Care Home: The Pines

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What the care home does well Information provided to residents and service users was helpful, clear and suitable for their needs (with pictures and easy to read writing). To provide a stable, settled home for its long term residents, the home restricted the number of people who used its respite places (with new respite referrals no longer accepted). Residents liked living at the home. One resident said "I am happy living at the Pines...I have many friends...I like some staff". Staff treated residents with respect and kindness, and helped them lead ordinary lives. Residents liked the food, with excellent meals provided. The home was clean, safe and comfortable. The staff team did not change very often, so residents, service users and staff got to know each other very well. Staff were properly recruited, were well trained and were well supported by the management team. One staff member said they were "impressed with back up from management". What has improved since the last inspection? To help keep each resident fit and well, new and very detailed records about their health had been started. More helpful information had been provided for residents and service users, with new pictorial menus. To make sure any complaints were listened to and sorted out, a new recording system had been started. To improve the entrance, `tarmac` had been laid and flowers and plants provided. The `flats` had been redecorated and refurbished. Staff meetings had been reorganised to encourage more people to come. There had been a staff day to look at ways of improving the service. CARE HOME ADULTS 18-65 The Pines The Pines Hostel Mayfield Road Orrell Wigan Lancashire WN5 0HZ Lead Inspector Sarah Tomlinson Unannounced Inspection 30th April 2008 09:30 The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Pines Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Pines Hostel Mayfield Road Orrell Wigan Lancashire WN5 0HZ 01942 760015 01942 621320 d.litherland@wiganmbc.gov.uk Wigan Council Social Services Department Mrs Ellen Prescott Care Home 29 Category(ies) of Learning disability (29), Learning disability over registration, with number 65 years of age (6) of places The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Within the maximum numbers registered there can be up to 29 LD and up to 6 LD(E) The service should at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Staffing levels are to be calculated in accordance with a Residential Forum Staffing Guidance (Older People) by 1 April 2004. The matters detailed in the attached schedule of requirements must be completed within the stated timescales. 6th June 2006 Date of last inspection Brief Description of the Service: The Pines is owned by Wigan Council and is run by their Social Services department. It is registered with us (the commission) to provide care for up to 29 people who have a learning disability. There are 24 long term (permanent) places, 4 short term (respite) places and 1 emergency place. The home is purpose built, on 2 floors, although there is no lift. There are 29 single bedrooms; 18 have wash hand basins, 11 do not (no en-suites are available). There is a large dining room with a small adjoining lounge area, another separate lounge, plus two further lounges (one on each floor). Open, lawned areas surround the building, with a patio area to rear. There is private car park, which is shared with the adjacent day centre (also run by Wigan Social Services). The Pines is in the Orrell area of Wigan. Local shops and bus stop are within close walking distance. The home is in the middle of a small housing estate. Neither the Pines nor the day centre blend in with nearby housing and are very noticeable. Current fees for respite care range from £7.67 to £18.37 a night. Fees for long term care range from £51.88 to £98.60 a week (hairdressing, dry cleaning and toiletries are extra). The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit, which the home was not told about beforehand, lasted just over 8 hours. We looked around parts of the building and spent time watching how staff supported residents. We talked to several residents, a relative and also to staff (carers, senior carers, assistant managers, the chef and the manager). We also looked at some paperwork. Before the inspection, we sent surveys to people who live, visit and work in the home. Five residents, 4 staff members and 1 relative returned them. Their views are included in this report. We have also used information from a form called an Annual Quality Assurance Assessment (AQAA). The home has to complete this each year, telling us what they do well and what they would like to do better. What the service does well: Information provided to residents and service users was helpful, clear and suitable for their needs (with pictures and easy to read writing). To provide a stable, settled home for its long term residents, the home restricted the number of people who used its respite places (with new respite referrals no longer accepted). Residents liked living at the home. One resident said “I am happy living at the Pines…I have many friends...I like some staff”. Staff treated residents with respect and kindness, and helped them lead ordinary lives. Residents liked the food, with excellent meals provided. The home was clean, safe and comfortable. The staff team did not change very often, so residents, service users and staff got to know each other very well. Staff were properly recruited, were well trained and were well supported by the management team. One staff member said they were “impressed with back up from management”. