Pinehurst Rest Home

Pinehurst is a care home providing accommodation and personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 19 people with dementia and frailty needs.

People’s experience of using this service and what we found

People told us they felt safe living at Pinehurst and relatives gave us positive feedback about the safety and quality of care. One relative told us, “I can’t praise them enough, we would recommend [Pinehurst] to anyone.” There were robust infection prevention and control procedures in place and thorough health and safety checks were taking place on equipment and the environment. Necessary improvements had been made to recruitment processes to ensure that staff were recruited safely.

People had confidence in how the service was being run and how the provider had handled the risks of COVID-19. Quality monitoring systems were in place and improvements had been made to people's records which contained accurate information about their care and support needs. The provider was aware of and acted upon their duty of candour. People and staff were given the opportunity to feed back on the service. The service worked in partnership with others and had a good relationship with the local GP surgery.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inspected but not rated (published 16 November 2020) and there were two breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced targeted inspection of this service on 17 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance and to ensure they were employing fit and proper persons.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pinehurst Rest Home on our website at www.cqc.org.uk

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Pinehurst is a residential care home providing accommodation and personal care to 17 people aged 65 and over at the time of the inspection. The service can support up to 19 people with dementia and frailty needs.

People’s experience of using this service and what we found

We found the service had improved since our last inspection. However, there was still further work to be done to embed those improvements as we found some continued shortfalls. Recruitment processes were not always robust with some new employees recruited at the service without the necessary checks taking place.

Record keeping still required further improvement as records did not always accurately reflect people’s care needs or known risks to them. We have made recommendations about the management of medicines. People told us they felt safe living in the service. Relatives gave us positive feedback about the safety and quality of care given to their loved ones.

The service was clean, tidy and odour free. We saw staff wearing masks, gloves and aprons in line with government guidance. Thorough health and safety checks were taking place on equipment and the environment.

Staff said that they felt well supported by management. Staff said that they had enough time to support people and we observed a caring approach from staff during our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 27 September 2019) and there were multiple breaches of regulation. These were in relation to safe care and treatment, management oversight of the service and recruitment processes. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvement to the service and the registered provider was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, we found a continued breach of Regulation 17 in relation to poor record keeping and Regulation 19 in relation to appropriate recruitment checks not being completed.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pinehurst Rest Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Pinehurst Rest Home (“Pinehurst”) is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

Pinehurst accommodated people on two floors. The building had been adapted to meet people’s needs. People moved about the floors by use of a stair lift.

People’s experience of using this service and what we found

People were looked after by enough staff who were caring, kind and considerate. However, the provider’s recruitment processes did not evidence this was in line with Regulations and always safe.

Staff knew how to identify and act on concerns about people’s safety. However, we have recommended the provider ensures they are fully aware of the requirements of the local authority and CQC in respect of what situations to report and how.

We found there were concerns in respect of the safe management of people’s risk assessments, medicines, infection control and ensuring people’s safe care and treatment at all times.

The systems around leadership and governance of the service were not always as required to ensure a safe service. People, family members and staff felt the home was run well. Everyone felt they could contribute ideas to improve and sustain the service.

People’s health and dietary needs were met. People were supported by staff who were responsive to their needs and wanted people to be as independent as possible and well cared for while living at Pinehurst. Staff knew how to respect people’s capacity to consent to their care and treatment.

We have recommended the provider reviews their system of ensuring the catering staff have an up to date record of people’s dietary need and, their recording of significant health care events to ensure the full story is available for review. This was because the records were either incomplete or absent altogether.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported practice.

The provider and manager have responded positively to the outcomes of the inspection and updated us on the progress they have made in respect of the concerns raised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires improvement (The report was published on 4 October 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements. However, enough improvement had not been made and the provider was still in breach of regulations.

There have been four rated inspections in 2016, 2017, 2018 and 2019. This service has been rated requires improvement for the last two consecutive inspections. The inspection in 2016 was also rated requires improvement. The service had improved to Good in 2017 but Effective remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pinehurst Rest Home on our website at www.cqc.org.uk.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We have identified breaches in relation to recruiting staff safely, ensuring safe care and treatment and governance of the service at this inspection.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

Pinehurst Rest Home is registered to provide accommodation for up to 19 older people who require residential or nursing care. At the time of our inspection there were 17 people living at the home.

