Care Home: Pinewood Nursing And Convalescent Home

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What the care home does well The home has an assessment process which enables the manager to decide whether Pinewood can meet the needs of the individual. The ones we saw on this occasion were completed and were used to inform the care plan. When we spoke with people using the service they told us they were happy with the activities that are available for them. Daily routines in the home were flexible and people who use the service are being encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. People who live at the home were generally positive about the food that the home provided and the condition of the accommodation that they occupied. The home is regularly maintained and is comfortable with pleasant furnishing. There is more communal space available following the refurbishment and extension to the home Staff have undertaken training in most mandatory areas and in caring for people with Parkinson`s and confusion for example. We saw that for most of the new staff that had been recruited the home had carried out checks to protect people who use the service. New staff have begun induction training in working at the home. Staff have received updated training in many areas such infection control. People who use the service are consulted about the home and what they would like whilst they live there. What has improved since the last inspection? No requirements for action had been made following the last visit to the home. They have employed someone to train staff in oral care and hygiene. Since we last visited the home has extended and has more people living there. They have introduced a newsletter to help people be informed about the happenings at the home. The resident and relatives meetings are facilitated by an advocate. The home had carried on with delivering a service in a way that they felt met everyone`s needs. What the care home could do better: Care plans must reflect all identified needs of individuals and there must be a record of what staff should do to support those needs. This includes care for wounds and pressure areas. Medication records must be kept reflecting the action staff have taken to meet instructions given by the GP to maintain peoples health. Recruitment checks must be in place before employment commences for example this will be either two references, POVA First check and the individual be supervised or full CRB check and all other recruitment checks. The registered persons must ensure that all staff are in receipt of all mandatory training and any other training which staff need to support people who live at Pinewood. Key inspection report Care homes for older people Name: Address: Pinewood Nursing And Convalescent Home Conifers, Cot Lane Chidham Chichester West Sussex PO18 8ST     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Sevier     Date: 1 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Pinewood Nursing And Convalescent Home Conifers, Cot Lane Chidham Chichester West Sussex PO18 8ST 01243572480 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Lawrence Marsh,Mrs Deryl Ann Marsh care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Pinewood is a care home registered with the Commission for Social Care Inspection to provide nursing care for up to twenty-one older people. The service is owned by Mr and Mrs Marsh, Mrs Deryl Marsh, a first level nurse, is the registered manager. The home can accommodate thirty people. The home has two double rooms and the majority of rooms have en-suite facilities. All first floor rooms are serviced by a passenger lift. Care Homes for Older People Page 4 of 35 Over 65 30 0 Brief description of the care home The home is situated in the village of Chidham, some four miles west of Chichester with its shops, pubs, banks and other amenities. The detached home stands in beautiful grounds with stunning views of the sea and countryside. There is a large car park at the front of the house to accommodate staff and visitors. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 Star. This means the people that use this service experience Good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 12th October 2009 between the hours of 10:00 and 5:00 pm. Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in October 2007. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Older People Page 6 of 35 meeting the needs of people who live at the home. Mrs Deryl Marsh is the registered manager for the home and she assisted along with her husband the registered provider Mr Marsh with the visit. We met with two visitors and there were five people who use the service involved in the inspection visit. We looked at four pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had six surveys returned from people who use the service four professionals and eleven staff. We raised concerns with the registered provider Mr Marsh and registered manager Mrs Marsh whilst we were at the home. The concerns were with manual handling training, recruitment, medication storage and care planning. Since our visit the manager has written to us regarding the action they have taken in the two weeks following our time at the home. They have outlined the work they have done and how they will ensure that the practice they have altered will become embedded in the way the home is managed and staff work. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must reflect all identified needs of individuals and there must be a record of what staff should do to support those needs. This includes care for wounds and pressure areas. Medication records must be kept reflecting the action staff have taken to meet instructions given by the GP to maintain peoples health. Recruitment checks must be in place before employment commences for example this will be either two references, POVA First check and the individual be supervised or full Care Homes for Older People Page 8 of 35 CRB check and all other recruitment checks. The registered persons must ensure that all staff are in receipt of all mandatory training and any other training which staff need to support people who live at Pinewood. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. Evidence: The AQAA for the home said: New residents are assessed fully by a qualified member of staff before admission to the home, they will have been supported by a family member or other trusted person, or care manger throughout this process, and any existing care plan will be obtained. Care is taken to ascertain an individuals wishes and future plans and form part of a full needs assessment. Management ensures good record keeping and that information is kept up to date in regard to new legislation and guidance. Residents are assumed to have full mental capacity unless assessed to the contrary, it is recognised that capacity fluctuates on a day to day basis and within different situations staff will always seek to assist residents to make decisions and not pre empt their actions or preferences. The staff team works to the strengths of Care Homes for Older People Page 11 of 35 Evidence: individual residents to assist them where possible to maintain skills and ability to rehabilitate where able to do so. We looked at four pre admission assessments for people who had moved to the home in the last ten months. We saw that there was information on individual needs based on their present and past medical history for example, communication and personal care. The assessment offered choices and space for individual issues to be written. For example needs assistance at present due to fracture but should improve and mobilise with frame. The assessment, alongside the care plan is reviewed after two weeks, when any alterations are made as needed to these two documents. We saw for example for eating and drinking that the initial assessment said encourage fluids, normal or soft diet, puree at times had been added at the two week period and the care plan altered accordingly. Visitors spoken to on the day said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. The surveys we received also indicated that people had been visited and or had come to the home to decide if Pinewood was for them. One quote from a survey said, As a family placing our mother in Pinewood was our first experience of adult care at a time when our mother was extremely vulnerable and we were very apprehensive. The reality was that the level of care and genuine kindness shown to her made that enormous transition as easy as possible for all concerned. Excellent communication support and care system in place to welcome and settle new residents into Pinewood. Care Homes for Older People Page 12 of 35 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. The care plans do not always have detail of the needs of the individual and support staff are to give. The medication records and administration within the home do not always show that this is carried out in a safe manner to protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that: All residents and the wider Pinewood community are respected valued and treated with consideration and politeness. The atmosphere is relaxed and friendly. Residents are assisted to retain inherent skills interests and beliefs within an open and inclusive ethos where the opportunity and encouragement to do so is built into daily life. Residents shopping is managed via care staff and birthdays of close family and friends are recorded if residents choose and they are reminded of them in order that they can choose to send presents or cards with the assistance of staff. Pre admission meetings assessments are well managed and very thorough. Care plans are continuously updated. Residents are encouraged to manage Care Homes for Older People Page 13 of 35 Evidence: their own health care where appropriate and they are able. Skin viability assessment is continuous and ongoing and appropriate intervention is applied such as ripple mattress or other pressure relieving equipment and recorded on residents care plan as are sores and sore areas and where appropriate external clinical input is engaged. Care plans reflect residents needs and wishes both long and short term via person centred holistic approach. We will engage physiotherapy services at the request of a resident or relative. We will assist with hospital and other appointments by prior agreement. Our cook is pro active with residents to ensure that any fancies and identified nutrition is made available without delay. Fruit bowls for example are within easy reach of residents if appropriate within their care plan. Good nutrition and hydration is a high priority and weight checks undertaken as indicated in care plan. We undertake risk assessments specific to falls prevention as part of our holistic care plan approach. GPs visit the home as indicated and residents are able to choose preferred doctors by mutual consent. The home has a policy for handling medication and the registered manager ensures this is maintained at all times. We have adopted the Liverpool Care Pathway for palliative care of the dying and include advance directives or less formal instructions as part of the pre admission assessment where possible, sensitivity drives the time and place where this is addressed and this can fluctuate according to privacy issues capacity issues and engagement of prospective resident. Decisions made by residents are recorded and acted upon. Residents are afforded absolute respect for their privacy and lifestyle choices, staff always knock on doors before entering and use preferred salutations and adhere to personal idiosyncrasies as far as they are able. The proprietors and manager have a high profile within the home reinforcing the family run ethos, pets visit the home with visitors and the homes cat mingles around to the pleasure of residents. We looked at care plans for five individuals living at the home and all documents associated with their care and support. The home has implemented the key worker system where named staff have responsibility for ensuring that the care plans are implemented and updated for a certain number of people. On the first plan we saw that there was information on family and social support. We saw that they had suffered a fracture before moving to the home. A physiotherapist had assessed them and had given the home advice on how to support the individual. For example not able to weight bear suggest try stand aid and if able to manage review. We saw that the care plan instructed staff to: have two carers and