Care Home: The Pines Residential Home

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What the care home does well The manager and her staff try to find out what people living in the home like to do and try to arrange for them do it and they find out what they like to eat and try to make sure that is what they get for their meals. If a person is ill they make sure that they get the right treatment. If someone needs medicines or creams they will make sure they get them. If a person doesn`t like something they can complain to the manager or the staff who will look at the problem for them. The home is clean and well decorated. Each person can keep their own belongings in their room and those rooms can be decorated how they would like them to be. The home has a pleasant and secure gardens for people to sit and walk in. The staff are cheerful friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. The manager is also cheerful friendly and helpful and does most of the things that help the staff to do their job. What has improved since the last inspection? The staff are now meeting more regularly with their manager so issues around the care of the people who live in this home can be discussed confidentially and in depth. Written plans about how activities can be carried out more safely have also been drawn up. A large amount of work has been carried out to the building, not only to increase the number of people who can live there but also, by such things as adding a conservatory, to increase the space available to those who were already living there. What the care home could do better: No formal requirements or recommendations have been made as a result of this inspection. However, the home should record the day to day activities of each person in more detail so that those people who are responsible for making decisions on their behalf are better informed of their likes, dislikes and needs. Key inspection report Care homes for adults (18-65 years) Name: Address: The Pines Residential Home Nr Colebatch Bishops Castle Shropshire SY9 5JY     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: Michael Moloney     Date: 2 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Pines Residential Home Nr Colebatch Bishops Castle Shropshire SY9 5JY 01588630564 01588630233 bccastlecare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Rachel Jane Hicks care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 4 Date of last inspection Brief description of the care home The Pines is a home for 11 people with learning disabilities. Is managed and part owned by Rachel Hicks. The building is set, surrounded by fields, about ten minutes walk from the centre of the town of Bishops Castle in South Shropshire. The gardens for the home are divided into two parts so that the smaller of the two units has its own small area but still has access to the main grounds. The home has extensive car parking for use by both staff and visitors. This is an older style building that has been renovated and converted to its current use. Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 4 Brief description of the care home Further information is available within the home?s service user guide. Fees were not available in the service user guide Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A range of evidence was used to make judgements about this service. This includes: information from the provider which included a self assessment document that they are required by law to complete, records kept in the home, medication records, discussions with the staff team, tour of the premises, previous inspection reports and talking with as well as observing the care experienced by people using the service. A number of the people who live in this home have difficulty expressing themselves clearly. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live in this home are able to visit it to make sure it is where they want to live. The home makes sure that it can meet their needs before they are able to move in. Evidence: Since the last inspection the number of people living at this home has increased. People have moved from another home that was owned by the proprietor of The Pines as their changing needs could not be met there due to the nature of that building. Most of those people had lived at the other hom, Castlehaven, for many years and their needs and preferences were well known to the manager and her staff. Talking with some of the people who had moved they made it very clear that they like their new home. The part of The Pines in which they now live was being used as a day activity centre at the time of the last inspection and those people who used that part of the service, from Castlehaven, had been able to watch the building improvements as they were carried out. They said it was interesting to watch and they were pleased to be able to choose their bedrooms and decor. Care Homes for Adults (18-65 years) Page 9 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are involved in decisions about their lives and play an active role in planning the care and support they receive. Evidence: The records of two of the people who live in the home were looked at as part of the process of finding out how well peoples needs and choices are met. Those records contained documents such as those entitled All About Me, Care Plan and Activities I Want To Do which identified peoples likes and wishes and how they should be met. Where an activity had been identified as having some element of danger, such as traveling in a car, to either a person living or working in the home written plans had been developed that outlined what should happen in order to reduce any risks. All of these documents were seen to have been reviewed regularly to make sure that the home was providing the service that the person wanted and needed. Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: Listening to the staff talking with the people who live in this home as well as each other it was clear that they were aware of the contents of the individuals files. They were heard talking to people in a friendly and respectful manner. Choices were heard being offered and decisions respected. In one case one person was showing a reluctance to get out of bed. Staff were heard discussing how they were going to negotiate with him as he had an appointment that day. They said that this appointment had been made at his request but if he would not get ready to go out they would respect that decision. Talking with other people also showed that they regularly talk about what they like to do with the staff and how they then go off and do those things. Care Homes for Adults (18-65 years) Page 11 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are able to make choices about their life style and are supported to develop their life skills. Social, cultural and recreational activities meet individuals expectations. Evidence: A number of the people who live in this home were spoken to about the social activities and interests that they are able to be involved in and the records for two of them were looked at to make sure that their wishes and needs had been recorded so that everyone would be aware of them. Each file contained a weekly activity chart which listed such things as walks, craft sessions, cleaning, visiting Ludlow leisure centre, yoga, the Gateway Club, pottery, music, dog-walking, watching films and bowling. The people living in this home enthusiastically confirmed that these activities take place and they talked about a Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: recent trip to the bowling alley. The same people were heard talking to each other as well as the staff about the next trip to the local Gateway Club. The people spoken to also said that they had recently enjoyed a holiday in a holiday cottage near Cardigan and one man said how he liked playing chess and during the inspection staff were seen playing against him and he appeared to enjoy this. Few detailed records of what activities had taken place were found and these would make it easier for those who have responsibility for, but not day to day contact with, the people living in this home to check that their needs were being met. However, the homes diary and some of the records showed hair appointments and group visits to places such as Attingham Park and Wenlock Pottery. The people who live in this home were also complimentary about the meals that they are served. Talking with them as well as the cook showed that they are asked for what they would like and menus are changed as necessary. The menus showed, and people confirmed, that an alternative main course is offered each day. Examples of this were liver and bacon or salad, sausage and mash or chicken chow mein and fish pie or quiche. Care Homes for Adults (18-65 years) Page 13 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Throughout the visit the staff were heard talking with the people who live in the home in a friendly but professional manner. The staff were always sensitive when discussing issues that were personal to an individual person. Plans of how an individuals healthcare needs should be met were seen to have been developed. Those records contained assessments of such things as peoples self care skills, medication and medical needs and personal preferences as well as any behaviour management strategies. The records looked at showed when each person had either visited or been visited by a healthcare professional, what for and what the outcome was. These professionals included GPs, dentists and chiropodists. Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: The arrangements for the storage and administration of peoples medication were looked at. Storage was seen to be appropriate and records correctly maintained. Controlled drugs storage and recording was seen to be appropriate. Staff said that they receive training in the safe handling of medication before they are allowed to give them to people and their records confirmed this. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse and have their rights protected. Evidence: The manager confirmed that the home has received no complaints since the last inspection. A copy of the homes complaints procedure was seen and this contained the information someone would need if they wished to raise a problem with the home. The manager confirmed that no issues had been referred into the local procedures that are designed to protect vulnerable adults. Although the disabilities of some of the people living in this home means that they are unlikely to be able to access these formal policies, observation of the staff talking with them and each other indicated that they, the staff, would be aware of any dissatisfaction expressed and it was seen that a whistle blowing policy is available to be used. However, talking to a number of the people who live in this home established very clearly that they are able say if any issue causes them concern. The manager also explained that some of the peoples monies are managed by the Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: home. Full records were seen to be kept outlining any transactions and those records are monitored by her. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: This home is divided into two distinct areas. Seven people live in one area which has recently been converted to provide a home for the people who formerly lived in Castlehaven and four live in the original part of the home which was inspected at the last inspection. That original part has since had a conservatory added to the dining room to increase the amount of communal space for the people who live there. Throughout, the home was seen to be spacious and clean. The newly converted area was seen to contain a large dining area which also had easy chairs in it. This area, according to the people who live there, was where people spend most of their time. There was, however, a separate lounge that some people did say that they used if they wanted to sit quietly or watch television away from distractions. In the newly converted part of the house bedrooms were seen to be on two floors with Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: five on the first floor and two on the ground floor. A shaft lift was seen to be available to get between the two so that people with mobility difficulties would find it easier to move around the home. Each of the bedrooms looked at were seen to have been decorated to each persons taste with one having model cars and other vehicles on display. The laundry facilities were seen to be appropriate to meet the needs of the people living in both parts of the house. Staff confirmed that they had received training in how to reduce the risk of the spread of infection when handling soiled items of clothing and bedding. The grounds of the home are divided into three main areas. One area is the large car park for the use of the homes vehicles as well as those of visitors and the staff. The second is the garden for the smaller unit and this has been equipped with a summer house and various patio furnishings and equipment. The third part is the rest of the gardens which can be used by any of the people living there. When asked what she liked best about The Pines one of the people who had lived at Castlehaven said More space in the garden. Another said More space see and another just said I like it here. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions and to support the smooth running of the service. Evidence: Each part of this home has its own staff team. Each is lead by its own manager who answers directly to the Registered Manager. Looking at the staffing rotas and talking to the staff on duty as well as a number of the people living in the home showed that there are enough staff available to meet the various needs of the occupants of both parts of the home. Watching and listening to the staff as well as looking at their training records showed that they receive the training that helps to give them the skills and knowledge they require to meet the needs of the people that they support. This training included such things as the basic foundation training required by anyone who is new to this type of work through to National Vocational Qualification to level 2 or above as well as more specialist training such infection control, the safe handling and administration of medication, manual handling and food hygiene. On the day of the inspection a number of the staff met with their assessor as part of the homes ongoing programme of Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: National Vocational Qualification training. Talking with a number of staff at the time of the inspection confirmed that they meet with their manager on a regular basis to discuss issues relating to the care of the people who live in the home and their performance. Looking at the records held at the providers human resources office for people who started work in this home since the last inspection showed that appropriate checks are carried out as part of the routines for making sure that those people wishing to work with vulnerable people are fit to do so. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The manager confirmed that she has gained the Registered Managers Award which is an appropriate qualification for someone running a facility such as this. She also confirmed that she had undertaken training in how to manage situations where it was necessary to deprive people of their liberty. She was also able to confirm that no such situations had been identified within this home and therefore no referrals into the local authority procedures that deal with such issues had been necessary. Record keeping throughout the home is generally acceptable but there was some difficulty in establishing what activities had been undertaken by the people living there making it difficult to assess and give a clear picture of a persons lifestyle should other professionals need to be part of any best interest decisions. As mentioned in the Staffing section of this report each of the two parts of this home Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: is managed by a senior member of staff. Talking to one of them confirmed that she has achieved National Vocational Qualification level 3 in care. The Registered Manager is a director of the family owned company that runs The Pines and is in day to day contact with the people who live in the home. Talking with those people as well as the staff showed that other members of the family are regular visitors to the home enabling them to monitor how well the home is meeting their needs. A number of Satisfaction Surveys were also seen to have been carried out as part of the effort to find out what individuals wanted and how there needs could be met. A variety of records were seen that showed that safety issues are constantly monitored. Records of such things as fridge freezer temperatures, fire equipment tests, hot water temperatures and portable appliance testing were seen to have been maintained. Accident records were looked at and these showed that such incidents were monitored by the senior management. Equality and diversity for the service users were seen to be promoted throughout the home within the assessments, care plans and policies. Hazardous materials were seen to have been stored in locked cupboards. Staff records also showed that the mandatory training that is necessary to keep the service users safe has been taking place. This includes training in such things as food hygiene and fire prevention. Staff spoken to confirmed that these records were accurate. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 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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