infection control, first aid, moving and handling, and fire safety. Training such as induction training was also provided for new staff, along with their basic mandatory training which was in line with Skills for Care specifications. Staff spoken to were satisfied both with the level and quality of the training they received. Training was at the time of the visit, delivered almost on a weekly basis and the manager provided electronic evidence of a training matrix, which enables her to identify and follow up the staff that required generic, specific as in Dementia and medication, and refresher training. At the time of the visit over fifty per cent of the staff had achieved at least an National Vocational Qualification (NVQ) Level 2 in Care, with both the deputy and the manager achieving their Level four in Management and Care. Some staff had been on End of Life training and there were plans for others to have the same training. Plans were also in place for the kitchen staff to do their NVQ qualification. It was reported that all staff were given Liverpool Care Pathway (LCP) folders in lieu of them preparing to skill up for the implementation of the model, which is positive. Residents and their relatives were very pleased with the skill and knowledge level of the staff that are responsible for providing care and support to their loved ones. This is a much improved area of the homes operations and it can be stated that the improvement has had a positive impact on the reduction of the level of safeguarding issues and other general incidents over the last year. Care Homes for Older People Page 24 of 31 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. At Pinewood, residents can be assured that the home is managed and run by an individual who is committed and fit to so do. The active engagement and implementation of quality assurance mechanisms ensure that the service is reviewed and developed. Good financial, and health and safety practices promote and protect the health, safety and welfare of staff and residents alike. Evidence: The manager has the qualifications and experience to manage the home and was able to demonstrate a clear understanding of the diverse needs of the residents accommodated in the home. Since taking over the home in December 2008 she has worked continuously to improve the service and the quality of life for the residents. It must be noted that Pinewood as a service has been unable over the last two inspection years - to demonstrate a sustained pattern of improvement, which has been aided by the repeated changes over the same period in its management structure. Denise Brown has an experienced and suitably qualified deputy manager, who also demonstrated a commitment to improving the quality of life for the residents Care Homes for Older People Page 25 of 31 Evidence: at Pinewood. Most of the staff spoken to were happy with the manager and her style of management, although a very small percentage of staff felt that she takes to long to act on serious matters affecting residents, which is something she may need to look at. The Commissions experience has been somewhat different in that she has been very responsive to taking action in putting things right to improve the quality of the experience for residents. This could be evidenced by the strategies put in place to improve the handling of medication, as well as the action taken in relation to the resident with behaviours that became quite challenging on the Dementia Unit referred to earlier in this report. Relatives and external professionals have provided positive comments about Denise and the general sentiment is, that they hope she brings some stability to management of the service. Denise has also been upgrading her skills and knowledge in a number of areas related to the service for example; the Mental Capacity Act, Care Planning,Handling Grievances Manual handling Trainer and Recruitment. More importantly she reported that she has the support of her Area Manager, who provides her with regular supervision. Should this drive towards improvement keep pace, then it is likely that residents would enjoy an enhanced level of service in the future. There was good evidence that quality assurance monitoring was taking place in the home. This included; regular residents surveys covering Activities, Care, Catering and laundry, an annual service quality audit (undertaken by Sanctuary Homes Ltd), and regular Regulation (26) monitoring visits, Feedback is often obtained from; relatives formally and informally, external professionals at reviews and safeguarding meetings, and staff through staff meetings and supervision. Residents views are also captured in their residents meetings and so there is a good range of activity taking place with a view to developing the service -not omitting the complaints process. An annual development plan is in place for the home and so the registered persons have complied with the requirements of this standard. Sound systems were in place for managing residents finances, most of which is handled by their relatives and/or representatives. This is managed by an administrator who is also subject to her work being audited. A random sample of up to five of the residents personal finances and financial transactions were assessed during the course of the inspection. They were all found to be in order and secure facilities were in place for the safekeeping of residents money and valuables. It was conclusive that residents finances were safeguarded at the home, as strict protocols were in place to ensure that this happens. A wide range of records were looked at including; fire safety, emergency lighting, lift and hoist maintenance/service, gas and electrical certificates, and accident and Care Homes for Older People Page 26 of 31 Evidence: incident reports. All these were found to be in good order an up to date. Safety signs were appropriately posted throughout the home and all staff had mandatory health and safety training. Risk assessments were also in place for all safe working practices, and health and safety policies were updated and accessible to all staff. As such, residents and staff can feel assured that good safety management and control measures are in place at Pinewood to ensure their safety. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 8 12,13 The registered persons are 17/11/2008 required to ensure that the healthcare needs of residents are adequately provided for at all times. This includes the support provided to residents with their medication. This is to ensure that the health and welfare of all residents is promoted at all times. 2 12 16(2)(m)&(n) The registered persons are 17/11/2008 required to provide activities that are in line with needs, wishes and interests of residents. This is to enhance the wellbeing of residents. Care Homes for Older People Page 28 of 31 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 8 13 The registered persons must 24/04/2010 take appropriate action to ensure that the health care needs including specialist health care needs are best provided for. To enhance all residents health and well-being. 2 10 9 The registered persons must 25/04/2010 implement strategies similar to what is contained in their improvement plan to ensure that residents get the best possible support with their medication. For residents to lead a more healthier and comfortable lifestyle. 3 12 13 The registered persons are 26/04/2010 required to demonstrate that they are providing activities that are appropriate to the needs, wishes and interests of the residents. Care Homes for Older People Page 29 of 31 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 This is to provide a greater sense of fulfillment and wellbeing to residents. 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 Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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