hoist to transfer, as fracture heals encourage to weight bear with Zimmer frame. When in bed use slide sheet to help alter position. This plan was updated in October as the individual had been able to stand and sit in chair. We saw assessments for risk, moving and handling, nutrition, and tools used to monitor the individuals pressure Care Homes for Older People Page 14 of 35 Evidence: areas and support needs such as Barthel and Waterlow. These documents had been reviewed monthly and as needed. We saw reference to personal preferences and how people like to express themselves for example: all staff to remember to put jewellery on as X likes wearing it. There were also assessments regarding nutrition and mental capacity. For the second care plan we saw that the individual had difficulty in expressing their needs although they could communicate. The plan said ensure all staff are aware and assist with assessment of needs and wishes. Although it was not clear how staff would do this, staff spoken with on the day said that they observed the individuals behaviour and listened to what they did say. We saw that the individual had a care plan related to pressure areas and skin tears with two areas identified on the 7th and 14th of September 2009. We could not see that this plan had been reviewed since that time. We saw that the plan told staff how to care for one area which was to apply cream and nurse side to side, for bed rest after lunch. When we looked at daily notes related to this individual we saw staff had recorded that they had noted other areas of concern. Daily notes indicated that staff were changing dressings but there were no care plans or treatment plans for these issues. There was a record that staff had noted blisters on 1st September but no record that anything was done until relatives noticed the same issue four days later. The individual also required care for catheter and stoma care and the plan indicated that staff had received training in this; we saw on staff files that staff had had training. We spoke to the manager Mrs Marsh about the pressure are care plans and she said that the nurses were due to update them. We highlighted that some of these issues had been noted in August and September 2009. On the third care plan we saw that needs had been identified with attention drawn to the fact that the individual has a potentially serious problem with swallowing and staff would have to do the Heimlich manoeuvre to remove any blockages. There was nothing on the care plan about this although when we asked the manager about this she said nurses were trained to do this procedure. For eating and drinking the care plan told staff that the individual was to have a soft diet only with foods to be cut up into bite size pieces, supervision as needed as tendency to choke, ensure food accessible. We noted that the individual has aids to enable them to communicate; a voice recorder, the care plan did not tell staff how to look after the machine and how to encourage the person to relax when they become frustrated at not being to speak quickly enough. We saw in the daily notes, two small pieces of paper with instructions Care Homes for Older People Page 15 of 35 Evidence: for staff on implants, remote control and batteries. On the fourth care plan we saw that the individual also had pressure areas with instructions for staff to redress areas three times a week Monday, Wednesday and Saturday. We saw that the there was only one note in the daily notes up to the date of our visit when the dressings according to the plan should have been changed twice. The care plan had no record of what staff had seen, or of there was any improvement. We saw that the individual had requested to administer and keep their own medication. We could not see that a risk assessment had been carried out. The manager said one had been done. We saw a note that said the GP had advised the individual not to self medicate. The last plan we saw, the individual had been diagnosed recently with dementia and was a diabetic. We noted that they had expressed a preference to only have female staff when they had personal care. We saw that records were kept of regular blood sugar checks. The care plan mentioned an alarm mat however we could not see that this was being used or why. We spoke to the manager about this and it was unclear if the mat was being used, or if the mental capacity assessment had been carried out. The daily notes had some post it notes on them related to personal care for the individuals, such as bedtime 8:00ish likes commode at night does not tend to wander. Bottle at night can become agitated. We spoke to the manger about these post it notes with reference to the care plans. Mrs Marsh has written to use following the inspection to say that all care plans have been reviewed and she is ensuring that staff continue to monitor and review them. One visitor we spoke to at the home, a community matron told us that; the management lead an excellent team of staff in providing a nursing home with excellent care. One individual who was offered care to stay at home, hospital admission or to move to Pinewood chose to move to the home. Other comments from people who use the service included: I feel that I am attended to well. A lovely atmosphere I feel special and loved for who I am. Pinewood makes the residents happy and comfortable. We looked at the medication storage and administration records MAR charts. We saw the medication records for 24th September to the day of the visit. In the office downstairs we saw a fridge on some filing cabinets. It was not a medical fridge and was not locked. There were no records of the fridge temperature. We saw that the Care Homes for Older People Page 16 of 35 Evidence: medication kept in there needed to be kept at a certain temperature. There were five boxes of one medication for an individual some dated May 2009 others August 2009 the staff had not recorded when they had started which box. There is one medication trolley. The manager said that medication for people who have their bedrooms upstairs is kept locked in a cupboard in the medical room. The trolley holds medication for people who have rooms downstairs. The home has methods and records for disposing of medication no longer needed. Two staff sign to say