The Pines

The Pines is a care home providing personal care to eight people aged 40 and over at the time of the inspection. The service can support up to 10 people.

We found the following examples of good practise

The home had remained free of COVID-19 throughout the pandemic. The registered manager confirmed staff were supporting people to have a healthy diet and take additional vitamin supplements to keep their immune system strong, this included Vitamin D tablets.

Appropriate zoning had been introduced to the home. This enabled staff to keep people safe and encourage social distancing in communal areas.

The provider had maintained a plentiful supply of personal protective equipment (PPE) throughout the pandemic and was utilising the government portal to ensure the PPE stock remained at a safe level. Regular stock checks also ensured the level remained safe.

Thorough cleaning schedules had been implemented in response to the pandemic. This included regular cleaning of high touch areas such as banisters. Evidence was seen of these high-risk areas being sanitised three times a day.

The provider was taking part in the regular testing programme and ensured all staff and people living in the home had access to regular testing. This followed guidance and ensured appropriate steps were taken in recording tests in a timely way.

Visits had been arranged following the most recent change to government guidance. There was a clear path for visitors to take around the side of the building to a safe, sanitised area for visits to be conducted. Extra safety precautions were taken such as PPE provided to visitors and all visitors completing a lateral flow test at the beginning of the visit.

Further information is in the findings below.

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

The provider failed to involve some people, their relatives and professionals where relevant and had not maintained a record of decisions made in their best interests, in line with the Mental Capacity Act 2005. The provider had not identified an issue that we found at this inspection and taken action to improve in a timely manner.

The service had a positive culture, where people and staff told us they felt the provider cared about their opinions. The registered manager had knowledge about people living at the home and made sure they kept staff updated about any changes to people’s needs. They encouraged and empowered people and their relatives to be involved in service improvements. The provider had worked in partnership with a range of social and healthcare professionals.

People gave us positive feedback about their safety and told us staff treated them well. The registered manager and staff understood what abuse was, the types of abuse and the signs to look for. Staff completed risk assessments for every person and they were up to date with clear guidance for staff to reduce risks. There were enough staff on duty to support people safely and in a timely manner. Staffing levels were consistently maintained to meet the assessed needs of people. The provider carried out comprehensive background checks of staff before they started work. Medicines were managed safely. Staff kept the premises clean and safe. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.

Staff carried out pre-admission assessments of each person’s needs to see if the service was suitable and to determine the level of support they required. Staff received appropriate support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach the registered manager, at any time for support. Staff assessed people’s nutritional needs and supported them to have a balanced diet. People told us they had enough to eat and drink. The provider had strong links and worked with local healthcare professionals in a timely manner. The provider met people’s needs by suitable adaptation and design of the premises. Staff completed health action plans for everyone who used the service and monitored their healthcare appointments.

Staff asked for people’s consent, where they had the capacity to consent to their care. Some 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 this practice. Staff showed an understanding of equality and diversity. They supported people with their spiritual needs where requested.

Staff involved people or their relatives in the assessment, planning and review of their care. Staff respected people’s choices and preferences. People told us staff treated them with dignity, and their privacy was respected.

Staff recognised people’s need for stimulation and supported them to follow their interests and take part in activities. People responded positively to these activities. Staff had developed care plans for people based upon their assessed needs. Care plans were reviewed on a regular basis and reflective of people’s current needs. People told us they knew how to make a complaint and would do so if necessary. The provider had a clear policy and procedure for managing complaints. The provider had a policy and procedure to provide end-of-life support to people.

Rating at last inspection – The last rating for this service was good (report published on 8 June 2017).

Why we inspected - This was a planned inspection based on the rating at the last inspection.

Enforcement – We have identified one breach of regulation. The provider had not always worked within the principles of Mental Capacity Act (MCA). Please see the action we have told the provider to take at the end of this report.

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.

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

The Pines is registered to provide care, support and accommodation for up to eleven people who are living with dementia and have a learning disability. At the time of our visit nine people were living at the service.

A registered manager was 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.

At our inspection in April 2016 we made a recommendation that the registered provider follows the guidance and recommendations of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards when making specific decisions in people’s best interest. During this inspection we found the provider had addressed this. We found that decisions were made in people’s best interest and there was evidence that the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were being followed in daily practice. Records of the procedures to be followed when people did not have the capacity to make specific decisions were clear.