The inspection took place on 29 August 2018 and was unannounced.

As Pinehurst is a single location it has a registered provider who is also the manager of the home.. 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. The manager is referred to as the registered provider throughout the report.

The last inspection of Pinehurst Rest Home was undertaken in April 2017 and the service was rated as ‘good’. Unfortunately, this rating had not been maintained.

There were not enough staff to safely and effectively care for people at the service which affected the quality of care they received. Staff were not able to spend time with people as they were focused on their tasks. Accidents and incidents were recorded and reported but there was no overview or analysis of the data by the registered provider. This meant that opportunities to identify patterns or trends were missed. Best interest decisions were not considered for people who lacked capacity which meant that the Mental Capacity Act (MCA) was not always being adhered to. The premises were not completely adapted to meet the needs of people living with dementia.

People were not always treated with kindness and dignity by staff, we had received a complaint prior to our inspection about this. The service was not always clean and smelled in some areas. People did not always have their concerns and complaints recorded and were not confident these would be addressed or responded to. Care plans were not always person centred or sufficiently detailed and activities for people required improvement. The registered provider had not implemented strategies for person-centred care or enabled continuous development or learning at the service. Quality assurance and audits had not been effective or robust in identifying issues or improving the service.

People and staff were engaged through meetings with management although people had not been enabled to complete questionnaires. People had enough to eat and drink, and received support from staff where a need had been identified. People's individual dietary requirements where met.

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Staff managed medicines in a safe way and were trained in the safe administration of medicines.

People would be protected in the event of an emergency. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. Appropriate safety checks were carried out on equipment and fire safety systems. Risks to people were managed safely. Staff routinely assessed individual risks to people in areas such as falls, skin integrity, pressure damage or behaviour. People were protected against the spread of infection within the service.

Staff induction and ongoing training was tailored to the needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff recruitment procedures were safe to ensure staff were suitable to support people in the service. End of life care was provided sensitively and in line with people's needs and preferences to ensure people had a pain free and dignified death.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s privacy and dignity was respected and promoted.

During the inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the first time that the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

The provider was also the designated manager. The provider was responsible for the day to day

management of the home. They also have oversight of the management of the regulated activities and the main contact for the service with CQC. Providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 15 December 2015, we told the provider to take action on staff deployment, management of risks to people and good governance. We found improvements had been made and these actions have been completed. We also told the provider to ensure that processes were in place to ensure that people’s rights were protected if they lacked mental capacity. Some improvements had been made, however further work needed to be done to met the requirements.

People’s human rights were not always protected as the provider ensured that the requirements of the Mental Capacity Act 2005 were followed.

Where people were assessed to lack capacity to make some decisions, mental capacity assessments had been completed, but best interest decisions had not been recorded. Staff were heard to ask peoples consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had not always followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Some applications had been made to the local authority, however some had not.

The provider told us that they would take action to rectify this after the inspection. Improvements could be made in staff’s knowledge of the MCA.

There were sufficient staff to keep people safe. There were recruitment practises in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. For people who had ‘as required’ medicine, there were guidelines in place to tell staff when and how to administer them.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as falls and moving and handling.

The provider ensured that actions had been taken after incidents and accidents occurred to reduce the likely hood of them happening again. However, they were not always informed of when incidents occurred. We have made a recommendation.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was an induction programme in place which included staff undertaking the Care Certificate. Staff now received regular supervision and an annual appraisal.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives and health professionals were involved in planning peoples care. People’s choices and views were respected by staff. Staff and the provider knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care and support was person centred and this was reflected in their care plans. Care plans contained information for staff to support people effectively; however the detail around people’s personal histories was inconsistent.

There were activities in place which people enjoyed. People who did not like to join in with group activities had 1:1 sessions.

The home listened to staff, people and relative’s views. There was a complaints procedure in place. There had been no complaints since the last inspection.

The management promoted an open and person centred culture. Staff told us they felt supported by the manager. Relatives told us they felt that the management was approachable and responsive.

There were procedures in place to monitor and improve the quality of care provided. The management understood the requirements of CQC and sent in appropriate notifications.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Pinehurst Rest Home is a residential care home for up to 19 older people, with a range of support needs including personal care and for some of who live with dementia. On the day of our inspection there were 16 people living at the home.