which medication and quantity to be destroyed and they are put into a yellow bucket for collection by waste management services. We saw that one individual was on Fentanyl patches we asked how staff disposed of these. There was no policy on safe disposal of the patches. The home has Temazepam, and Fentanyl patches stored as a controlled medication and these were kept locked in cupboard in the medical room. We looked at the Controlled Medication book and saw the total number of tablets written in the book matched the stock. One individual was prescribed Paracetamol to be used as prescribed this was also written on the box, we could find no information of when, how often or the amount of medication that should be given. The same individual is prescribed Tramadol 1 or 2 at night. The records showed a mixture of O, signatures and E refused and destroyed. There was no date on the box of when it was started and no record of the amount staff had given. We saw Lactulose for one individual give as prescribed, no information as what these instructions were. We saw records that indicated that staff had given 15mls or 20mls and there were two signatures with no amount. We saw that MAR chart records signature part had been photocopied and stuck over the top of the original record. It was not clear if the individual had received their medication or not as the records did not match the calendar dates. The individual was prescribed Alendronic acid once a week, the MAR sheet had a signature for 25.9.9 two tablets had been taken from the box which was dated by staff as opening on the 21.9.9. The copied MAR chart had then been altered by staff. We saw that medication that was prescribed to be given regularly, and was not as required had no signatures to say if given or not, for example Senna two 5mls at night. We saw that medication that was prescribed to be given as required for example Co codamol had been given regularly for some individuals four times a day. Lactulose that was prescribed to be given at night had been signed for as given in the morning. We saw that O had been recorded on the MAR charts this is not a code that is on the record to be used by staff and is not a staff signature. There were several examples where staff had not recorded how much medication they had given and why, where there was a variable dose available. Medication that had been prescribed to be given as required for Care Homes for Older People Page 17 of 35 Evidence: example Lorazepam if agitated had been given nine times between the 24.9.9 to the day of the visit with no outcome for the individual recorded. We saw that there was no record of whether creams and lotions that had been prescribed had been administered. We saw that staff could read guidelines and policies on medication administration, errors, household remedies, prescription terms, and generic abbreviations. Medication had been booked into the home and there was a record of the amount the home had received Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that: We listen to our residents wishes and try to meet them as far as we are able. Residents are able to live as structured or relaxed a lifestyle as they choose within the confines of their health; they choose which visitors they see or do not see and engage with activities as they choose. We give information clearly and accurately within our Service User Guide. We are situated in a small close knit community and a Friends of Pinewood group has evolved informally, local friends who visit daily for social interaction, most of whom are older people themselves and relate well with residents. We organise activities such as Easter, Christmas, Halloween, Valentines Day celebrations, as appropriate to all residents, barbeques in the summer and occasional parties around the year. Residents are encouraged to participate in whatever way they choose and some may wish to just watch. Meals are acknowledged as a source of enjoyment and are well presented even when liquefied and contain full nutrients for health and wellbeing and accord with preferences and Care Homes for Older People Page 19 of 35 Evidence: medical and religious requirements. The beautiful grounds are well maintained for residents enjoyment; we are lucky in the number and range of wildlife visiting the garden and this is a source of enjoyment for all. Many residents have bird tables outside their bedroom windows and enjoy replenishing feed and attracting wildlife some of which is quite tame. Pets are allowed by negotiation and visitors bring pets into the home frequently where they are allowed to wander in public areas if well behaved, residents tell us that they enjoy this. Children from Chidham Parochial Primary School visit occasionally and are always welcome; they usually perform songs and chat with residents. Residents are supported to visit the local public house a few yards from the home. Residents are supported to visit local churches or alternatively ministers visit Pinewood regularly for religious observance as requested by individual residents. Residents are supported by the management to travel as they wish, if this is not possible alternative transport services are accessed for them; wheelchair accessible if indicated. Residents and relatives can access external information via the leaflet rack in reception. We have a planned programme of activities. Residents follow their own chosen leisure activities or hobbies at will. Newspapers and magazines are delivered to order. Compilation of Life Books is chosen as an ongoing daily activity and aids recall. The Relatives and Residents meetings have gathered pace and are well managed, they provide an opportunity for discussion and planning of events and activities. The second Pinewood newsletter has been produced. People we spoke with told us about the newsletters and we saw examples of newsletters for the home on the notice board in the hallway. We saw that several people had magazines and newspapers some were offered by the home, for others their family bought papers in for them. We saw people using the patio area when their visitors came which afforded them a view of the grounds. Visitors told us they always feel welcome and that this is a home from home. Some of the activities we saw that occur weekly are exercises, games, film, music and movement, arts and crafts and communion. We noted that the home is relaxed at meal times with people choosing to have breakfast when they wished either in their room or in the dining area. One person had a late lunch as they had been busy in the morning and was running late. We saw that for lunch there was cowboy casserole made with sausages, tomatoes, onions and beans amongst other things. We had noted earlier that one person had food allergies with some of these items mentioned. We asked staff in the kitchen what this person had had and we were told that they had the same meal but made with alternatives. We saw that an alternative had been made for some people who wanted cheese and toast and cheese and biscuits. Although people liked the food one person told us that there was not a choice but an alternative could be made. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staffs knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said: The Service Users Guide explains how complaints can be made and how they will be dealt with under the homes complaints policy. The residents charter explains under Citizens Rights how complaints can be made and taken to the registering body is wished. Complaints will always be dealt with rigorously and actions fed back to complainant who would then decide upon further action or not. We will give information about advocacy services to support any complainant, or if they choose they can ask for a specific member of staff to support them and they are made aware of these options. Full records are maintained of any complaints made and actions arising. The residents voice process of meetings and individual questionnaires assist to bring concerns into the open before they fester into a formal complaint. Restraint is not used at Pinewood as our resident group is physically frail and not able to act aggressively in the accepted sense. There is a policy on restraint however should this be indicated, that explains how aggressive behaviour would be managed. This would be as a very reluctant last resort to prevent the resident from injuring themselves or others. Verbal aggression is possible where a resident may be upset or confused. Should this occur we will support staff to deal with such incidences and initiate partnership working with that particular resident if Care Homes for Older People Page 21 of 35 Evidence: considered appropriate. We will undertake to work with GPs and family members to address such sensitive issues and seek a root cause whilst supporting staff fully. A senior staff member has attended training on the Sussex Safeguarding Adults Procedures in order to provide cascade update training. This will empower them to recognise abuse in all its many forms. The homes policies and procedures are up to date including Whistle blowing. We saw that the home has a complaints procedure, which was outlined in the Statement of Purpose and Service User Guide and on display on a notice board above the visitors signing in book. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. We saw that the manager had purchased information relating to Mental Capacity Act and guidance on Deprivation of Liberty. We noted that the home uses an advocate to facilitate the residents meetings where they are enabled to speak about concerns that they may have. Surveys we received from people who use the service all stated that they knew who to complain to. Professionals who returned surveys said that they know who to speak to if they were concerned and one said all residents carers and families have multiple roots to engage with the home management either directly or anonymously. The views are heard, responded to and acted upon. Care Homes for Older People Page 22 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a living environment which is homely and continues to have ongoing redecoration and refurbishment to improve it. Evidence: The AQAA for the home said: The home has undergone a complete refurbishment. We included our residents and families in the planning of the new environment and colour schemes reflect the consensus. The Residents and relatives forum were asked to contribute ideas to the internal arrangement of the public areas. The home is kept clean and fresh at all times. Residents are free to choose how they use the home and are supported to do so. We continue to maintain all furnishings, fittings and equipment on a rolling basis that is strictly recorded, thus each item is maintained and checked at regular intervals. We continue to rigorously apply infection control protocols and staff are trained internally against required standards. They are supported by full appropriate range of barrier nursing materials. These measures have prevented any cross infection from occurring and all staff are aware that vigilance and good practice is crucial. Pre admission assessments will identify where infections are present before a resident enters the home and the assessor will act accordingly. The home continues to train staff regularly via local Fire Service information and guidance and adhere to all of their instructions. The home has a fire prevention policy that all are made aware of. Toilet and bathing facilities are in accordance with NMS and we ensure that all areas have required aids to mobility as indicated by resident need and Care Homes for Older People Page 23 of 35 Evidence: falls prevention is considered in respect of furniture placing and thresholds, planned new furnishings incorporate safety elements. Sight impaired individuals will be assisted via aids. We provide comfortable well appointed rooms for residents the majority for single occupancy they all have access to private bathing facilities with associated mobility aids and individual effective heating controls in most rooms. All laundry is managed in accordance with NMS. The area outside of the building is a big draw for many residents with lovely well maintained gardens and views to the Solent on clear days. The conservatory and large windows and patio doors bring even more light into the building and have increase seating areas. Pinewood is situated in its own large, well kept grounds. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. We saw that equipment was available for use where needs indicated that with ceiling hoists and specialist nursing beds. Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The home is checked as the regulations indicate to ensure that the machinery, electrics, plumbing for example are all in a safe working order to avoid any risk to them or the staff that use them. Individuals commented to us that they were happy with their accommodation. They liked the lounges and dining areas where they could sit with others and chat, watch television, read or listen to music or just be quiet. They like the new conservatory area and outside seating where they can look over the surrounding countryside. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices at the home help to protect the people who use the service. Whilst staff have received training to help them meet specific needs they have not received all the mandatory training that is expected each year, which may leave both people who use the service and staff at risk. Evidence: The AQAA for the home said: We have increased our staff team. We continue to display our staff rota in the staff room clearly indicating those on duty and line manager. Staff are supervised regularly and records maintained. Our staff work within an atmosphere of openness and co operation. We continue to encourage by example and via supervision, person centred holistic care where staff support residents to take risks and choose their lifestyle mode where possible for them. Staff are inducted fully and engage in their own negotiated training programmes, this is ongoing. Our recruitment process continues to be fully inclusive and we conduct this in a fair and open way, we ensure that all references are received and checked and a Criminal Records Disclosure is obtained prior to employee commencing work. All staff receive their job description with their contract of employment. We continue to discuss staff members needs at staff meetings and supervisions and appraisals and encourage professional development. Over 50 of the workforce have NVQ2 or above qualification and sundry certificates as indicated such as West Sussex Adult Protection Procedures. We have a continuous process of internal staff training inc Oral hygiene, Care Homes for Older People Page 25 of 35 Evidence: and moving and handling. At the time of the visit there were twenty eight people living at the home, on the day of the visit the twenty ninth person was admitted and there was one person at the home on respite. The staffing structure at the home consists of the registered providers Mr and Mrs Marsh who is also the registered manager, nursing staff, care staff, kitchen staff, and housekeeping. There are three night staff one nurse and two carers. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. We sampled four staff files for people have been employed to work at the home recently and we saw that there were two references, there was evidence that a CRB had been received or applied for and that a POVA First check had been carried out for three of those seen. With the exception of one POVA First check, the documents were dated before the employee commenced work at the home. We saw that the individuals had commenced an induction process. Not all files had current photographs of staff on them; we saw photo copies of passports. Supervised placements take place before the employee has begun work, and after recruitment checks have been returned. All staff information is kept at the home in locked drawer in the managers office. We saw the training plan for staff for the years 2009 to 2010, we could see what staff had done and what was planned. Staff have undertaken medication administration training, food hygiene, fire safety, first aid, infection control and dementia awareness. We saw that training was planned for October 2009 in infection control, Parkinsons, dental hygiene and fire training was being offered on four dates in the month. The administrator is the trained trainer for moving and handling. We looked at training for the four new staff members whose recruitment files we had seen. We saw that one had had moving and handling training in May 2009. The other three had not. Two staff had come to the home from an agency in April and July 2009, we asked about their moving and handling training and were told that they had certificates from their previous employer however there was no evidence that these certificates had been seen or if the training they had received was appropriate to the needs and equipment of Pinewood. We asked to look at other training records and noted that six people had last received training in moving and handling in August 2008. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack with questionnaires on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as Care Homes for Older People Page 26 of 35 Evidence: completing the induction. Mrs Marsh has written to us since our visit and assured us that the staff have now received training or have been updated in moving and handling and that they have reviewed their policy on recruitment and checks. In the eleven surveys returned by staff when we asked do the ways you share information about the people you support or care for work well? Ten responded usually and one sometimes. For the question are there enough staff to meet the individual needs of all people who use the service? One responded never, one always, one sometimes and seven usually. For the question do you feel you have enough support, experience and knowledge to meet the different needs of people who live at the home staff responded with: five always and six usually. Comments from staff included: What could make the home better? More one to one communication to see how I am getting on. Better communication so we can all work as a team. Instead of running the home to minimum legal requirements of staff a few more extra pairs of hands to help with workload wouldnt go amiss. Although Pinewood is a family run concern we are one large family, we should have more staff some of the time. Pinewood is a very caring home. Following the home receiving a copy of the draft report Mr and Mrs Marsh have written to us to state that they have engaged an independent advocate to work with them and the staff to address any issues that staff have and to enhance the management and subsequently