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a consistent and stable home environment, where residents’ care and support needs were being met. The service review will hopefully address the difficulties brought about by the age range of residents and by the building design. EVIDENCE: We looked at information provided to long term residents and respite service users about the home – the Service User’s Guide (brochure). Good practice was noted, as it was in a format suitable for people with learning disabilities, with pictures and photographs, and easy to read, large print text. We advised additional information was needed about the likely cost of the service (prior to somebody moving in for long term care or them staying for respite care), e.g. the lowest to the highest fees, with details of what is (and what is not) covered. Once a person had moved in, files showed they received a service agreement that included how much their individual fee was. Good practice was noted, as the service agreement was also in an easy to read, pictorial format. However, personalised fee information was only on file for long term residents. The The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 9 home needed to confirm respite service users and their families also received clear, personalised and easy to understand fee information. The main purpose of the home was to provide long term care. Although planned, long term care referrals were no longer being made. Referrals were only made to the emergency place. However, over the past five years several new long term residents had moved in. These residents had initially been admitted as an emergency, but then stayed (with their bed status changing from ‘emergency’ to ‘permanent’). Several others who had been admitted had moved on to live more independently. Due to the absence of any planned, long term admissions, the comprehensive ‘getting to know you’ process provided to new residents had not been used. This process provided a gradual, very personalised introduction, whereby the prospective resident and their family and the home staff get to know each other (with visits to the family home, as well as to the Pines and any day centre attended). People referred to the emergency place were usually known to the home, with comprehensive assessment information being available (the current service user had used another of Wigan Social Services respite services prior to their admission). Two staff raised concerns that at times there was a lack of information about people referred in an emergency. We discussed this with the manager. With regard to the respite service provided, to minimise the disruption to long term residents, new referrals for respite care were no longer taken. Consequently, a specific group of 14 people used this service. These service users usually stayed a regular night each week (plus weekends and holidays). There were respite service users staying usually every night (although at the request of long term residents, no respite service users stayed over Christmas and new year). We discussed the wide age range of residents (from 19 to 75 years of age), and the home’s registration with us to admit up to six new service users over the age of 65 years. The manager recognised compatibility was an issue, as residents’ needs and lifestyles differed greatly. Plus, the limitations of the building in meeting the needs of older people (and younger adults with physical disabilities). Responsibility for ensuring the needs (including specialist needs) of any person admitted could be met lay with the Pines. We were informed Wigan Social Services had just started a three year programme to look at the future of the home. (With regard to existing older residents who have reached or passed the upper age limit of 65 years of age, we confirmed they could continue to live at the Pines as long as their needs could be met. No formal variation or additional registration category was needed for this group of residents). The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care records were generally completed to an excellent standard, with the needs of residents and service users being clearly understood and met. EVIDENCE: We looked at four care files. Good practice was noted, as there was an extensive amount of personalised and very detailed information about residents’ personal and social support needs. This included daily routines and how they liked their care to be provided, plus likes/dislikes and aspirations. Records included ‘help notes’ for staff use; pictorial/easy to read six-monthly reviews; and communication diaries (which helped staff interpret the behaviour and gestures of non-verbal residents). A new, one-page profile had also recently been introduced. As a quick reference guide, these were in a helpful, clear and positive format, reflecting the strengths and personality of the resident. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 11 Each long term resident was allocated a link worker. Good practice was noted, as their role included the expectation of regular weekly 1 to 1 time with ‘their’ resident. Plus where possible, the provision of any necessary intimate personal care (to maintain dignity and lessen embarrassment). The staff we spoke to were very knowledgeable about residents’ support needs. Risk assessment were in place and were being regularly reviewed. However, some of these would benefit from more detail (e.g. about possible triggers for physical aggression and how a person self-harmed and what with). A record of ‘inappropriate’ behaviour was also now kept. We advised how these two documents fitted together should be looked at - as the latter were not yet being formally reviewed, with information from them not being fed back into risk assessments. At times, information was difficult to find in care files (which were very large). We advised they would benefit from old information being archived, leaving a ‘working file’ for day to day use. We also discussed the frequency of diary entries, as staff did not write in them on a daily basis. We advised this should be reviewed, particularly for service users staying for respite (so at least one entry was made for each stay, regarding their health, wellbeing and the care provided). In view of the recently introduced Mental Capacity Act (2005), we discussed ways staff could demonstrate how they supported residents to make decisions (e.g. by what they write in diary sheets). The manager and assistant managers had received training about the new Act. We suggested they could provide informal training sessions to care staff (whilst awaiting formal training to be organised by Wigan Social Services). The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and service users were supported to take part in ordinary and meaningful activities both outside and in the home, which reflected their choices and capabilities. Excellent meals were provided. EVIDENCE: Due the size of the home, participation in ordinary domestic routines was limited – the large number of residents meant a professional catering team staffed the industrial sized kitchen; a team of domestics took responsibility for cleaning; and care staff took the lead in working the industrial sized washing machines. However, there was a domestic style kitchen that residents could be supported to use. Several people who had been admitted to the home via the emergency place had moved on to more independent living. A current resident was in this position. However, whilst their latest review notes identified this, there were no details about how it was to be achieved. Whilst The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 13 separate community staff were taking the lead in preparing for this move, we advised Pines staff still needed guidance about how they were to support the work being done. Several older residents (of retirement age) preferred to lead more unstructured lives, spending most of their day at the home. However, the majority of residents and service users led busy lives, attending a range of educational, therapeutic and social activities. Consequently, staffing levels were low during weekdays, increasing considerably from late afternoon and at weekends to support residents and service users as they returned home. Good practice was noted, as the home was taking a lead role in an initiative to support residents to actively engage and participate in local communities (with a view to obtaining part-time paid work). For example, one resident volunteered at a local hairdressers one morning a week. Currently supported by staff from the Pines, the aim was for them to gradually withdraw. Another resident helped run an art class at a local community centre, whilst another helped at a local church coffee morning. Another resident volunteered at a local charity shop one day a week. Residents and service users were supported to take part in ordinary leisure activities outside the home at weekends and evenings (e.g. visiting the local pub, shopping, going out for a walk, to church or to the cinema). Holidays were dependant on residents’ individual finances, as no budget was available to cover staff costs (residents had to pay for staff accommodation and expenses). Three residents were about to go to Blackpool for a short break, whilst one resident was travelling down to London in the summer to see a show. Two older residents enjoyed weekends away together, whilst day trips were organised for others during the summer. These trips were on a small scale, with several residents and staff visiting local destinations (e.g. Southport). Good practice was noted, as strong links were maintained with families. One relative commented they felt welcomed and very included by the home. With regard to daily routines, we discussed access to residents’ and service users’ bedrooms. Although several residents kept their bedrooms locked, the domestic routines in the home (influenced in part by the size of the building and resident numbers) meant staff regularly accessed residents’ rooms during the day (e.g. domestic staff on a daily basis to clean the rooms, care staff to make residents’ beds). Although some residents’ personal hygiene needs and disabilities dictated such support, we advised the general assumption should be, as private bedrooms, access (from any of the home’s staff) occurred with the resident present. Staff could support residents to take more responsibility for their own rooms, with rooms only being cleaned with residents’ participation (even though staff may take the lead). Beds could be made later in the day (with staff support), or left unmade. We discussed whether The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 14 domestic staff could provide a more housekeeping role, retaining responsibility for communal areas but supporting residents (with care staff) to keep their own rooms clean and tidy. As noted above, a staffed, industrial kitchen provided residents meals. The catering staff prepared breakfasts, weekday evening meals and weekend meals, whilst care staff provided weekday lunches for the few residents who were at home. We were impressed with the excellent choice and variety of the