The provider was also the designated manager. The provider was responsible for the day to day management of the home. They are also have oversight of the management of the regulated activities and the main contact for the service with CQC. Providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff recruitment processes were not always robust. The provider had not always obtained references and Disclosure and Barring Service (DBS) checks before employees started work.

People were not always safe from harm as risk assessments for people were not always in place and some risk assessments had not been reviewed regularly. This included the use of bed rails for people.

People’s medicines were not always managed safely. For people that were prescribed PRN medication (this is medicine that can be taken as required, such as pain relief medicine) there were no guidelines in place to tell staff when and how to administer. However, people’s medicines were stored safely.

Mental capacity assessments had been completed, however the form the provider used to evidence the assessment was not robust as it did not follow the Mental Capacity Act Code of Practise guidance.

Staff had knowledge of safeguarding adult’s procedures and knew what to do if they suspected any type of abuse. Staff had received training regarding safeguarding and this was confirmed from the training records. People told us they felt safe in the home “Yes it’s safe here, I have nothing to feel unsafe about. I have a secure room, there are always people around and the call bell at a touch of a button they will come and help.”

There were sufficient staff deployed to meet people’s needs. The majority of people we spoke with told us that they thought there was enough staff to deal with their needs. One person told us “There is enough staff, very good. Everything done so well.”

People were supported to have enough to eat and drink. The chef and staff had a good knowledge of people’s likes and dislikes reading food and drink. Another person said “I am a fussy eater. I tell them if I don’t like something. If I don’t like the dinner they give me a choice I generally have an omelette.”

People were supported to access to healthcare services and maintain good health. There was evidence that people saw the GP, optician and community nurses. Health professionals told us that the home responded proactively and always contacted them if they were concerned about anyone.

People told us that they were happy living at the home. One person said “The staff treat me very well. They are happy and jolly and I can have a laugh with them. I haven’t had to do any washing for five years. My carer will do anything I ask.”

People’s privacy and dignity were respected. Staff knocked on doors before entering and referred to people by their preferred name. People appeared relaxed and content.

People told us staff always involved them in decisions on what care they were going to have. One person said “The staff always asks what you want to do. If you decide you want to have your dinner in your room that is okay. They always ask what help you want.” Staff knew peoples preferences, likes and dislikes well.

Care plans contained peoples personal history’s which provided staff with information as to what the person did prior to moving in and an initial assessment. People generally received personalised care and staff were responsive to peoples changing need. It was not always recorded in people’s care plans that they were involved in planning or reviewing their care or that there needs had changed.

There was a fixed weekly activity timetable. Relatives said that the activities on offer could be improved. There were regular outings to the local town for shopping and coffee. One person said “We have lots of activities here. A lady comes in and gets me to do exercises. This is good for me mentally and physically. A man comes in and plays the piano. He is very good.”

People told us that they knew how to make a complaint and they were confident it would be resolved. One person said “Once I made a complaint about the food. The owner listened to what I was saying and my suggestions for improvement and dealt with it straight away. The provider said “I speak with people and their relatives daily, so people can raise concerns to me and I can deal with them straight away.”

Recording keeping was inconsistent. The provider had not always recorded accidents and incidents appropriately, despite some people who had falls. The provider told us “I am aware that the paperwork is lacking and know that it requires improvement, this is something that we will work on.” The provider did not keep a record of complaints. There were no systems in place to monitor and improve the quality of care.

Staff did not have regular supervisions and appraisals. We asked the provider for evidence that staff had received this support of these and they were unable to provide us with any information. This was confirmed by staff. As staff supervisions did not occur, there was a risk that people may not be effectively cared for. Staff meetings did not occur on a regular basis.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they were treated with respect and dignity and that their privacy was always respected. We saw that a wide range of activities were arranged by Pinehurst that promoted peoples' independence and involvement in the community.

Pinehurst staff were knowledgeable about the people that they looked after and were actively involved in monitoring any changes in their care needs. Representatives of people who used the service told us that their views and opinions on how the home was run were being continually sought. They told us that they felt relatives were being cared for in a safe and secure environment and by staff who treated their relatives well.