the service of Pinewood. Care Homes for Older People Page 27 of 35 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. People living at the home are not always safeguarded in the areas of care planning, medication, recruitment and staff training because monitoring by management and staff do not always mean that these areas are kept up to dates. Evidence: The AQAA for the home said: The manager and proprietor has over 22 years management experience in a care setting and has attained NVQ level 4 in management and care. We maintain a structure of line management that is clear and well understood by all staff who understand how to use the line manger in respect of day to day activities and also difficulties arising from possible suspicions of abuse or conflict of interest when confidences made by residents may have a negative health implication etc. All staff continue to have supervision sessions at least at 6 times yearly with appraisals 1 yearly both of which cover all aspects of care, philosophy of home and training needs. Office record keeping procedures continue to be maintained to ensure that actions are accountable and updated. All records are kept for 3 years minimum post last entry, in a secure cabinet. Pinewoods policies and procedures are Care Homes for Older People Page 28 of 35 Evidence: updated and maintained on a yearly basis or more frequently should issues be identified. We have established an internal quality assurance system to will inform our annual audit of services and development plan; based on planning, action, review cycle, part of which are regular forum meeting findings and annual satisfaction questionnaire findings. Where residents choose not to handle their own finances either by choice or lack of capacity and have no relatives willing to do so we continue to work with social services staff to identify appropriate lines of support either via corporate appointeeship, family solicitor or voluntary sector organisations. We continue to signpost relatives to appropriate sources of support should lasting powers of attorney be appropriate for example Age Concern, or with social services assistance engage a solicitor to act for resident. We continue to assist residents with day to day management of personal spending in respect of shopping etc via the home proprietor and also storage of valuables or cheque books if wished and full records of any such transactions are maintained. Following the inspection visit the manager Mrs Marsh has written to us to tell has what action the home has taken since the visit regarding feedback we gave. Mrs Marsh has told us that the care plans have been updated, Medication records are now being kept, a medical fridge has been ordered, training in moving and handling has been updated, a system for monitoring training is in place. There registered manager for the home is Mrs Deryl Marsh who is a registered nurse and has achieved the NVQ 4 in care and management. She works at the home as both manager and sometimes nurse in charge. Several staff began their NVQ at Chichester in September 2009 and this means that Mrs Marsh works as the nurse on Mondays. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. The statement of purpose has been updated to reflect the changes made at the home in the fabric and extension to the building. We saw that there have been staff and resident meetings. The residents commented on food and activities. We also saw in the AQAA that people who live at the home, professionals and relatives have completed surveys about the service provided at Pinewood. The registered person told us that they manage personal monies for one person living at the home. The commission was informed in the AQAA that the servicing of all utilities and Care Homes for Older People Page 29 of 35 Evidence: equipment used in the home has taken place. The fire service carried out a full building check, training and safety records check following the completion of the extension, in September 2009. We saw the policies available to staff and that new ones have been introduced or updated as necessary for example training and medication. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment has been tested regularly and that staff have received training every six months. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15 Sch 3 (1)(b) Residents must have clear individual care plans describing the support that staff give to meet identified needs. For people to be assured that there is information for staff to support their needs. 23/11/2009 2 8 15 15 Sch 3 (3)(m) People who use the service must have care plans detailing the needs and action for staff to take with regard to pressure areas, skin tears and blistering. For people to be assured that there is information for staff to support their needs. 23/11/2009 3 9 13 13(2) The registered person must ensure that the fridge meets medication standards and that records of the temperature are kept. 23/11/2009 Care Homes for Older People Page 32 of 35 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 For safety and meeting guidelines. 4 9 13 13(2) The registered person must ensure that a record is kept of the amount of medication that is given where there is a variable dosage and why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 5 9 13 13 (2) 23/11/2009 The registered person must ensure that lotions and creams are administered at the times and in the amount that it has been prescribed, and that a record is kept. This will ensure that the individual receives the correct medication and helps to monitor their health. 6 29 19 19 Sch2(7) The registered person must ensure that appropriate recruitment checks are undertaken before a person commences work at the home. 23/11/2009 23/11/2009 Care Homes for Older People Page 33 of 35 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 To ensure that people who use the service are protected. 7 38 23 23 (4)(d) The registered person must ensure that moving and handling training is in place for new staff and undertaken regularly by all staff. To ensure that the people who use the service and staff are protected. 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 23/11/2009 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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