Background to this inspection
Updated
11 November 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 30 September 2015 and was unannounced.
The inspection team consisted of three inspectors, a pharmacist inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Prior to this inspection we looked at information we held about the service including the last inspection report and the provider’s action plan. We looked at the notifications the provider had sent us, this included safeguarding, death and serious injury notifications. These are notifications that about serious incidents that the provider is required to send to us by law. We had received information of concern from the local authority and were aware of a safeguarding investigation into the service.
We spoke with nine people who used the service and four visiting relatives. We spoke with the area manager, manager, deputy manager, fourteen members of staff and a visiting health professional.
We looked at three care records, staff rosters and quality assurance systems the provider had in place. We did this to check that records were comprehensive and ensured a consistent improvement in the quality of service.
Updated
11 November 2015
This inspection took place on the 30 September 2015 and was unannounced. At our last inspection on 1 July 2015 we found that people were not receiving care that was safe and that met their needs this was because the providers quality assurance systems were ineffective. There were insufficient staff deployed to meet the needs of people who used the service and some people were being deprived of their liberty unlawfully. We had asked the provider to make improvements and issued a warning notice in relation to the insufficient staffing levels. At this inspection we found that staffing had been increased and people were no longer being unlawfully restricted of their liberty. We found that there had been some improvements made in all areas of concern since our last inspection, however further improvements were necessary. You can see what action we have told the provider to take at the end of the full version of the report.
Pine Meadows provides accommodation and personal or nursing care to up to 70 people. The service is divided into three living areas. One area called Acorns provides residential care, one area called Chestnut provides nursing care and the other area called Fir Cones cared for people living with dementia.
The service was being managed by an acting manager (for the purpose of this report we will call them ‘the manager’) and there was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People’s medication was not managed safely. Previous professional advice had not been followed to ensure systems were safe.
People did not always have their health care needs met as staff did not always follow health professional’s advice.
Most people were supported by sufficient numbers of staff, however some people were in the process of having their needs reassessed to ensure that staffing levels were sufficient for them.
When people were at risk, such as falling, assessments were completed and control measures put in place to reduce the risk of the incident occurring again.
People felt safe and protected from abuse. Staff knew what constituted abuse and what to do if they suspected abuse had taken place.
The Mental Capacity Act (MCA) 2005 is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The provider followed the guidelines of the MCA to ensure that people were not being unlawfully restricted of their liberty.
People’s nutritional needs were met, however specialist diets were not always presented in a pleasing manner. People who had been identified as losing weight were referred to their GP or dietician for advice and support.
People were treated with dignity and respect and their privacy was maintained. Relatives and friends were free to visit at any time.
Care was not always delivered in a way that met people’s personal preferences. Staff did not always ensure that people had their belongings which they required.
People were encouraged to engage in hobbies and activities of their choice. New activity coordinators had been employed to support people in their chosen activity.
People were involved in their care. Regular meetings took place for people who used the service and their relatives.
The provider had taken steps to meet the breaches of Regulations following our previous inspections, however further on-going improvements were required. Quality systems had been put in place and were proving effective however the service required a period of stability to embed the systems.
Staff felt supported by the management; however some staff lacked direction due to inconsistent management.