At our last inspection we made a recommendation that the registered manager must ensure that all staff talk using the English language when with people as they had become upset not knowing what staff were saying. During this inspection we found that the registered manager had taken action to improve this. Staff were being provided with English lessons paid for by the provider. During this inspection we did not hear any staff talking in a different language.

People told us they felt safe living at the service. Staff had received training in relation to safeguarding adults and staff were able to describe the types of abuse and processes to be followed when reporting suspected or actual abuse. Information about keeping people safe was displayed in the home. The provider had carried out recruitment checks to help ensure that only suitable staff worked with people at the home. People were cared for by a sufficient number of staff to meet their care needs safely.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required. Risks to people had been identified and documentation had been written to help people maintain their independence whilst any known hazards were minimised to prevent harm.

Staff had received training and regular supervision meetings that helped them to perform their duties. New staff received a full induction to the service which included the mandatory training as required. Regular resident and staff meetings took place with the registered manager where people could put forward any suggestions about the home.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when required such as the doctor, dentist and psychiatric support.

People’s nutritional needs had been assessed and people were supported by staff to eat and drink as and when required. The menus provided a variety of meals and people were able to choose a meal that was different to the menu. People and their relatives were complimentary about the food provided.

People were treated with dignity and respect. Staff were observed supporting people with their personal care needs in the privacy of their bedrooms. People and relatives we spoke with were positive about the care provided and that their consent was sought by staff. People were positive about the caring culture of the home and all the people we spoke to said that they liked living at the home. Staff interacted with people in a caring manner spending time with them and supporting them to take part in their chosen activities.

Documentation that enabled staff to support people and to record the care and treatment they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

People and relatives told us they thought the home was well run and they were able to have open discussions with staff. People told us they felt able to raise concerns and make complaints if they needed to.

Quality assurance processes were in place to help drive improvement at the home.

The Pines is registered to provide care, support and accommodation for up to eleven people who are living with dementia and have a learning disability. At the time of our visit nine people were living at the service.

A registered manager was 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.

We found that decisions were made in people’s best interest, however, we found evidence that the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were not being fully adhered to in daily practice. Records were not clear about whether one identified person had the mental capacity to make a particular decision.

We made a recommendation that the registered provider follows the guidance and recommendations of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards when making specific decisions for people.

People were not always treated with dignity and respect. People and staff told us that some staff used a different language when they spoke with each other in front of people. This caused upset to some people at the service.

We made a recommendation that the registered manager monitors the communication to ensure staff can be understood by those they are caring for at all times.

People told us they felt safe living at the service. Staff had received training in relation to safeguarding and were able to describe the types of abuse and processes to be followed when reporting suspected or actual abuse.

Staff had received training and regular supervisions that helped them to perform their duties. New staff received a full induction to the service which included the mandatory training as required.

People and relatives we spoke with were positive about the care provided and their consent was sought. People were positive about the caring culture of the home and all the people we spoke to said that they liked the home.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when required.

People’s nutritional needs had been assessed and people were supported by staff to eat and drink as and when required. The menus provided a variety of meals and people were able to choose a meal that was different to the menu. People and their relatives were complimentary about the food provided.

Documentation that enabled staff to support people and to record the care and treatment they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

Staff showed kindness and compassion and people’s privacy was upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private.

There were enough staff to ensure that people could undertake their activities and to meet the assessed needs of people. Staff encouraged people to be independent and to do things for themselves, such as cooking and cleaning their bedrooms.

People and relatives told us they thought the home was well run and they were able to have open discussions with staff. People told us they felt able to raise concerns and make complaints if they needed to.

Quality assurance processes were in place to help drive improvement at the home.

People who used the service were able to tell us that they liked living at the home. They told us they made choices about what they wanted to do. One person told us, 'I am going shopping on my own this afternoon.'

People we spoke with told us that the food was nice and they could choose what they wanted to eat. One person told us, 'My favourite pudding is bananas and custard and we have this.'

People told us they liked their bedrooms and they were able to use them whenever they wished to. One person conveyed to us that they liked being able to have their own posters on the walls.

We were told by people who used the service that there were enough staff on duty to help them. They stated that staff were nice to them.