meals, which were nutritious, well balanced and mostly homemade. A two week rolling menu was used, with three or four choices available at every meal (e.g. kebabs, Thai green curry, salmon parcels, meatballs, taglietelli, Mexican wraps, steak, with a healthy option of salad and jacket potatoes always available). Further good practice was noted, with new pictorial menus. These were specific to each meal and displayed on each table. Residents commented positively about the food in our surveys and in the home’s six monthly reviews. The two chefs were very enthusiastic and motivated - encouraging residents to try new and sometimes unfamiliar dishes, and to eat healthier (puddings were not provided during the week as most residents and service users ate a full meal at day centres etc). Most food, which used to be ordered in bulk through Social Services, was now bought from Asda, enabling more choice and flexibility. Residents and staff used to go and carry out this shop together, but the large amount of food required made this difficult. The Asda shop was now done via the internet. However, residents continued to be involved where possible, recently visiting a local butcher to buy and try out new meat dishes. Good practice was noted, as staff were expected to eat with residents. For those residents and service users who required support to eat, we observed staff providing this in a discreet and sensitive manner. Various dietary needs were catered for, with soft and pureed food provided. Good practice was noted, as pureed foods were presented separately (to maintain texture, appearance and taste). The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support needs of residents and service users were well met, promoting good health and responsive, person centred care. EVIDENCE: Relationships between staff and residents seemed warm, friendly, caring and respectful. Staff treated residents with courtesy and supported them to make choices. The feedback we received from residents’ surveys and from talking with residents was very positive about the home. One resident said “I am happy living at the Pines…I have many friends...I like some staff”. Good practice was noted, as ‘health action plans’ had recently been completed for all long term residents. These contained comprehensive and very detailed information about each resident’s health. Accompanying records had been introduced to track and identify when appointments and check ups were due, and to record their outcome. Accidents records were being completed appropriately. We reminded the manager we must be formally notified of all The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 16 accidents or incidents where a resident or service user visited A&E (even if they were not admitted and returned to the home). Staff had a good understanding of medication procedures. Medicines were stored safely (in a locked cabinet in a locked room), although a better cabinet lock and a vertical blind (as the window was adjacent to the entrance) would improve this. Also, following a change in the law, the Pines must now have a controlled drugs cupboard. Clear records were kept regarding medicines leaving the home - a carbonated returns book for those returned to the pharmacist and ‘booking out’ forms to list medicines sent out with a resident (e.g. to a day centre, with the full blister pack sent to avoid secondary dispensing). With regard to medicines entering the home, clear records were kept. However, it would be more efficient to use the space on the pre-printed administration records (MARs) for this purpose, rather than handwritten sheets. Regarding respite service users’ medicines entering the home, there was duplication, with a record made on the MARs and on a separate booking in form. MARs were well kept and included photographs and a staff signature and initial list. Handwritten MARs were used for respite service users’ medication. However, these were not being checked and countersigned. The form was also unhelpful, as it was not designed for frequent respite stays (it was difficult to track information, which increased the potential for error). With regard to emergency admissions, we advised written confirmation of medication should be requested from the GP, on or before admission (via a fax). No residents were currently looking after their own medication. We discussed how medicines were actually administered. Most were prescribed for the morning. These were taken on an individual basis from the medicines room, along the corridor and into the dining room (as each resident or service user got up). This was very time consuming. Whilst a mobile drugs trolley might be inappropriate, a domestic style, lockable cupboard in the dining room, or a locked box should be considered. This would provide temporary storage of medicines during each medication round. We also discussed Social Service’s guidance that required a daily stock check of every medicine. Both the inspector and the pharmacy inspector (who was consulted after the inspection) felt this was unnecessary and a waste of staff time. Whilst an audit of medicines should be carried out on a regular (e.g. monthly) basis, daily was unnecessary where there were no formal concerns. With regard to the death of a resident, good practice was noted, as staff had recently supported an older resident to die at the home (rather than be hospitalised). The home had worked closely with external professionals and specialists for advice and practical support. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for protecting residents and service users from abuse or harm and for taking any concerns seriously were in place. Improvements in the recording of complaints should further strengthen this system. EVIDENCE: There was an open culture in the home, where residents and service users were encouraged and supported to express their views and opinions (e.g. individually at their six monthly reviews and collectively at consumer meetings). Surveys showed residents knew what to do if they were unhappy or if they had any concerns or wished to complain. Good practice was noted, as the complaints procedure was provided in an easy read format. However, whilst in the Service User’s Guide, it was not displayed around the home. Whilst the home had a very positive approach of deliberately keeping notices and signs outside the office to a minimum (to promote a more homely atmosphere), we advised one covered notice board could be provided in the dining room (where it would be seen by all residents and service users). This could be for residents’ and service users’ use only, e.g. displaying the complaints procedure, minutes and agendas for the consumer meetings (minutes for these were currently kept in the office), plus local events. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 18 In response from feedback from us, a new system of recording complaints had just been introduced. The aim was to improve the initial recording and reporting process (including the need to report all serious issues to us), plus the subsequent monitoring. All complaints, both minor, informal issues and major, formal concerns were to be logged. We had not received any complaints about the service. Two complaints had been made to the home, one was not upheld and the second concerned day centre staff. Two compliments had also been received from families. With regard to abuse awareness, good practice was noted, as all staff that worked in the home (including domestic and catering staff) received training in this area. Money kept on residents’ and service users’ behalf was stored safely and securely, with appropriate records kept. We checked three balances at random and found them to be correct. Money transferred from bank accounts could be clearly tracked and accounted for. The maximum amount of cash that could be held by the home had been confirmed with their insurance company. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the Pines was clean, comfortable and safe, it was unable to provide a non-institutional, small group living environment. EVIDENCE: The Pines was comfortable and pleasant, with an acceptable standard of furniture and fittings. There was a large dining room with an adjoining lounge area, a separate, second lounge and two further smaller lounges in the ‘flats’. The ‘flats’ (one on the ground and one on the first floor) had once been separate living quarters for staff, but were now fully integrated in the home. Each had three bedrooms, an unassisted bathroom and a domestic size kitchen and lounge. Both of these lounges had just been refurbished. The lounge walls were waiting for paintings commissioned from residents (and were being done with day services support). Appliances were due to be removed from the first floor kitchen, for it be converted into a storeroom (storage space was very The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 20 limited, particularly for residents and service users’ suitcases). Other recent work in the home, included improvements to the entrance, with tarmac replacing uneven paving and staff and residents providing attractive, flower filled tubs. The bedrooms of long term residents were personalised and well decorated. There was however, an inherent conflict between the overall design and lay out of the building - with all 29 residents and service users sharing the same staff group, dining room and lounges (with an industrial kitchen and laundry) and good practice of small, family-scale, group living. The size of the building also meant it was not discreet and was easily identifiable as a care home. The entrance was also adjacent to the main lounge, creating frequent noise and disturbance and detracted from residents’ privacy. The building was not designed for wheelchair users either. Although level access was provided, there was no lift. Consequently, all of the building was not accessible (with demand on the 12 ground floor bedrooms from an older resident population and wheelchair users). Some bedroom sizes were also inadequate, with not enough useable floor space. Wash hand basins had had to be removed from some bedrooms to allow for wheelchairs, overhead tracking and mobile hoists (only 18 rooms had wash hand basins and none had en-suite facilities). The free movement of wheelchairs was also restricted with narrow doorways and few doors automatically held open. Although assisted bathrooms were provided (with overhead tracking), the building did not have lowered light switches or raised sockets. We identified several maintenance issues - the standard of décor and furniture in communal rooms could be improved; bathrooms were stark and clinical in appearance; and the small internal courtyard (adjoining the dining room and lounge area) was in an unattractive and unusable state. Opposite room 52, the light switch pulls needed replacing in the bathroom and toilet, and the bath panel needed replacing or repainting. We were told funding had been agreed (for this financial year) for the refurbishment of the second lounge (the settees and carpet were looking tired and worn); re-decoration of the ground floor corridors, including new flooring (the carpets were worn and stained); and new dining furniture (varnish had worn off the tables). The minor repairs to the bathroom had been reported and were waiting to be fixed. We found the home was clean and tidy and smelt fresh. Residents’ surveys confirmed this was usual. We did note some malodour in both stairwells (plus two small areas of plaster coming away). Neither had a window to let in fresh air. To remedy this we found a fire door had been opened in one stairwell. However, we were concerned about the security risk (as this exit opened onto a secluded part of the grounds and was not easily observed from inside). Liquid soap and paper towels were provided throughout. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and service users benefited from a rigorously recruited, well trained, well supported, enthusiastic and knowledgeable staff team. Better training records and clear expectations of core training needs would support and enhance this. EVIDENCE: On the day of the inspection enough staff were on duty to meet the needs of residents and service users. Good practice was noted, as there was a stable staff team, which changed very little. Shift patterns and staffing levels reflected the needs and activities of residents and service users. As most were out during weekdays, staffing levels dropped from six carers (between 7.30/8am and 11.30am) to two carers over lunchtime and early afternoon, returning to a minimum of eight carers from 3pm to 10pm. There were three waking night staff (between 10pm and 8am). Good practice was noted, as senior carers received a paid, 15-minute handover period at night (and also had a half an hour crossover period with night staff in the morning). Due to their complex needs, two respite service users required 1 to 1 support, with The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 22 extra staff provided when they stayed at the home. Additional commissioned staffing hours were also agreed for two long term residents (these were provided by separate community staff). There were vacancies for two part-time night staff (with these hours currently worked by existing staff). The manager and three assistant managers worked Monday to Friday, with a member of the management team on duty between 8am and 5pm. On call cover was presently just provided by the manager. The assistant managers had been part of this rota, but proposed changes had raised concerns that were currently being considered. Staff recruitment records were held centrally at Wigan Social Services’ head office. A sample of these was looked at during a visit by two of our inspectors in June 2007. Information seen included a completed application with full employment history, two written references, health information, contracts and criminal record checks. These details had been gathered prior to new staff commencing their employment, ensuring residents and service users were protected. NVQ training was excellent. All staff had completed an award – two assistant managers had NVQ level 4, one assistant manager had NVQ level 3 (and was about to start level 4), all senior care staff had NVQ level 3 and all day and night care staff had the level 2 award. We looked at training records for four staff. Although individual records were in place, these were not up to date and did not contain sufficient information. This was needed to monitor staff training needs – ensuring all staff met mandatory and any additional service specific training requirements, to monitor professional development and to also evidence that each staff member received at least five paid training and development days (pro rata) per year (including documenting any local, on site training, e.g. as provided by the complex needs team). Shortly after the inspection, the manager provided additional information that confirmed staff had received annual moving and handling refresher training. This was currently provided off site. However, we advised that due to the building design, small bedroom sizes and the complex needs of some service users and residents, this training should be provided on site. We also discussed the need for annual fire safety training. The manager responded promptly, arranging shortly after the inspection, for four fire awareness training sessions to be provided on site (in June 2008). (The manager also subsequently received advice from the fire safety officer that if staff participated in a formal fire drill each year, a formal refresher course was not required). The need to be clear what training was required for staff working at the Pines was discussed (and to show this had been undertaken and maintained), The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 23 particularly with an older resident group and for those with more complex needs. For example, not all staff had attended physical intervention and challenging behaviour courses. We discussed induction training. Good practice was noted as new starters attended a Social Services induction, followed by a two week shadowing period at the home (which included group supervision with the manager). However, we were concerned the shadowing was too informal. With a resident and service user group that included people with complex needs and communication difficulties, we advised a structured, formal framework was needed. For example, a proforma could be developed to guide the new starter and the staff they are shadowing (who are of sufficient seniority and competence). This could list the tasks and skills the new starter needs to observe and then demonstrate before they can be judged and signed off as competent (e.g. bathing, eating, getting up/going to bed routines, accompanying residents and service users out in the community). This process should take place over time, with new staff not working alone until they felt confident and were judged competent to do so. There were three staff teams, with an assistant manager supporting each. Full staff meetings, combining all three teams had been held. However, as attendance was poor, the assistant mangers were now to chair their own, smaller team meetings, with full staff meetings being held quarterly. With regard to formal, individual supervision, sessions took place on regular basis. Good practice was noted, as both the supervisor and the supervisee signed the meeting record, with a formal note showing the latter was offered a copy. Staff also received an annual appraisal. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, service users and staff benefited from an excellently managed home. EVIDENCE: The registered manager, Ellen Prescott, had been in post for five years. Mrs Prescott has the management and care qualifications, knowledge and experience to run the home. She was effective and highly competent, ensuring staff followed policies and procedures, whilst also providing them with support and guidance. Over the past year, Mrs Prescott had been overseeing two other Social Services residential services. This had taken her away from the Pines for approximately 15 hours per week. Staff and ourselves were The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 25 pleased to note this had now ended, with Mrs Prescott being based back at the Pines full time. Good practice was noted as the management team created a warm, open and inclusive atmosphere. The views of staff were sought and listened to, e.g. to further improve morale and motivation, a staff development day had recently been held. Each staff team had met to explore common issues, plus those identified by individual teams. A range of ideas and suggestions had come from this, including reorganizing staff support at meal times. A follow up day was being planned. Staff commented positively about the management team, one care worker said they were “impressed with back up from management”. Another staff member said “my manager has always been very supportive since I started and is very approachable”. In addition to feedback sought from staff, residents’ and service users’ views were sought at consumers meetings and at their individual six month reviews. We advised the views from families (of both respite service users and long term residents) were also needed. Those that involved professionals and community stakeholders should also be requested (e.g. GPs, social workers, community nurses, day services). The home also monitored the quality of its service by monthly unannounced quality monitoring visits. At the last inspection we had been concerned these were not being done regularly. Since then, these visits had being taking place although not every month. However, since the appointment of a new area manager, the last three months visits had taken place. Working practices in the home were safe and based upon good practice. Prior to our visit, the home had provided details (in their AQAA) showing all safety and maintenance checks were up to date. During the inspection we confirmed the fire alarm, emergency lighting and means of escape were being checked weekly. To encourage confidence and familiarity with the home’s fire safety systems, we advised different staff (e.g. care, domestic and catering staff) should be asked to help with this each week (with their name being recorded). Regular fire drills were being held. Although these were not as frequent as detailed in the home’s policy guidance (of monthly). We also confirmed hoists and lifting equipment were being serviced appropriately. We advised clear records of these visits needed to be kept on site. We also confirmed the home’s electrical wiring (NICEIC) check needed to be repeated by May 2011. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 4 4 2 X X 3 X The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement Due to a change in the law, a controlled drugs cupboard must now be provided. Timescale for action 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations To ensure risk management strategies are based on up to date, accurate information, all relevant care records should be regularly reviewed, with appropriate links made between them. To promote privacy and provide further opportunities for resident responsibility and involvement, routines regarding entering and cleaning bedrooms should be reviewed. To ensure residents and service users receive the correct medication • medicines for any new emergency service user should be confirmed in writing with their GP (preferably by fax) on or before admission • hand written entries on MARs should be checked and DS0000032683.V363673.R01.S.doc Version 5.2 Page 28 2 YA16 YA11 3 YA20 The Pines countersigned. To improve efficiency and effectiveness – • how the medicines round is carried out should be reviewed • the daily stock check of all medicines should stop. 4 YA35 To ensure staff training needs can be monitored, individual training records should be accurate and up to date. To guide, support and assess new staff, a formal framework to direct their period of shadowing should be developed. 5 YA39 To involve and gain the views of those involved with the home, satisfaction surveys should be sent to families of residents and service users and involved professionals and community stakeholders. The Pines DS0000032683.V363673.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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